Permit CITY OF TIGARD PLUMBING PERMIT
� 7 '' '`' COMMUNITY DEVELOPMENT Permitft: PLM2022-00387
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 9/22/2022
Parcel: 2S102CD00500
Jurisdiction: Tigard
Site address: 9585 SW OMARA ST
Project: BOYDSTUN Subdivision: FREWING'S ORCHARD TRACTS Lot: 25
Project Description: Relocating master bathroom:(1)sink,(2)tub/showers,and(1)water closet.
Contractor: FIVE STAR PLUMBERS INC Owner: BOYDSTUN, DENNIS GREGORY&
PO BOX 28 BOYDSTUN, SALLY BAUCUS
BANKS, OR 97106 9585 SW O'MARA ST
TIGARD, OR 97223
PHONE: 503-324-0717 PHONE:
FAX: 503-324-0883
FEES
Quantity Description Date Amount
1 ea Sink 09/22/2022 $25.02
Specifics: 2 ea Tub/Shower/Shower Pan 09/22/2022 $25.02
1 ea Water Closet 09/22/2022 $25.02
Type of Use: SF 1 12%State Surcharge- 09/22/2022 $9.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $84.87
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 m y obtain a cop of the rules
Issued By: 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 Application
Building Fixtures
City of Tigard RECEIVED Received
13125 SW Hall Blvd.,Tigard,OR 7 DateBy: Permit No.: i(4,4,, tj9 ra_, v y
/1Plan Review /
Phone: 503.718.2439 Fax: 503.598.1960 Dot 2 8 202Z eRy Other Permit No..
SEP T I GA RD Inspection Line: 503.639.4175 Date Ready,By: error to See Paget for
Internet; wwzr.tigard-or.gov Notilicd/Method:
I f1 "]�;,(� Supplemental Information
TYPE OF woRIJITY OF TIGARD FEE* SCHEDULE
❑New construction EA t7't40NC DIVISION For special information use checklist
Description [ Q:Y. ( Ea. I Total
13kAddition/a1Ieration(replacement 0 Oilier: New 1-2-family dwellings(includes 100 O.fur each utility_connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
SFR(2)bath 437.78
' I-and 2-family dwelling 0 Commercial/industrial
ElAccessory building 0 Multi-family SFR(3)bath 500.32
Each additional batiOcitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
'+ i Catch basin or area drain 18.76
Job site address: (r r !
7 "Jtt S ��1(�i�
City/State/ZIP: '+' - I ' 2_, Drywall,leach line,or trench drain 18.76
�i�ii`llf: t Q'Y2 �� Z �a
f Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: -! , Project name: :,.jy $7l.t '
factured borne utilities 50.03
Cross streetidirections 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: I Lot no.: Fixture or Item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater sake 12.51
Clothes washer 25.02
r=( (� i v1 1- :.4- ,_1 VI �, n
} l�Iv 1 �� � Dishwasher 25.02
\\ 8k�14fJ(J�Yf i90 �•� Drinking fountain 25.02
ri!.:. .41-,J G 1L 7)s. ga rD e"'• Ejectors/sump 25.02
0 PROPERTY OWNER. 1 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drsin/floor sink/'hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
9 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: t ' / Medical gas(values S_) Page 2
r-r��iY`�"}�lr�tMkr151 t4lC'
Contact name: \t .( v 0. V c��' t RoPrimer 12.51
3� �7T Roof drain(commercial) 12.51
Address: Ir tJ ``✓ ✓Iei Sink/basin/lavatoiy 1 25,02
City/State/ZIP: ( ( s 4i i c`},?y , (. [1,Ci LQ Solar units(potable water) 62.54
Phone:(f)(P9 '2,7 L\- 0-1 t"-1 Fax::( ) Tub/shower/shows pan 1-,. 12.51
E-mail:Q.,tkfSCA .(6
Urinal zs.o2
Water closet 1 25.02
CONTRACTOR .
f C,r,,.�-L 'i�( t�' Water heater 37.52
Business name: t,V-e f 1 GI t '2',�°'l ( 1 El t<. . Waterpiping/DWV 56.29
Address: Other: 25.02
City/Stale/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
/� -2 Plan review (25%of permit fee)
CCB Lie.: \911 t �C 2> Plumbing Lie.no.: F' 1�j 3
State surcharge 02%of permit fee)
Authorized signature: TOTAL PERMIT FEE f1i;Ir W,4 7
Prim name: ..�. Date: } 7 This penult application expires ifs permit b not obtained ssilb 80 days
i�l2 P{2 Y e L L- after It baa been accepted as complete.V *Fee methodology set by Tri-County Building Industry Senses Bosrd.
I?guildingigerwusPCMU.Permiusyp.deu test os 440-1616T(IW02,COseWEB)
9/22/2022 https://pay.paygov.us/EndUser/PaymentReceipt.aspx
Confirmation Number: 9859170
Oregon
City of Tigard �ayGO V„U5
PERMIT CENTER- COUNTER
Transaction Details Credit Card Payment Address Information
Order Number 9859170
Customer Name JEFF D PARSON
Email Address
Address
Phone Number (503) 939-8294
Credit Card Number 4XXXXXXXXXXX0916
Credit Card Type Visa
Expiration Date 0126
Operator Name
Transaction Time 9/2212022 1:19:52 PM
Authorization Code 212291
Convenience Fee 212291
Authorization Code
Transaction ID 2071961009
Purchase Type sale
Agency Total 84.07
Convenience Fee $2.52
Total Amount 86.59
Charged to Card
Customer Signature
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