Permit CITY OF TIGARD11111
PLUMBING PERMIT
�: COMMUNITY DEVELOPMENT Permit#: PLM2022-00192
Date Issued: 5/24/2022
TIC;A li i7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S110AD12300
Jurisdiction: Tigard
Site address: 10871 SW ANNAND HILL CT
Project: Annand Hill Partition, Lot 2, Primary Subdivision: ANNAND HILL CT PARTITION Lot: 2
Project Description: Interior plumbing for a new multi-family dwelling on the main level with(2)attached ADUs.
Contractor: RAZORBLADE PLUMBING LLC Owner: BLUE PALOUSE PROPERTIES LLC
18045 SE MAIN ST 333 S STATE ST STE V452
PORTLAND, OR 97233 LAKE OSWEGO, OR 97034
PHONE: 503-550-6280 PHONE:
FAX: 1
FEES
Quantity Description Date Amount
3 ea Clothes Washer 05/24/2022 $75.06
Specifics: g ea Sink 05/24/2022 $225.18
5 ea Tub/Shower/Shower Pan 05/24/2022 $62.55
Type of Use: MF 5 ea Water Closet 05/24/2022 $125.10
Class of Work: NEW 3 ea Water Heater 05/24/2022 $112.56
Type of Const: 1 12%State Surcharge- 05/24/2022 $72.05
Occupancy Grp: Plumbing
Stories: 40 If Sanitary Sewer 05/24/2022 $62.54
0 12%State Surcharge- 05/24/2022 $7.51
Plumbing
Total $742.55
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 he 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 of the rules
Issued By: Permittee Signature:
4e'''..1---Arr\-04--- '-'°- ."-f3 ).'
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
Site Utilities
City of Tigard DateReceived Permit No., ct)l
lig 13125 SW Hall Blvd.,Tigard,OR 97223 t tau Review 1 � `-7�� �"� - .
1 G `/Phone: 503.718.2439 Fax: 503.598.1RCCFIl! "'�7ateBy Other PermitNo.: !(fte i �44 3
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov , , t t . Notified/NI ethod --c. Supplemental Information
". FEE* SCHEDULE
I. New construction ❑Dert n> ;10F u I For special information use checklist
ti 1 IILDING D VI`.'ION Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: 5 1 New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION ' SFR(1)bath 312.70
❑ 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building V_I,Mu1ti-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION��� AND LOCATION ,' Site utilities:
Job site address: ja- / AV\V\`,NA V\�i1 G f. Catch basin or area drain 18.76
City/State/ZIP: f71
J 1/ LI f,� O 6 Dl) g 722`� Foµ'ell,rainh line,or trench drain 18.76e
�j J I � Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: y,„,,4/Ail,4/5 5 Z.N/1 L re( Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
0�7 LG "f� �`�, Rain drain connector I 18.76
` f'% Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
' "= Backwater valve 12.51
DESCRIPTION OF WORK
'71 3 , Clothes washer 3 25.02 75 .ex„
V)e 1..1 ('.p y1-51./N(--k.4v' t- 1 t^AA✓"5 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
(,APPLICANT ❑ CONTACT// PERSON Interceptor/grease trap 25.02
Business name: a�/'7 o J&. 1 L/I g�,).#1.4 1 b Medical gas(value:$_) Page 2
Contact name:
IJ A)AA) IA)) N'l(A Primer 12.51
Roof drain(commercial) q 12.51
Address: �()u JS Se (ni.. Sir1k/basin/lavatory ` 25.02 - (p
City/State/ZIP: Po,1,T .vr) / 0P 6 D f.1 11233 Solar units(potable water) $/\,.62 64
Phone:( 5 3) SSt 6Z i b Fax::( ) Tub/shower/shower pan ,S 12.51 Got _53
E-mail: r Q w Urinal 25.02
✓G2o 41Ne► y. ' L,,,,e,1 , moor"
Water closet S 25.02 /A5 4 /}
CONTRACTOR
J1 7/ Water heater -3 37.52 '(),-�
Business name: Jt 2cti..e lCc1L P/u.1 ' ) Waterpiping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: / Subtotal Or 6t. ) 'i
Phone:( (S� `') Fax:( ) Minimum permit fee: $72.50
CCB Lic.: 1,1'5 SI tg a,6-VA Plumbing Lic.no.: p(3 i-1?,� Plan review (25%of permit fee)
���/� State surcharge(12%of permit fee) 7d,Ql�rj
Authorized signature: > 1l r"Tip 7�l�f TOTAL PERMIT FEI /e ) 5'1,
6
Print name: Date: S Z. _ZZ This permit applkadon expires if a permit is obtained within 15ays
0
,i,,.. - 4.x'rt./.s after it has been accepted as comnotplete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:'Building\Permits\PLMl1-PemtitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)