Permit Support Document •
CITY OF TIGARD PLUMBING PERMIT
1111
COMMUNITY DEVELOPMENT t IS Permit#: PLM2021 00221
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Ft 7 �� �C7 Date Issued: 5/24/2021
Parcel: 1 S134DD00101
Jurisdiction: Tigard
Site address: 10525 SW TIGARD ST
Project: 21-180 Subdivision: None Lot: None
Project Description: plumbing for kitchen remodel. 6/17/2021: REPRINT permit to add(1)pot filler.
Contractor: THE PLUMBERS INC. Owner: VERMILLION, JOEL B &DEANN M LIVING TR
11420 SW PACIFIC HWY 10525 SW TIGARD ST
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503-519-6644 PHONE:
FAX: 503-684-1202
FEES
Quantity Description Date Amount
1 ea Ice Maker 05/24/2021 $12.51
Specifics: 1 ea Sink 05/24/2021 $25.02
1 12%State Surcharge- 05/24/2021 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 35 ea Minimum Fee Adjustment- 05/24/2021 $34.97
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 9A/
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.
Plumbin;a Permit Applic AECEIVED .G-s129/27
Building Fixtures 1 O R ()I i 1( I 1 ',I OM1
MAC' 2 5 2021eceived ) I�Lr? ZD / Gb2 2/
City of Tigard R DaterBy: 0(7/'U C Permit No. 2
1111 -. 13125 SW Hall Blvd.,Tigard,OR OF TIGARD Plan Review Other Permit No.:
_ Phone: 5nLine: 3 Fax: 5oBUILDING DIVISION Date Be. June: QJ See Page2for
inspection Line: 503.639.4175-or.go Dateo Ready/By:� o : Su.plcmental Information
HUARU Internee www.tigard-ot.gov
;;> x -SCHEDULE
0 New construction 0 Demolition
For apaeial information use checklist.
Description I Qty. I Ea. i Total
•• •ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
«f,r SFR(1)bath 312.70
SFR(2)bath 437.78
1 1-and 2-family dwelling 0 Commercial/industrial SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
' 4, f , °TON ANI3;LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: r�' G r 9- Drtch leach line,or trench drain 18.76
City/State/ZIP: li 0 �� Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no. Project name: 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:
l Backflow preventer 31.27
Tax map/parcel no.: Backwater valve 12.51
DESCRIPTION OF WORK Clothes washer 25.02
4- -h 1 to/ 4/4/W1 ''/tDishwasher 25.02
V l 1 / Drinking fountain 25.02
l
�// /l) 2 Ejectors/sump 25.02
0
� � �
PROI'ERI'Y OWNF,R"'r .r 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: -- - Floor drain/floor sink/hub 25.02
j Address: - Garbage disposal 25.02
Hose bib 25.02
City/State/ZIP: __ 12.51
Phone:( ) Fax:( ) Ice maker
1 0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
2
Medical gas(value:S ) Page
Business name: Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: __
Solar units(potable water) 62.54
Phone:( ) Fax::( )
Tub/shower/shower pan 12.51 Urinal 25.02
E-mail: _ Water closet 25.02
T CONTRACTOR n Water heater 37.52
Business name. ! r� �U/ � h. I t -� Water piping DWV 56.29
�/ j/ Other: 25.02
, ` ::e
SubtoJZ1P: Lam'
Minimum permit fee: $72.50
Phone:( V) �1 J(!J1. Fax:( ) Plan review (25%of permit fee)
CCB Lic.: i 7-7 i Plumbing Lic.no.: re/' � State surcharge(12"/°of permit fee)
Authorized signature:, Pe/02 TOTAL PERMIT FEE
/ I This permit applkation expires it a permit is not obtained within 180 days
Print name: �jJ�` r i Dater � �1 after it has bap accepted as complte.
1111 iiii VV`i `Fee methodology set by Tri-County Building Industry Service Board.
I.\Budding+Pernoo`PLMU-Permit App dot 10,01J(W 440-4616T(10/02/COM/WEB)
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