Permit Support Document CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit#: PLM2021-00320
^� Date Issued: 7/27/2021
T f G A R L7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.243' lit
O� it• parcel: 2S111 CB02200
Jurisdiction: Tigard
Site address: 14845 SW 100TH AVE
Project: Barton Addition Subdivision: MURDOCK HILL Lot: 3
Project Description: laundry room fixtures,new bathroom addition.REPRINT 03/30/22-add new footing drain,new sewer line and
rain drain.
Contractor: OREGON PLUMBING AND PUMP LLC Owner: BARTON LIVING TRUST
PO BOX 261 BY BARTON, BRADLEY&
MOLALLA,OR 97038 BARTON,CASSANDRA TRS
14845 SW 100TH AVE
TIGARD,OR 97224
PHONE: 503-678-9886 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 07/27/2021 $25.02
Specifics: 2 ea Hose Bib 07/27/2021 $50.04
1 ea Sink 07/27/2021 $25.02
Type of Use: SF 2 ea Lavatories 07/27/2021 $50.04
Class of Work: ADD 1 ea Tub/Shower/Shower Pan 07/27/2021 $12.51
Type of Const: 1 ea Water Closet 07/27/2021 $25.02
Occupancy Grp: 1 12%State Surcharge- 07/27/2021 $22.52
Stories: Plumbing
1 ea Catch Basin or Area Drain 03/31/2022 $18.76
50 If Footing Drain 03/31/2022 $50.03
100 If Sanitary Sewer 03/31/2022 $62.54
400 If Storm Sewer 03/31/2022 $175.10
0 12%State Surcharge- 03/31/2022 $36.77
Plumbing
Total $553.37
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: /1A Permittee Signature: 7t, ^_„�I CG i� ^
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. I '
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.
JI C
Plumbing Permit Application •
Site Utilities MAR , 1 %02. I-I)Ft 1)1 I It t l .I ()NI 1 'I
GI IY.OI- HU l� r Permit No
City of Tigard �+ "�'D���p 1L ' PLu(20Z1-DD3Zn
III13125 SW Hall Blvd.,Tigard,OR 97223 . UILDIN\� nRn
III Phone: 503.718.2439 Fax: 503.598.1960 Altar Pemm No.
l r.t is 1 Inspection Line: 503.639.4 t 75 - ,A`• .;y. 1y�a 0 See Pape 3 f.r
Interact www.tigard-tr.gov ,r 7�� Fglploeet.l Infarmano.
TYPE OF WORK , / e I FEE* SCHEDULE
❑New construction 0 Demolition r For special ie/broneMon use checklist
Description I Qty. .1 La. I Total
ig Addition alteration'replacement 0 Other: Naw I-2-family dweTiogs(includes 100(L for each utility connection)
CATEGORY OF CONSTRUCTION SFR 11)bath 312.70
,KI I-and 2-family dwelling CICommerciaVitulustrial SFR 12)bath 437.78
SFR 13)bath 500.32
0 Accessory building 0 Multi-family
Fact additional badthitchen 25.02
❑Master builder ❑Ot cr: File sprinkler t sq_ft) Page 2
JOE SITE INFORMATION AND LOCATION She utilities:
Job site address /yg f/f sW }/Oo a �rrr Catch basin a area drain l 1 g.76 I:el TG
'r Drywd h line.
l,!cacti or trench drain 18.76
City/State T
ZIP: pari v/2 Y Y72.t Footing dram(no.linear ft.: SO) / Page 2 rit.0,
Suite/bldg/apt.no.: I Project name: (T,aQrn J Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76 '
/00 f,( i /ViGcr/o esfC/ Rain drain connector 18.76
Sanitary ewe too.linear It.: ICU) ( Page 2 4 4,J'[f
Storm sewer(no.linear fL:4/.(4) q Page 2 f 7$7/0
Water service(no.linear ft: ) Page 2
Subdivision: I Lox no.: Fixture or item:
Tax map/parcel no.: Back rimy ptevertter 31.27
DESCRIPTION OF WORK Backwater valve 12.51
-/ // / / Clcaben washer 25.02
../tyiax/ Tarn C/Aruritl df AdLLa'j elk Tp 1(2 4.tOD . Dishwasher •
25u2
,ills)// lGr J//aer !n L h0414 eal.
4. &rpm* rLMa� 1 Drinking fountain 25.02
/7Ju r y CLfpi rt Rf bat,. a4'cL ,Jr1 Ejectors/sump - 25.02
() 'PROPERTY OWNER I 0 TENANT Expansion tat* 12.51
(i �/a Fixuurluacr cap 25.0,
Name: /�q !,f /' O/1 •
Floor drainitlotr sink/hub 25.11_
Address:A/b//s Ski /40 14 p�lfpC Garbage disposal 25.02
City/State ZIP: 7tb-� 02 f 7,2?'/ Hose bib 25-02
Phone:I ) Fax:I ) Ice maker I2.51
•
® APPLICANT 0 CONTACT PERSON Inuxceptoogre sctrap 25.02
Medical gas Ivaluc:S_1 Page 2 •
Businns name: LS PAA/AJ il 4,..1-cOLLAT61 Primer 12.51
Contact name: Oen) Mdk LLE,e-
Q /
Roof drain(commercial) 12.51
Address: 7�T.Zaj eoovei /e-Etedev Ei Sink/basin/Lavatory 25.02
City/State'ZIP: Liu ice dIc.,e 60 O' 9 70.fx" Solar units(potable water) 62.54
Phone:(s UJ) 749 - d 9S/,? I Fax::( ) Tub/shower/shower pan 12.51
E-mail: 0/orl (! �j�nhti.l.cc Urinal 25.02
i Water cline[ 25.0'
CONTRACTOR Water hinter 37.52
Business name: „cc p Jr;l-.,124H/NC. -COuSTrQ()G I-- OA) Water piping/DWI/ 56.29
Address: A6). Qp x i ja ? Other: 25.112
City/State ZIP: s•1ecevooc. Ore p7/410 Subtotal J06, ttj
Phone. 3-0„j - 78-4! f 90 7 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: Plumbing Lie,no.;2 tj/,�/GeSB/o Plan review (25%ofp snit tee) ](p. 6 I
State sureha ge 112%of permit feel 7(,77
Authorized signature: -------_... TOTAL PERMIT FEE d'/ft0/
Print name: Date: 1�penman epplieah.a agues It.permit Is ant Attired within 1110 days
po.tJ ��t:LF'C 3 n/- Utzatter it M beam accepted as rnarylidt.
•Fee methodology set by In-Cooly building Industry service board.
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