Permit Support Document (44) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENTPermit#: PLM2022-00160
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 RSE D Date Issued: 5/2/2022
Parcel: 1 S125DB04800
I ]AVj e.), Jurisdiction: Tigard
Site address: 7185 SW SHADY CT
Project: Lawrence Subdivision: SHADY DELL NO.2 Lot: 22
Project Description: Plumbing for relocating the kitchen and 50 sq,ft.addition: (1)dishwasher, (1)garbage disposal,(1)hose bib,(1)
ice maker,and(1)sink. 8/3/22: REPRINTED permit to add(1)water heater.
Contractor: DELTA PLUMBING INC Owner: LAWRENCE, BRIAN J REVOCABLE TRUST
12205 SE 108TH AVE 7185 SW SHADY CT
HAPPY VALLEY, OR 97086 PORTLAND, OR 97223
PHONE: 503-998-0683 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Dishwasher 05/02/2022 $25.02
Specifics: 1 ea Garbage Disposal 05/02/2022 $25.02
1 ea Hose Bib 05/02/2022 $25.02
Type of Use: SF 1 ea Ice Maker 05/02/2022 $12.51
Class of Work: ALT 1 ea Sink 05/02/2022 $25.02
Type of Const: 1 12%State Surcharge- 05/02/2022 $13.51
Occupancy Grp: Plumbing
Stories: 1 ea Water Heater 08/03/2022 $37.52
0 12%State Surcharge- 08/03/2022 $4.50
Plumbing
Total $168.12
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; opted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You mayo a copy the rules
i
Issued By: Permittee Signature: '
Call 503.639.4175 by 7:00 a.m.for the next available inspectipA date.
This permit card shall be kept in a conspicuous place on the job site un4c/ompletion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures
"DatelBy:
d
City of Tigard PermitNo.: 01 ,,?hone S50 Hall Blvd.,Tigard,OR 9 ECEIVED N-1
Phone: 503.718.2439 Fax: 503.59 1 Plan Review
DateBy: Other Permit No.:
Inspection Line: 503.639.4175 ^'!G 3 222 Date Ready/By: J see Page 2 for
Internet: www.tigard-or.gov AU
Notified/Method: J j I Supplemental Information
TYPE OF WORICI-Y OF TIGARD FEE; SCHEDULE
❑New construction M&UNG DIVISION For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: nmlAkmilift New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTIOPUP
SFR(1)bath 312.70
] 1-and 2-family dwelling ❑Commere Uin SFR(2)bath 437.78
ElAccessory building ElMulti-family
SFR(3)bath 500.32
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: 7185 SW Shady Ct. Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:
Portland, OR 97223 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Projectname: Additon Lawrence Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
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
Subdivision: Tax I D:R231305 Lot no.: Fixture or item:
Tax map/parcel no.: 1 S125B04800 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Adding ft an repositioning he kitchen Dishwasher 1 25.02
f Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Brian Lawrence Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 7185 SW Shady Ct Garbage disposal 1 25.02
City/State/ZIP: Portland OR 97223 Hose bib 25.02
Phone:( )5033098868 Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: R One LLC Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Raul Onescu
Roof drain(commercial) 12.51
Address: 5321 Lakeview Blvd. Sink/basin/lavatory 1 25.02
City/State/ZIP: Lake Osweo OR 97035 Solar units(potable water) 62.54
Phone:( ) 97 1 32294 1 6 Fax::( ) Tub/shower/shower pan 12.51
E-mail: raU1one28 mail.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Delta Plumbing, Inc. Waterpiping/DWV 56.29
Address: 12205 SE 108th Ave Other: 25.02
City/State/ZIP: Happy valley, OR 97086-5849 AMP subtotal
Phone:( )5039980683 Fax:( ) Minimum permit fee: $72.50
CCB Lie.: 182846 Plumbing Lic.no.: P B '5562 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Raul SCU Date: 7/29/202 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1Building\Permits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COMMEB)