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Permit (155) CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2019-00377 Date Issued: 09/23/2019 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103BC01300 Jurisdiction: Site address: 12121 SW LANSDOWNE LN Project: Libonati Subdivision: Lot: Project Description: Replacing hot&cold lines. Contractor: PEX PLUMBING Owner: GLEN&SANDRA LIBONATI 1915 NE STUCKI AVENUE SUITE 400 12121 SW LANSDOWNE LN HILLSBORO,OR 97006 TIGARD, OR 97223 PHONE: PHONE: 503-886-8664 FAX: FEES Quantity Description Date Amount 1 ea Water Piping/DWV 09/23/2019 $56.29 Specifics: 1 12%State Surcharge- 09/23/2019 $8.70 Plumbing Type of Use: SF 16 ea Minimum Fee Adjustment- 09/23/2019 $16.21 Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. riumultiig rigout[3u1»<lc41L1 ", Building Fixtures ' FORlOFFICE USEONLY City of Tigard SEP 2 3 2019, Date/By: r_l' r k 1"l Permit No. NCjPi.. Q11,3T- a 13125 SW Hall Blvd.,Tigard,OR 97223 I Plan Review aIN Phone: 503.71$.2439 Fax: 503.59 0+' C Y 1 I(3 A�sj Date./By: Other Permit No.: Inspection Line: 503.639.4175 i t c y i ` DIVISION O N Date Read By: runs. @i See Page 2 for TIC 1P 17 ��`! it �' lA Via r Ready /By: www.tigard-or.gov Notified/Method: Supplemental Information + �..�;: ac tu„dC+1�' $.�`1:11'33-'32k oAai�tA.°,'� `,�re.• � ':�i k,- �' �",�'e�� ... , ,�; *, � ..M t •�.,,4 ❑New construction ❑Demolition For special information use checklist. Description I Qty. I Ea. I Total 'Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) 4, ,k vi., ,4.0.„-,0,„v,:- ' ,1,4,-,p,,,,,,,,,, da , SFR• • \bath 312.702f,.,s,." fi ,e,_;.!1,0„,. _ki 'r :" C - .Y\ 11•4',' N71 S.'v r-7. V1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 ' x*, `i©y t i,,p o;u -91,-*„. o P b5 z ':a %,' Site utilities: Catch basin or area Job site address: i 2,12 r SP �Y15d o t n&, L Y1 drain t 18.76 Drywell,leach line,or trench drain 18.76 City/State/ZIP: Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 :t Backwater valve 12.51 ' :''' ' , �;' .4. 1'- .,i I"t "i. fiWOR -"4'' x4 3 '�... '4'. Clothes washer 25.02 gep pe C0U I ([lt�s Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 i , 6 .s,07-�i` ,6 A " a:v. ° al ` `x' Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 y4 ®(. , -,SCE , r, '' CO* ,,,,, g4;* `_� Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 Primer 12.51 Contact name: Roof drain(commercial) 12.51 ' I Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62,54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 E-mail: • Urinal 25.02 'r 1 - ZWater 2.5.02,-2 4041.. :4 ' .,. .1, : ","' . Water heater 37.52 Business name:Pey i L1 'n hi Y1 "Water piping/DWV l 56.29 o Zef Address: J( is'' NE s Aft. 0-Lick Other: 25.02 City/State/ZIP: }-h-l LSbt< -o F.)0. C7 )(q--7ccio Subtotal Phone:50:5)ssti,...gulv,4 Fax:( ) Minimum permit fee: $72.50 Plan review (25%of permit fee) CCB Lic.: ,2"z Plumbing Lic.no.:P62392, State surcharge(12%of permit fee) Authorized signature:,, TOTAL PERMIT FEE ill./ 2.0 Print nameT. ,(�� e4 C' Date: i�� This permit application expires if a permit is not obtained within 180 days y"'\ after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:1BuildingU'ermits\PLMU-PermitApp.doc 10/01/09 440-4616T(I0/02/COM/WEB)