Permit (70) CITY OF TIGARD PLUMBING PERMIT
1 , , COMMUNITY DEVELOPMENT Permit#: PLM2019-00284
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/17/2019
Parcel: 25111 DB08700
Jurisdiction: Tigard
Site address: 15430 SW OAKTREE LN
Project: THORNE Subdivision: SUMMERFIELD NO.10 Lot: 548
Project Description: (1)dishwasher, (1)garbage disposal,(1)ice maker, and(1)sink for remodel.
Contractor: ASSURED PLUMBING INC Owner: THORNE, CLIFFORD D JR
PO BOX 230816 THORNE, STEPHANIE E
PORTLAND, OR 97281 15430 SW OAKTREE LN
TIGARD, OR 97224
PHONE: 503-985-9093 PHONE:
FAX: 971-249-3145
FEES
Quantity Description Date Amount
1 ea Dishwasher 07/17/2019 $25.02
Specifics: 1 ea Garbage Disposal 07/17/2019 $25.02
1 ea Ice Maker 07/17/2019 $12.51
Type of Use: SF 1 ea Sink 07/17/2019 $25.02
Class of Work: ALT 1 12%State Surcharge- 07/17/2019 $10.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $98.08
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:
_.o0.171 Alt
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 y - Received 7�7 /c( '9--- Permit No.: /°171'1c2c:d y-C0c2"`
13125 SW Hall Blvd.,Tigard,OR �7
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
t _ Other Permit No.:
Inspection Line: 503.639.4175 j is 1 i Z.G 19 DateBy: tl�--Celt 7�
C 1 G A R D Date Ready/By: I3 See Page 2 for
Internet www.tigard-or.gov�' ••44,.. ,,,,;i4,743-',..-,,,'.' g r i y Notified/Method: Supplemental Information
r ' : 4'., ,.. ,�„ ^I., i 9 . .,�, 1,„r,„ '.„f Mme., ,. . ,' •,,,,•, . "°',,, ro n
0 New construction i 0 emolition For special information use checklist
Description Qty. Ea. Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
A G R r OV'COi9StR 'flON SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
011 SirE 1 1 MW LOCATIOP4 Site utilities:
Job site address:15430 sw oaktree lane Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:tigard OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:oak tree lane 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: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
{ D "�011 OF
', , ,."' ,, ,.` Clothes washer 25.02
1 ice maker,1 kitchen sink,1 dishwasher
Dishwasher 1 25.02 0/5 C�
Drinking fountain 25.02
Ejectors/sump 25.02
►' 1P' F O`itl,4 IiIki i 2`I.... Expansion tank 12.51
Name:Cliff Thorne Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:15430 sw oaktree lane
Garbage disposal 1 25.02 ,2.6--.,0,)„,
City/State/ZIP:tigard OR 97224 Hose bib 25.02
Phone:(503)9365342 Fax:( ) Ice maker 1 12.51 /j,,5"i
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 1 25.02 015'
City/State/ZIP:wilsonville OR 97070 Solar units(potable water) 62.54
Phone:(503)9842783 Fax::( )
E-mail:timl@tlremodel.com Urinal 25.02
Water closet 25.02
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 17 5`7
Phone:(503)9859093 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:194423 Plumbing Lic.no.:pb1005 Plan review (25%of permit fee)
li ______" State surcharge(12%of permit fee) j(}„ ¶5 r
Authorized signature: i TOTAL PERMIT FEE
Print name:miguel Dorantes Date• jr .1 1 This permit application expires if a permit is not obtained within 8livdays
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PemutApp.doc 10/01/09 440-4616T(l0/02/COM/WEB)