Permit (88) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00272
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/16/2019
Parcel: 2S 111 CA04300
Jurisdiction: Tigard
Site address: 9720 SW LAKESIDE DR
Project: Funicello Subdivision: SUMMERFIELD NO.12 Lot: 663
Project Description: (1)dishwasher, (1)garbage disposal, (1)ice maker, (3)sinks,and (2)showers for remodel.
Contractor: ASSURED PLUMBING INC Owner: FUNICELLO, KATHLEEN MARY
PO BOX 230816 9720 SW LAKESIDE DR
PORTLAND, OR 97281 TIGARD, OR 97224
PHONE: 503-985-9093 PHONE:
FAX: 971-249-3145
FEES
Quantity Description Date Amount
1 ea Dishwasher 07/16/2019 $25.02
Specifics: 1 ea Garbage Disposal 07/16/2019 $25.02
1 ea Ice Maker 07/16/2019 $12.51
Type of Use: SF 3 ea Sink 07/16/2019 $75.06
Class of Work: ALT 2 ea Tub/Shower/Shower Pan 07/16/2019 $25.02
Type of Const: 1 12%State Surcharge- 07/16/2019 $19.52
Occupancy Grp: Plumbing
Stories: 1 ea Investigation Fee 07/16/2019 $90.00
1 ea Investigation 12%State 07/16/2019 $10.80
Surcharge
Total $282.95
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: 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 E.IVED FOR OFFICE USE ONLY
City of Tigard II; 8 2015 Rpis 6 Permit No.: L/��d 5 7
13125 SW Hall Blvd.,Tigard,OR 97&g3 �11t y 4'
s Phone: 503.718.2439 Fax: 5098 960 Date/By:an Review Other Permit No.:
r`
T I GA R D Inspection Line: 503.639.4175 y qi I'r''SIC
p) Date Ready/By: Jugs: ® See e 2 fo�r�c lC het
Internet www.tigard-or.gov tIjiL ? t' '�IC' Notified/Method: ' .4 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special information use checklist
Description Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
►1 1-and 2-family dwelling‘t
0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building
0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9720 sw lakeside dr
City/State/ZIP:tigard OR 97224 Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:I e dr F ri c-- 424)1.6 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
C\-: 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 valve 12.51
Clothes washer 25.02
2 showers,3 sinks,1 DW,and 1 icemaker,replace two toilets Dishwasher 1 25.02 2....5";.<12,
Drinking fountain 25.02
(1", Ejectors/sump 25.02
►5 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:Katie Funicello Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:9720 sw lakeside Dr
Garbage disposal 1 25.02 1)S,,0
City/State/ZIP:tigard OR 97224 Hose bib 25.02
Phone:(818)43827661.
Fax:( ) Ice maker 1 12.51 41, .51
0 APPLICANT ►� CONTACT PERSON Interceptor/grease trap 25.02
Business name:TI remodel&construction Medical gas(value:$ ) Page 2
Primer 12.51-
Contact name:Tim labunsky
Roof drain(commercial) 12.51
Address:25030 sw parkway ave Sink/basin/lavatory 3 25.02 -75-#444,City/State/ZIP:wilsonville OR 97070 Solar units(potable water) 62.54
(* Phone:(503)9842783 Fax::( ) Tub/shower/shower pan 2 12.51 3,27;
`
-.)m
E-mail:timl@tlremodel.com Urinal 25.02
V CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:assured plumbing inc Water piping/DWV 56.29
'. Address:po box 230816 Other: 25.02
City/State/ZIP:portland or 97281 Subtotal I(o,,63
Phone:(503)9859093 WI fr a Fax:( ) I IBJ Minimum permit fee: $72.50
CI% ( Plan review (25%of permit fee)
... CCB Lic.:194423 "Akf f-G.-fi ix Ar • /,Dumbing Lic.no.:pb1.005 ,_/ - f
PoJ State surcharge(12%of permit fee) A .
/`•
.. Authorized signature: � i'., TOTAL PERMIT FEE /0. 19'
iThis permit application expires if a permit is not obtained within 180 days
Print name:miguel Dorant Date: i-S-
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:1Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9720 SW LAKESIDE DR, TIGARD, OR, 97224 September 6, 2019 at
9:08:13 AM
Record Type: Record ID:
Residential - Plumbing PLM2019-00272
Inspection Type: Inspector:
399 Plumbing final Jeremy Burrows
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
9720 SW LAKESIDE DR, TIGARD, OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2019-00272
Inspection Type: Inspector:
320 Plumbing rough-in David Young
Result:
FA I L
Comments:
DWV not under test. 712
Open non used DWV pipe by moved sink not capped or removed.
Non used vent thru roof not capped or removed.
Violation Summary:
Inspector Contractor