Permit Support Document (39) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT ' , _ Permit#: PLM2018-00023
Date Issued: 01/16/2018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 %fir/fL , Parcel: 2S111CA02000
Jurisdiction: Tigard
Site address: 15505 SW SUMMERFIELD LN
Project: RYTEL Subdivision: SUMMERFIELD NO.7 Lot: 333
Project Description: NEW HALF BATHROOM: 1-WATER CLOSET, 1-LAVATORY. 1/22/2018: REPRINT permit to change lass of
work from ADD to ALT. 1/29/2018: REPRINT permit to add ice maker.
Contractor: JAY JAY'S PLUMBING Owner: RYTEL, MICHAEL G&TIMOTHY D
19447 E. BURNSIDE 16942 CANAL CIR
PORTLAND, OR 97233 LAKE OSWEGO, OR 97035
PHONE: 667-8420 PHONE:
FAX: 503-492-3863
FEES
Quantity Description Date Amount
1 ea Ice Maker 01/16/2018 $12.51
Specifics: 1 ea Lavatories 01/16/2018 $25.02
1 ea Water Closet 01/16/2018 $25.02
Type of Use: SF 10 Minimum Fee Adjustment- 01/16/2018 $9.95
Class of Work: ALT Plumbing
Type of Const: g 12%State Surcharge- 01/16/2018 $8.70
Plumbing
Occupancy Grp:
Stories:
Total $81.20
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
or direct questions to O NC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / 't Permittee Signature: t2 ,2 /� 70 A./
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.
CITY OF TIGARD +• r• . PLUMBING PERMIT
- r COMMUNITY DEVELOPMENT if 424
Permit#: PLM2018-00023
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/16/2018
Parcel: 25111 CA02000
Jurisdiction: Tigard
Site address: 15505 SW SUMMERFIELD LN
Project: RYTEL Subdivision: SUMMERFIELD NO.7 Lot: 333
Project Description: NEW HALF BATHROOM: 1-WATER CLOSET,1-LAVATORY. 1/22/2018: REPRINT permit to change class of
work from ADD to ALT.
Contractor: JAY JAY'S PLUMBING Owner: RYTEL, MICHAEL G&TIMOTHY D
19447 E. BURNSIDE 16942 CANAL CIR
PORTLAND, OR 97233 LAKE OSWEGO, OR 97035
PHONE: 667-8420 PHONE:
FAX: 503-492-3863
FEES
Quantity Description Date Amount
1 ea Lavatories 01/16/2018 $25.02
Specifics: 1 ea Water Closet 01/16/2018 $25.02
1 12%State Surcharge- 01/16/2018 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment- 01/16/2018 $22.46
Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: tPermittee Signature: QJ✓i_/,V
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 .r.
Building Fixtures A y .1 `',.
City of Tigard # Received
13125 SW kIalt Blvd.,Tigard,OR 9'17 q Y Iran Reviedr z/ /a mt No 4/1020/e.-.0tv,A3
3
Phone: 543.718.2439 Fax: 503.5 .l0 ' Date/By. Other Permit No.:
1 l G.R U Inspection Line: 503.639.4175 Date Ready/By: hire: 0 see Page 2 for
Internet: www.tigard-or.gov Notifieit/Melhod: SupplementaE teforneation
TYPE OF WORK FEE* SCHEDULE
❑New construction - j ❑Demolition For special information use checklist
Description f Qty. I Ea. I Total
IS�ee ddi' teratio cemgnt/ ❑Other:
-Addition � New l-2-family dwellings(includes 100&for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
12'1-and 2-family dwelling 0 Commercial/industrialSER(2)bath 437.78
0 Accessory building 0 Multi-familySFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.8.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address:
!559 5` 5'.iJ, Stun 1,,,,e,f'-1 &1C Ln
DCity/State/ZIP: -�''L�,�,�I a 7 ,k f q�2:2____\.\ Y 1,leach Sine ortrelcch drain age18 2
Footing drain(no.linear ft: ) Page 2
Suite/bldg-/apt no.: I Project name: LIT 1 . Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear It:_j Page 2
Storm sewer(no.linear A:__) Page 2
Water service(no.linear it.:_J 1 Page 2 ,
Subdivision: I Lot no.: Fixture or item:
Tax map/petrel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 32.51
Clothes washer 25.02
ADD1 t(c -re 6 Mori<F-_ "Tb e 'r-(s-rns 1-Rrvl(D ' Dishwasher 25.02
n
i..M 2_0IS- �QoZ3 Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 M
Name: Fixturefsewer cap 25.02 •
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:
Hose 25.02
Phone:( ) Fax( ) Ice maker i 12.51
`APPLICANT ig CONTACT PERSON Intemeptotigrease trap 25.02
Business name: Spoli j pry 75 I'LU.M 61111(-r0 DuC Medical gas(value:S ) Page 2
Contact name: k'E w 1V 5 11-14
Primer 12.51
Roof drain(commercial) 12.51
Address: to4R t}9 e. ' t...,..i S 106 sr. Sink/basin/lavatory 25.02
City/State/ZIP: l rkyD /1 cre-/ C'1. Solar units(potable water) 62.54
Phone:(503) (,f7- g 40 Fax::(5) 1Ffa3 gi2.3 Tub/shower/shower pan 12.51 i
E-mail: J ctkij& jsplttnnbtn3 bI LAc t'{oo.Cowl Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: 3-peyTAI(75 PL ,vtlilJ a10 C_ Water piping/DWV 56.29
Address: 1g.11+7 G.autNSfoe sr. Other: 25.02
City/State/ZIP: pc,„xfz Y.3b/v RI Sabtotal
Phone:(5,3 )6107 g` Fax:(303)rf l a-3g63 Minimum permit fee: $72.50
CCB Lic.: 14.33.q Plumbing Lie.no:„'t`-1 77 P,8 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: ✓ i . �� 7 TOTAL PERMIT FEE
s )�s�t II1L �
Print name: Weis./ S44 1Tit I Dale
a5/0
This permit application bas s if a permit is not oblalued within 180 days
[! atter it bas been accepted as compute.
'Fee methodology set by Tri.Connty Buildiat Industry Service Board
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