Permit (8) CITY OF TIGARD PLUMBING PERMIT
IN
COMMUNITY DEVELOPMENT Permit#: PLM2020-00030
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/21/2020
Parcel: 2S111 CC06000
Jurisdiction: Tigard
Site address: 9960 SW CENTURY OAK DR
Project: Gran Subdivision: SUMMERFIELD Lot: 83
Project Description: Remodel for(2)bathrooms and(1)kitchen.
Contractor: INNER CITY PLUMBING INC Owner: GRAN, CATHERINE M
6470 NE HANCOCK ST 9960 SW CENTURY OAK DR
PORTLAND, OR 97213 TIGARD, OR 97224
PHONE: 503-314-7313 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 01/21/2020 $25.02
Specifics: 1 ea Dishwasher 01/21/2020 $25.02
1 ea Garbage Disposal 01/21/2020 $25.02
Type of Use: SF 2 ea Tub/Shower/Shower Pan 01/21/2020 $25.02
Class of Work: ALT 1 12%State Surcharge- 01/21/2020 $12.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $112.09
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 952-001-0 90. Y may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.$90.332.2344.
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Issued By: - to Signature:---7
v.9`
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 RECEIVED Poll ()l-1.1( 1._ t St- OMl.)
City of Tigard Received Ai
• 13125 SW Hall Blvd.,Tigard,OR 97223 2020 DatelB : / /�1 Permit No.:�J p)��}1114
p Plan Review ��/«J�/
II Phone: 503.718.2439 Fax: 503.598.1960AII 2 Other Permit No.: u
Date/
By:Line: 503.639.4175 j"! "�)j��
1 I G A R D Internet: www.tigard-or.gov ITY OF TIGARD Date Ready/By: Juris:-�� H See Page 2 for
DIVISION Notified/Method. Z7..4* Supplemental Information
TYPE OF WORRUILDING FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
,ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
' and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: '960 SW ce-N'a']ey `z. Catch basin or area drain 18.76
City/State/ZIP: j r '�'). oe c -7 z v.t v Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: 4Rkr.„1 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
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1� 25.02,n- 2 it.
,T� �d•Ln Dishwasher
25.02 2-3--;42),
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: �ti
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT ,)NTACT PERSON Interceptor/grease trap 25.02
Business name: Tilt,/Ne �. y �r .17O#J Medical gas(value:$ ) Page 2
Contact name: AVG 'v/ r Primer 12.51
Roof drain(commercial) 12.51
Address:
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:(3 73 b 52?4g3 Fax::( ) Tub/shower/shower pan ,Z 12.51
E-mail: 'DAVE-- e. "p X.J& A Ci,,,1 Urinal
H"Iw 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: A/ye? cl-rty 7,140-16/A4
Water piping/DWV 56.29
AddresV/►7Cf , F�e1 6-7 Other:
`� i �J 25.02
City/State/ZIP:7ort ANi1 t V r11d� /q`7 2 f7 Z0 Subtotal (O0 rhg_
Phone:( )3 3111 7 3 13 Fax:( )) Minimum permit fee: $72.50 l tJ
CCB Lic.: 75 [3�r f_ Plan review (25%of permit fee)
i g p 2 o Plumbing Lic.no.: �fr�Il J ,
State surcharge(12%of permit fee) "Li Of
Authorized signature: TOTAL PERMIT FEE '(-
Print name: DUDate: l/ o/7Q This permit application expires if a permit is not obtained within' days
/l after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:UBuildingU'ermits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)