Permit Support Document CITY OF TIGARD , A 1 PLUMBING PERMIT II
COMMUNITY DEVELOPMENT ef' s d Permit#: PLM2021 00332
Date Issued: 8/5/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111AD10200
Jurisdiction: Tigard
Site address: 8730 SW REILING ST
Project: WOODY Subdivision: SCHECKLA PARK ESTATES Lot: 57
Project Description: PLUMBING REMODEL. 8/25/2021: REPRINT permit to add(1)laundry sink.
Contractor: MIKE PATTERSON PLUMBING Owner: WOODY, SAMUEL T& REBECCA R
PO BOX 850 8730 SW REILING ST
GLADSTONE, OR 97027 TIGARD, OR 97224
PHONE: 503-655-4306 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 08/05/2021 $25.02
Specifics: 1 ea Dishwasher 08/05/2021 $25.02
1 ea Garbage Disposal 08/05/2021 $25.02
Type of Use: SF 2 ea Hose Bib 08/05/2021 $50.04
Class of Work: ALT 1 ea Sink 08/05/2021 $25.02
Type of Const: 3 ea Lavatories 08/05/2021 $75.06
Occupancy Grp: 2 ea Tub/Shower/Shower Pan 08/05/2021 $25.02
Stories: 2 ea Water Closet 08/05/2021 $50.04
1 12%State Surcharge- 08/05/2021 $36.03
Plumbing
1 ea Laundry Tray 08/25/2021 $25.02
0 12%State Surcharge- 08/25/2021 $3.00
Plumbing
Total $364.29
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: de,).-b44,i_u(z_; / Permittee Signature: y
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 ApplicatiaECEIVED
Building Fixtures AUG 2 s 2021IIIIIIIIIIMIIIIIIIIIIIMIIIIIII
_
Cityof Tigard Retteived Nrp
11,,, • 1312S SW Hall Blvd,Tigard.OR 97223i Y.OF TIGARCJ DateBy CYf Z-S f do
/ permitL h( `Z J` � �` -
Phone: 503.718.2439 Fax 503 59�. \ plan Review Other Permit No..
Inspection Line 503.63941751iING DIVISION Dateroy:
Tie;:%R D Date Ready/By Suns. 0 See Page 2 for
Internet wwwtigard-or gov Notified/Meihod Supplemental Information
TYPE OF WORK FEE* SCHEDULE i
0 New construction 0 Demolition m_ Fors ecln!information use checklist.
. Dcscnption I Qty. E Es. I Total
(0 Addition/alteration/replacement 0 Other New 1-2-family dwellings(includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
El Master builder Each additional bath/kitchen 25,02❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 8730 SW Railing St. Catch basin or area drain 18.76
City/Stale/ZIP: Tigard, OR 97224
Drywall,leach line,or trench drain 18.76
Footing dram(no.linear ft, Page 2
Suite/bldg./apt.no.: Project name: DSC-Sam Woody _Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear fl.._} Page 2
Storm sewer(no.linear ft.: Page 2
Water service(no,linear ft.:_) Page 2
Subdivision: 4 Lot no.: ..Fixture or item:
Tax map/parcel no.: Buckflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12 51
Clothes washer 25.02
Add to existing permit PLM202I-00332
Dishwasher 25,02
Drinking fountain 25,02
Ejectors/sump 25 02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.5 1
Name Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal 25 02
City/State/ZIP: hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON ' Interceptor/grease trap 25.02
Business name: Medical gas(value $ ) Page 2
Contact name: Primer 12.5 1
. 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
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37,52
Business name: Mike Patterson Plumbing,Inc. Water piping/DWV 56.29
Address: PO Box 650 Other: 25.02
' City/State/ZIP: Gladstone,OR 97027 Subtotal
Phone:( ) 503-655-4306 Fair.( ) Minimum permit fee: $72.50
CCB Lic.: 81746 Plumbing Lie.no.; 3-359P8 ,�}
"" Plan review (25%of rrrtit fee)
State surcharge(12%of permit fee) 3.c U
Authorized signature: .tea Qom.-- TOTAL PERMIT FEE ZAP, 0 4,
Print name: Jennifer Date: o6l25 2O21 This permit application expires if a permit is not obtained within 188 days
after It has been accepted as complete.
'Fee methodology set by Tri-County Building industry Sen ice Board.
Ilan'r tioelPenoits,PLMU•PermitAppdoe Mel 440-1616T(1OiO000MJ EBI