Permit Bt
CITY OF TIGARD PLUMBING PERMIT
IN
s COMMUNITY DEVELOPMENT Permit#: PLM2021-00507
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/16/2021
Parcel: 2S111 CD09700
Jurisdiction: Tigard
Site address: 9870 SW KIMBERLY DR
Project: Trump Subdivision: KERWOOD ESTATES
Lot: 29
Project Description: Replacing(1)clothes washer,(2)hose bibs, (1)ice maker, (3)sinks, (2)tub/showers,(2)water closets,and(1)
water heater.
Contractor: OWNER Owner: TRUMP, DUSTIN
5921 NW ALFALFA DR
PORTLAND, OR 97229
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 12/16/2021 $25.02
Specifics: 2 ea Hose Bib 12/16/2021 $50.04
1 ea Ice Maker 12/16/2021 $12.51
Type of Use: SF 3 ea Sink 12/16/2021 $75.06
Class of Work: ALT 2 ea Tub/Shower/Shower Pan 12/16/2021 $25.02
Type of Const: 2 ea Water Closet 12/16/2021 $50.04
Occupancy Grp: 1 ea Water Heater 12/16/2021 $37.52
Stories:
1 12%State Surcharge- 12/16/2021 $33.03
Plumbing
Total $308.24
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: ;i tee► � 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 ApplieatiAECEIVED C
.:D
Building Fixtures DEC 7 2021
City of Tigard Re«;
Date/ y' Permit No.:
II q 13125 SW Hall Blvd.,Tigard,OR 9723'l OF TIGARD yl �5!� f� �t �-�X,�Sa 7
Phone: 503-718.2439 Fax: 503.598 1960 Plan Retiiew _
DateB Other Permit No.: 7 _
TIGARD Inspection Line: 503.639.4175 l DING DIVISION Date Re /B �� � � '�7
Internet: www.tigard-or.gov y: 6d See Page 2 for
Notified 'fethod: /pE))`�"'�/y( f- Supplemental Information
TYPE OF WORK i� -.r 4 / •Al A FEE* SCHEDULE
For special
0 New construction 0 Demolition
Descnption I Qty. I Ea. I Total
Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
r14 I-and 2-family dwelling 0 CommerciaUindustrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
0 Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft_) Page 2
JOB SITE INFORMATION AND LOCATION J Site utilities:
Job site address: t 6-7C) 5 V.t fi ,r, �L tr D` Catch basin or area drain 1 g.76
City/State/ZIP: �tCtl'n� Oa. 73 y
Drywell,leach line,or trench drain 18.76
2-1
Footing drain(no.linear ft.:_) Page 2
Suite/bldg.(apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: D�(`t{b;,,L+ t 10 ,r1 St-,/ i1 y3T 4 A va Manholes 18.76
W O A, k t i-t(.3 a_t-s'( 0 k. 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
V
Subdivision: C P W✓CI"J t S I%TEc I Lot no.: 21 l Fixture or item:
Tax map/parcel no.: p,(;Cj C.7 Z Backtlow preventer I 31.27
T DESCRIPTION OF WORK Backwater valve 12.51
ClotheQEei,t1C-e ptl,t/"''(S(tit.t tlkxi 'r-w ,,)!< Dishwasher 25.02
i 25.02 25,uZ
Dishwasher 25A2
ftj+'/Gg f'„+., I Drinking fountain
25.02
Ejectors/sump 25.02
4 PROPERTY OWNER I 0 TENANT ' Expansion tank 12.51
Name: 1�,.L T 1!✓ i,�„,act Fixture/sewer cap 25.02
t v - I Floor drain/floor sink/hub 25.02
Address:y h)...( iv Ad A t t (w 6 k
Garbage disposal 25.02
City/State/ZIP: +PC;.7-L.A'VC\ t)(L (1172 2. Hose bib 2 25.02 C
Phone:(So'N) S o Y- C I g 1 Fax:( ) Ice maker 12.51 (Z, 1
S
APPLICANT AI CONTACT PERSON Interceptor/grease trap 25.02
Business name: 1-Ru,titA 1401 t,:W v,Lo E'i' Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: p t<;•T 1,t, 1;Q ti;,,tp
Address: t, 2-( !l�',tz a(Fh (4, 64 I Roof drain(commercial) 12.51
Sink/basin/lavatory 1) 25.02 75,Uto
City/State/ZIP: Yo l=T LA&i/J ('R (7 71-7- Solar units(potable water) 62.54
Phone:(5 ) S-Cl(-1)1 6// Fax: :1 ) Tub/shower/shower pan Z 12.51 2.5, is-I-
E-mail: cf ty vAt L1 ca> e eiit A.,., . C,L,,..L Urinal 25.02
(!"" /COiVTRACTOR Water closet -1 25.02 S U c;1
Business name:'� ,�„11,. 8Water heater I 37.52 37 Si
( � t �� t �f Water piping/DWV 56.29
Address: I. 3./J /,),,, CA.( 1,4( r Other: 25.02
City/State/Zt . (SEA 67.yTy if..)(2 el 16 c bk -) Subtotal Z7 j;,1-1
Phone:(j } ) Li-vtg( I. ( ) Minimum permit fee: $72.50
CCB Lie.: t)y7Z Plumbing Lie.no.:
Plan review (25%of permit fee)
State surcharge(12%of permit fee) 33 C$
Authorized signature:
,/� TOTAL PERMIT FEE 3` ,ly
Print name: t2C..'Tt,v ( at._9 Date: (7/f I, ,y( I This permit application expires if a permit is not obtained within 180 days
f after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
I:\Building\PermitsPPLMU•Permi;App.dot, 10f0I/09 440-4616T(1O'02ICOM/WE:)
Property Owner Statement RECEIVED
Regarding Construction Responsibilities DEC 7 KM
Oregon Law requires residential construction permit applicants who are not licensed with tl7'OF TIGANU
Construction Contractors Board to sign the following statement before a building permit c3W1LDING DIVISION
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structuke and
— my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residenge that I reside in, or a residence that I will
IKI
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to HomeoWners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Print e of Permit Applicant
2.i
f2-(?(2(
Signature of Permit Applicant Date
Permit#: 1`00-,57>] —
} ,
Address Vo .�� / `
, cg q Vv trw.Mq hlbYt
Issued by: 15-7___— Date: 41 /G/.7-/ t
This Copy for Permit Offices