Permit Support Document CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021 00086
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ) I Date Issued: 3/2/2021
Parcel: 1S125DD09200
Jurisdiction: Tigard
Site address: 9670 SW VENTURA CT
Project: Cleanline Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 100
Project Description: Bathroom remodel-replace fixtures only.6/2/21: REPRINTED permit to include(4)sinks, (1)tub/shower,and(3)
water closets.
Contractor: D& F PLUMBING CO Owner: WILLIAMS, THOMAS JUSTIN
4636 N ALBINA AVE 9670 SW VENTURA CT
PORTLAND, OR 97217 TIGARD, OR 97223
PHONE: 503-282-0993 PHONE:
FAX: 503-288-0604
FEES
Quantity Description Date Amount
1 ea Investigation Fee 06/10/2021 $90.00
Specifics: 1 ea Investigation 12%State 06/10/2021 $10.80
Surcharge
Type of Use: SF 5 ea Lavatories 06/10/2021 $125.10
Class of Work: ALT 4 ea Tub/Shower/Shower Pan 06/10/2021 $50.04
Type of Const: 3 ea Water Closet 06/10/2021 $75.06
Occupancy Grp: 1 12°A,State Surcharge- 06/10/2021 $30.02
Plumbing
Stories:
Total $381.02
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:
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.
Plumbing Permit Application
' Building Fixtures i oR OFFICE>usi�,ONI.v ■Iwrmo
~�`° Cityof Tigard RECEIVE �r ltuuu,i
�� �+ Penult Nn.°
13125 SW Hall Blvd..Tigard,OR 97223 Y-. ! °' J �L�-®. / � � /�� �(,
1'lau Review
• ( = Phone: 503.715.2439 Ens: 5(13.5�)R.I c>bll pp qq ryry l)lhor Permit Nn,AlipAr i.4
Ply 1 [Q4� Italr�ny � .
ike� Inspection Line: 503 639.4175 pith,Rendvllty" )era Ql !tee Pare 7 for
Internet: www.tigard-or.gov rl Nuullw'M Itn'I' 5up4,knt,nt«I Information
`,�> CITY OF TIGAR
TYPE OF !WORK Ff.R• SIMI:D)ULL
�------- �U+1rDING DIVISION ---�-
❑New construction 0 1)t mu t uul Ito.tprt•lul!hormonal u(. rhetbUaf
...‘,0Kr' ._ I t Jo -I)cxwy,tlun _ _J �qty Ca� Tatdl
Addition/alteration/replacement El Other: i , ` �' Newt 2-fondly thvelllnpx includes 100 ft for each(thin connection)
CATEGORY OF CONS•rRUCTION 6 in 4 - SIR(I)bath 312.70
Ii'y4 1-and 2-family dwelling 0 Commercial/industrial SPR(2)bath11.11
037.71t
SFR�(3)bath 5(0)32
El Accessory building 0 Multi-family -Each additional bath/kitchen 25.02
❑• Master builder 0 Other: ____
Fire sprinkler( sq.0.) Page 2
C' JOB SITE INFORMATION AND LOCATION Site utilities:
ob site address: -1 6 70 5 W k4 n fr (`CL CT Catch basin or area drain 1li.76
�, / Drywell,leach line,or trench chain 18.76
� City/State/ZIP: %, �, 1 OR 9 9zz.
. � l Footing drain(no.linear ft.: ) Page 2
'I Suite/bldg./apt,no.: Project name: cleC4011.4Z Manullictured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
'� /� �j Rain drain connector 18,76
�" hoc 1 `f Sanitary sewer(no.linear II.: ) Page 2
C'Girl(.l 4,r ✓'[ f 4-. '7 7 .i f, ;! v Storm sewer(no.linear t).: ) Page 2
3 h Fib VIA l X•�+ r e %•( 4 ,,) I•L 10. Water service(no.linear tl.: ) Page 2
C Subdivision: -•dott
y
/2 Lav-S /u.✓da✓Sisb k,dje. Lot no.. Fixture or item:
,C 7
Tax map/parcel no.: 41 / . Back flow preventer 3 .51
DESCRIPTION OF WORK Backwater valve 12.51
1 , Clothes washer 25.02
//7e caiIO),d:v1Q P t It t re S ,S1,w:id. he. �e'Wm)* Dishwasher 25.02
'�L/Vj Z oZ I-,fDOU Z6, J we-/Cf or _ 4 " lc�t/$+ 7JStio.<ti t rilikn,g fountain 25.02
"C l Jr'C YI luiy GlY1 j Orie: .i, Ejectors/sump 25.02
W‘1. ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
N• ame: Fixture/sewer cap 25,02
Floor druin/tloor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
• Phone:( ) Fax:( ) Ice maker l2.Sl
❑ APPLICANT. 0t.
CONTACT PERSON Interceptor/grease trap 25.02
B• usiness name: 7 ` Medical gas(value:S ) Page 2
Ccn r l um+ LJ�n� Primer 12.51
Contact name: J"o5�. U d E+�jiCVl��- Rool'drain(corn mercial) 12.51
Address: I ZcO7 NE' ci 5 1l' �1 Sink/hnsin/lava Cory £4 25.02 Nteif
City/State/ZIP: Ve,.,i , W/} 6)9 G gZ Solar units(potable water) 62.54 I
Phone:(--)7I ) cidl-0Z Fax: :( ) Tub/shower/shower pan _I 12.51 it2.7 :
E-mail: je5 II bf ctic yi'Gi,,tcJ td-c p(tL✓/b ,t_CI)? Urinal 25.02
/ Water closet 3 25.02 757 04-,
CONTRACTOR i752
Water heater
Business name: JIDfie,{ / plum
)' �U ',� WaterpipinlffDV 56.29
Address: RROO 7 A)c 9 5./f 5 f - \V Other: 25,02
City/State/Z1P: V cgµ. ev W/r 9Sb6'G- Subtotal a,(�j_
Phone:(503) Z,gZ-c, 1cI 3 Fax:( ) Minimum permit fee: S72,50
CCB Lic.: LI 6s Plumbing Lie.no.: •26-- Zpg Plan review (25%ot'pemtit fee)
State surcharge(12°0 of permit(ice) ,� .52
Authorized signature: 4j- .J TOTAL PERMIT FEE 't1 1
U 'Fhb permit application expires Ira permit is not obtained wi in I vs
Print name: �C�Sti �f�j G/ic(t Date: / Z Z after It has been accepted as complete, ri ,6-0
L ak fW v iin/ ���/ C!d'� �" /•y��{C.J .�ILx,tJi �Prcnwfttwdoloby art by'1'ri•Cuw,ry Building ItKi,utsy Service tb I , ,
1:\Building\Permitt\PLMU-PernitApp.doc 10f01/09 W� 440-4616T(I WO COMAVEII) `� 'r-�-,Y . 4 /V J-r
Water Meter Fixture Unit Worksheet for Addiliotis/Remodels/ADUs
Please complete the following information:
Customer Name: l.:ti-k F )D/Um b 1171
Service Address: Street/Suite#: 9 6 70 `) (A) vefri.> .. CT _ _
/` City: /ie oZ.e State: 0 l' ! Zip: � Z 2
.
Phone Number: 917- 7- 409-- O233 Email: j05k- brc"Jev/Chugdli%1U t r
t,c.vr16;elZed
It
Please fill in the number of each fixture you currently have. Please fill in the number of fixtures you propose to add.
4 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 I = x 1 =
Bidet x 1 = x 1 =
q,,, Clothes washer 1 x 4 = x 4 =
Dishwasher I x 1.5 = 1� x 1.5
Pt Outside Water Spigot ' x 2,5 = f Z,,s x 2.5
c, Water Spigot,each add'l 1 x 1 = 1 x 1 =
Kitchen sink 1 x 1.5 = ),5 x 1.5 =
Pr! Laundry sink x 1.5 = x 1.5 =
Lavatory(bathroom sink) 5 j X 1 = . X 1 =
'1 Water closet,1.6 GPF(toilet) 3 x 2.5 = f' S.
x 2.5 =
.,. Bathtub/whirlpool ! x 4 x 4 =
Shower stall 2. x 2 = x 2 =
Bath/shower combo 1 x 4 = t+ x 4 =
Current Points: Proposed Increase: )
Current Points+Proposed Increase= =New Total Points =Required Meter Size / i
Meter Sizes: 1 to 30 points=5/8" 30.5 to 37 points=3" 37.5 and over points= 1"
° New Meter Size Needed for New Total Points: Cost: $ (see page I)
Current Meter Size per Utility Billing: Cost: $ (see page I)
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
Current Meter Size Confirmed with UB
Signature of UB Representative Date
1:/Building/Forms/WaterMeters_070120 Add.dOCX Page 2