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Permit Ill CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2021-00295 Date Issued: 7/21/2021 T1(-;ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1S135AD02300 Jurisdiction: Tigard Site address: 10915 SW HALL BLVD 19 Project: Billy Maxine LLC Subdivision: METZGER ACRE TRACTS Lot: 6 Project Description: New bathroom added to 460 sq ft of converted attic space. Contractor: SHERWOOD PLUMBING COMPANY Owner: BILLYE MAXINE LLC,THE P.O. BOX 1398 13500 SW PACIFIC HWY#499 SHERWOOD, OR 97140 TIGARD,OR 97223 PHONE: 503-349-5429 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Sink 07/14/2021 $25.02 Specifics: 1 ea Lavatories 07/14/2021 $25.02 1 ea Tub/Shower/Shower Pan 07/14/2021 $12.51 Type of Use: MF 1 ea Water Closet 07/14/2021 $25.02 Class of Work: ALT 1 ea Water Heater 07/14/2021 $37.52 Type of Const: 1 12%State Surcharge- 07/21/2021 $15.01 Occupancy Grp: Plumbing Stories: Total $140.10 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules Issued By:�� /f J: Permittee Signature: "/ O,6 ( / 4.y1, f L7 �. �7 nJ v Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the Job site until completion of the project. Approved plans are required on the job site at the time of each inspection. t Phone: 503.718.2439 Fax: 503.598.1960 132temy: .7 i 4-il , v a/ -Ova 7uris. See Page 2 for y� y Supplemental informafion / Interne: Line: 503.639.4175.orvoll ,, ,Tf hod:a14i TIGARD Internet: www•tigard-or.gav r FEE* SCHEDULE TYPE OF WORK �' I I E� Total 0 Demolition. 1?a Descr 2-f 0 New construction 0Other: L(�Y OF ( r New 1-2-(amity dwellings(includes 100 each utility connection ) 312.70 FE AdditiorJalteration!replacement I I ] ' - SFR(1)bath 13380111111.1 ® CATEGORY OF CONSTRUCTION SFR(2)bath 0 Commerciallindustrial 500.32 - IL A1- oesand ory b2-famuilyding dwelling 25.02 _ 0 Multi-family Each additional bath/kitchen ❑Accessory building ❑Master builder 0 Other: Ellel _ JOB SITEr� INFORMATION ANJD LOCATION /9 Catch or area drain _®- Job site address: / //1� J�`4 /�"` XI/ / -7 / Catch basin leach line.or trench drain f / 9 2 2 -J Footing drain(no.linear ft.:_) City/State/ZIP: �a'd/'../ �� Suite/bldg./apt.no.: Project name: �ry�.-, 50.03 - Manufaetured home utilities � ,w/'�7 L,? 't"� 18.76 Cross street/directions ections to job site: Rain drain connector _ 18.761111111111 Page 2 --- # - -- - --- Sanitary seer(no.linear ft.: ) Page 2 Storm se ter ino.linear ft..,_�) 4 - IM Water service(no,linear ft.:,___) _ Page 2 Lot no.: Fixture or item: 3]27 - Subdn tston Backflow preventer 12.51 _ Tax map parcel no.: water 25.02 _ DESCRIPTION OF WORK • 25.02 ,--- v / /p pj -- y/C L Dishwasher 111111 25.02 _ C �' 47 .1v,/ 1 Drinking fountain all 25.02 pJ l-I ����� .74c7 �+ IIIMI Z. Ejectors/sump _ D'6e/Cy G / dies 12.51 • PRE/ Y Expansion tank ._ 22,02 _ 0 TENANT I • PR 'ERTY OWNER 25.02 /� / G' L"' Floor drain floor sink/hub Name: ,, 25.02 11111111111 ' J` - `! /46 3 r Garbage disposal _ Address: c'-' / / 4/1 111111111 25.02 11111111111 ' f 2�..� .i Fax:( ) lell ®� Phone:(S J . Interceptor/grease trap [� APPLICANT , ❑ CONTACT PERSON e 2 - Medical gas(value:$_ Pag ) =®_ 12.51 �j, Business name: y/ ( _ 111111 / 4 f L' ✓�,1C7 �fdrnin tmcrcial) 25.02 Contact name: F /� IV ink/basin/1 V ory Sv Address: /G2 7/ v f�0` AffilalliM ` 67.54 NMI 2- 2._ Solar units' water) , 1 12.51 City/State/ZIP: �l I/,/�_• "� Ta ;howz/shower pan -- �2/! /�I Fax::( ) 25.02 Phone:( S C _,� 25.07. _ oil E-mail: CONTRACTOR 56.29 Water piping/DWV 25.02 ' O 0 J�.� ?1 � c'- � ✓ Other: 11.1111 O�5.Q' Subtotal Phone: (,.S'!i)'.3 Address:St 2 2- ! / /' 9 7/ y/ City/State/ZIP: ty/ atelZIP: �/rL`!'"eaitl✓r t/ /` Minimum permit fee: $72.50 / 2o0 Plan review (25%of pemlit fee) W''� � 2 L J�G�i l S.J"/ Plumbing Lic.no.: /�`�, State surcharge(12%of permit fee) /3-.. 1 CCB Lic.: TOTAL PERMIT FE' �� Authorized signature: This permit application expires if a permit is not obtained within 180 days Date:S ` 1 after ithas been accepted as complete.0dustr C�Oh .��iMara *Fee methodology set byTri-County ccepted as Industry Service Board.OY a40-a6i6T(torovcOM/\'1EB) � ( 0 r!0 /3 2 I:U3uilding\Pennies\PI,MU-PermdApPd°c i0/DItt19 -_/1 1_,- E__ ___- t.,p - V. 3. 0.2, ,,), ,....4__. SQL .4 m / f/7_ 7' ... 6 lei- C-e lio 4 n /0 L e,cjYG Licv Water Meter Fixture Unit Worksheet for Additions/Remodels/ADUs Please complete the following information: ,/ Customer Name: ' 2 0? 2e,?.f 2 2`e' -as /77/19.Kr e. ZI a'" Service Address: Street/Suite#: /D9/J' (fly /yA « 4/✓� /9 City: ,/,y At roc, State: /� Zip: 9,LL,2 Phone Number: �Q3 / Email: e7Ap/ra. .6G/7,('O•-7 410:7A.1dv c Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add. Multiply the quantity by the point value to arrive at the current Multiply the quantity by the point value to arrive at total. the proposed total. Fixture Unit Current Point Current Proposed Point Proposed Quantity Value Total Addition Value Total Bar sink x 1 = x 1 = Bidet x 1 = x 1 = Clothes washer / x 4 = y x 4 = Dishwasher / x 1.5 = /, ( x 1.5 = ls`Outside Water Spigot / x 2.5 = Z, se x 2.5 = Water Spigot,each add'l x 1 = x 1 = Kitchen sink / x 1.5 = / Jr" ' x 1.5 = L- s _3. o Laundry sink j x 1.5 = . / x 1.5 = /, s' Lavatory(bathroom sink) / X 1 = / / X 1 = Water closet, 1.6 GPF(toitet) ( x 2.5 — 2 ,f� / x 2.5 = Z. SS Bathtub/whirlpool x 4 = x 4 = Shower stall _jr_____ x 2 = _i_____ x 2 = Z Baal/shower combo / x 4 = V x 4 = Current Pooints:� / 7 Proposed Increase: -� d', /0 ` 0 Current Points+Proposed Increase= � =New Total Points =Required Meter Size /c4) Meter Sizes: l to 30 points=5/8" 30.5 to 37 points=3/4" 37.5 and over points= I" New Meter Size Needed for New Total Points: Cost: $ (see page 1) Current Meter Size per Utility Billing: /Pici Cost: $ (see page 1) New Meter Size Cost minus Current Meter Size Cost= $ (This is Your Cost to Increase Meter Size Due to Additional Fixture Units) ************************************************************************************* FOR OFFICE USE ONLY T!✓Id n - /16 EZ r t/'S1zG Current Meter Size Confirmed with UB Noi /- tctr —zs . 6 -7//21 / Signature of UB Representative Date 1:/Building/Forms/WaterMeters_070120_Add.dOcx Page 2 Plumbing Permit Application Building Fixtures FOR OFFICE USE ONLY City of Tigard Received - Pctmit No.: • 13125 SW Hall Blvd.,Tigard,OR 97223 y� II ga Plan Review Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: TIGARD Inspection Line: 503.639.4175 Date Ready/By: funs: ® See Page 2 for Internet: www.ligard-or.gov NotifiedMethod: Supplemental Information TYPE OF WORK. FEE* SCHEDULE ❑New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. Total = Addition/alteration/replacement ❑ Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) / CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 U I and 2-family dwelling ElCommercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 0 Accessory building 0 Multi-family Each additional bath kitchen 25.02 ❑ Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: // ,� / j c-- Catch basin or area drain 18.76 Job site address: /Lrf/fr .. L� j �` 45, ,'d / i �� � Drywell,leach line,or trench drain 18.76 City/State/ZIP: q p r z Z-J I.-7 -��� Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: 7 Project name: 0/2'7 /S e/uS7' 7 Manufactured home utilities 50.03 Cross street/directions to job site: Manholes - 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 rfIS'A ,i/7 %j t97 3' /f,-f" 'yr% //I, - Dishwasher 25.02 CO/1/1/6- ---�C=�_ '1- G _.1`Q/f-e___. Drinking fountain 25.02 ,�. Ejectors/sump .25.02 U. PROPERTY OWNER ❑ TENANT Expansion tank 12.51 i'Air) j� Fixture/sewer cap 25.02 Name: /7 / e2 L .44 Address: ' / / / / / Floor drain/floor sink/hub 25.02 ����/J �1/�" /LY b�eC v/ �� Garbage disposal 25.02 -City/State/ZIP: / ' ,o L- 4674- 9 2 Z 2-7 Hose bib 25.02 Phone:(,5 2, :If A c/4-.-f .X Fax: ( ) Ice maker 12.51 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: Primer 12.51 Contact name: /)<2 /2./c ',1 Roof drain(commercial) 12.51 co- City/State/ZIP:Address: /I '�J ~ J G!/ ,4*<//�L!/� ^�g Sink/basin/lavatory / 25.02 2 City/State/ZIP: �7,t7 G' -- 92 2- 2- 7 Solar units(potable water) 62,54 Phone:( S i' 1? :2/y Z 5 Ti Fax: :( ) Tub/shower/shower pan / 12.51 /Z 3' �7/ / Urinal 25.02 2--'E-mail: / /7'2. .6e i7✓C7'r, LI,./0A41 !7/✓7 J rr0 / Water closet 25.02 L.> CONTRACTOR rn.1� ,�� Water heater / 37.52 Business name: f�G f-w�yf/� ///ci-rr�ji� Waterpiping/DWV 56.29 Address: `2. 2_ e?Q e, Je..J ( dh,. f�`--))v Di.--- Other: 25.02 G City/State/ZIP: �, 6�uJl/ ' &- 7/Xf Subtotal ,4V Phone:(...S-a 3 6 2.2- ��/ Fax: ( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lie.: Zoo efj / Plumbing Lic.no.: /1<ra o State surcharge(12%of permit fee) , Authorized signature: TOTAL PERMIT FEE/� r' 7 f This permit application expires if a permit is not obtained within 180 days Print name: L!a/t7N A Date:J ,C.L -2/ after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:931ldwgTermastPLMU-PerrtitApp.doc 10l01/09 440-4616T(10/02/COM/WEB) --TJJT ¢ o Plumbin2Permit Application • Building Fixtures FOR OFFICE USE ONIA City of Tigard 4 Dariee ci•cu R Permit No.: 15111 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review — - Phone: 503.718.2439 Fax: 503.598.1960 pa yy. Other Permit No.: T I U et R D Inspection Line: 503.639.4175 Datc Ready/By. fu s ® See Page 2 for Internet: www.tigard-or.gov Notified/Method: _ Supplemental Information TYPE OF WORK FEE* SCREDULE 0 N construction 0 Demolition For special information use ckecklist. Description 1 Qty. I Fa. I Total Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) j CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 t SFR(2)bath 437.78 t-and 2-family dwelling ❑Commercial/industrial - SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 0 Master builder ❑Other: Fire sprinkler C. sq.ft.) Peg:2 JOB SITE INFORMATION AND LOCATION Site utilities: . Job site address: /8 f/f J.-le-- o! /4/ I'j �cc, Catch basin or area drain I R.7n Dtywell,tt.%ch line,or trtureh drain 18.76 City/State/ZIP: ,,Qt� ea/ 9j2 2 -12 _//]] � — Footing drain.(no.linear ft.: ) Page 2 /'/ ,e-y? L?<� ----� Suiteibldg./apt.no.: Project name: /5 c.f U Manufactured borne unlit es 50.03 Cross street/directions to job site: Manholes - 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.:^_) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Back flow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump .25.02 [T PROPERTY OWNER ❑ TENANT Expansion tank 12.51 ���� �Y Fixture/sewer cap 25.02 Name: '"Yee",,,,/d L� J `� / .� Floor drain/floor sink/hub 2.5.02 Address. / 2�/J ,f�C� /• b�L �d� ,..// Garbage disposal 25.02 City/State/ZIP: -773.70 j 6/ 92 2 2�7 Hose bib 25.02 �/ 2..CLITif Fax:( ) Ice maker 12.51 Phone:(,..$�� � �7 ' [9'eSPPLICANT 0 CONTACT PERSON Interceptor/grease trap ;502 . Medical gas(value:S,) Page 2 Business name: �_ Jn _ _ _—._�. Primer 12,51 name:Contact /`'/77 C/>/d h Roof drain(commercial) I2.51 /r�9/1" J e ) //soil UnL Address: �� Sink/basin/lavatory / 25.02 City/State/ZIP: Ty p i-- ,,� 4Jr 9,2 L 2-2 Solar units(potable water) 62,54 /2 r� Phone:( ...rJ73 /2/y Z.Jr„{-1 Fax::( ) Tub/shower/shower pan l 12.51 , Urinal 25.02 ,i92--j E-mail: 7)4 b«dam 4��/2q., p/h Water closet / 25.02 __ , CONTRACTOR Water heater / 37.52 3 7 Business name: j3 /^,ez.,0!/� ' /)//irr4lsf Water piping/DWV 56.29 Address: 2 Z 1PQeJ J / / (Ayti / v Ds...--- Other: 25.02 7 � � d r City/State/LIP: ij,4- ley 7 . � e 2 9 21/• 1 _ Subtotal /� Minimum permit tee: S72.50 Phone:(�$'�.� � 2 L J LJJ/ Fax:( ) plan review (ZS°h of permit fee) � '� CUB Lic.: 2.40 t�J—/ Plumbing Lic,no.: 4�'��` State surcharge(12%nfpermit..fe , _ Authorized signature: TOTAL PERMIT FEI:1,14/ Print name: �w2/ This permit application expires if a permit is act obtained within 180 days �G✓QH f0/yQ Date:sG.t► - after It has been accepted as complete. ");ec methodology set by Tri-County Building Industry Service Board. I:1auidvgtPerauterPt.MV-ParmitApp.doc 1010I I9 440-4616T(10/02R OMIWEa)