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Permit CITY OF TIGARD PLUMBING PERMIT s 'r COMMUNITY DEVELOPMENT Permit#: PLM2021-00498 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/13/2021 Parcel: 1 S 134CB02000 Jurisdiction: Tigard Site address: 12145 SW SUMMER CREST DR Project: Randall Subdivision: SUMMER HILLS PARK Lot: 19 Project Description: Relocating(1)clothes washer and(1)water closet;Converting(1)tub to walk-in shower;Removing(1)existing walk-in shower; Replacing(1)sink. Contractor: UNIVERSAL PLUMBING Owner: RANDALL, SEAN A&LENORA R 8811 SW SPRUCE ST 12145 SW SUMMER CREST DR TIGARD, OR 97223 TIGARD, OR 97223 PHONE: 503-452-7480 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Clothes Washer 12/12/2021 $25.02 Specifics: 1 ea Sink 12/12/2021 $25.02 1 ea Tub/Shower/Shower Pan 12/12/2021 $12.51 Type of Use: SF 1 ea Water Closet 12/12/2021 $25.02 Class of Work: ALT 1 12%State Surcharge- 12/12/2021 $10.51 Type of Const: Plumbing Occupancy Grp: Stories: Total $98.08 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: ! Permittee Signature: 1,1;4 ? 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 d rr ii EC �(��� OFFICE llL� City of Tigard Rcee€ved 13125 SW Ball Blvd.,Tigard,OR 97 23 _ D:t By: J y f 7 f}I Permit No,: 'yy �y ' C` Phone: 503.718.2439 Fax: 503.598.19 q qt Plan Review (�/Z"[0 TIGARD Inspection Line: 503.639.4175 (� �y [�L 6 Date/By:k:s Other Permit o 5�-��J t�� f,�, Internet: www.tigard-or.gov Date Ready/By: )aria: I !furl �See Page 2 ftn�r�ma (,ijZ Notified/Method: ��.>>,r J TYPE OF WOI2 t` /4,t( Sn plelnenial Information _. _ FEE* SCHEDULE ❑New construction ❑Dentnlltiotts s.l i d+sJ k'or special information uSe cfeecklist At Addition/alteration/replacement Description t ty Ea ] Total " acement ❑Other: New 1-2-family dwellings(includes 100 fl.fo-each utility connection) CATEGORY OF CONSTRUCTION SFR(I)bath 1 -and 2-family dwelling 31.2.70 ❑commercial/industrial SFR(2)bath 437.78 ❑Accessary building SFR(3)bath 500.32 El Multi-family ❑Master builder • Each additional bath/kitchen 0 Other: Page 25.02 ,, JOB SITE INFORMATION AND LOCATION Site utilities: ( sq.ft.) 2 Site util€tics: Job site address: !� C't 1 stA (i 1 Catch basin or area drain s Nf in \. C.)-€' Dr;t1 � I8.76 City/State/ZIP: it^p a -( € (�i-? (}r 22 FootinDryw ll,leach line,or peach drain Page 2 Suite/bldg./apt.no.: Project name: "1 Footing drain(no.linear ft.: ) 2 Cross street/directions to job site: Manufitctured home utilities ( 50.03 Manholes 1 18.76 Rain drain connector i 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Subdivision: lA� (lr t� 1" Water service(no.linear ft.: ) Page 2 �'(Ar . I Lot no.: 1 ci _Fixture or item: Tax map/parcel no.: 1 51"z ,,,, 02000 Back flow prevcnter i 1 31.271 �r p (� DESCRIPT1O OF WORK Backwater valve 12.51 o�✓ l U 1c�` t� ���p //yyy Clothes washer 1. 25.02 ? �j �` �r� ` cth-{ -R 0, . Dishwasher l.L0_11 V. -(( �. 4 Al ar t 25.02 .n Drinking fountain 25.02 i� Q.iL��t_ Electors/sump 25.02 ❑ PROPERTY OW:NE ' f ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 Cityress: /ZIP: Garbage disposal 25.02 Hose bib 25.02 Phone:( ) I Fax:( ) Ice maker 12.51 ❑ APPLICANT I 0 CONTACT PERSON Intetreptor/grease trap 25.02 • Business name: i Medical gas(value:$ ) Page 2 Contact name: Primer { 12.51 Address: Roof drain(commercial) 12.51 Sink/basin/lavatory ' City/State/ZIP: 25.02 Q Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan �/, Ji E-mail: Urinal 25.02 L02 CONTRACTOR Water closet 25,02 Business name: y�t !�}4�f � (` 4 Water heater 37.52 t i\vieY 50 up,---t 63�(\ 1.1�.i, Waterpiping/DWV Address: SG.29 rimy,.) cJ ,C,e, c Other: City/State/ZIP: 25.02 Phnne:�y`�) 1(�-" �`� �� � ��� Subtotal _�s�,5� J" v ��� Fax ( ) Minimum`.. permit fcc° it fee) CCB Lie.: r Plan review 1 Plumbing Lic.nn.: j— � (25A o'pe mit fee) Authorized signature: ' • State surcharge(12%o'pelmit fee) a -'�`� TOTAL PERMIT FEE I Print name: 1�r CA/( !� ( f,t,/1'e ( I Date: t 0— --2 I i This permit application expires if a permit Is no abtalne:with€ 1 �a �J lL yl Gr •! . f 4 '©X•Fee metsodnlaogftyeetbhyAT1e-eCpoacntcyptueidldaingcondmpuaetrye.Service a i:hnuiWing1PernitsTLrU-PnnitApp.dot 10/01/09 440-3616T(I0/02/COMIWEB)