Permit CITY OF TIGARD PLUMBING PERMIT
111
I. ' COMMUNITY DEVELOPMENT Permit#: PLM2020-00105
T I G A ft C1 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/09/2020
Parcel: 25110DB00200
Jurisdiction: Tigard
Site address: 15175 SW ROYALTY PKWY J
Project: Arbor Heights Subdivision: WILLOW-BROOK-FARM Lot: 8
Project Description: Replacing shut off valve.
Contractor: ANYTIME PLUMBING&DRAIN CLEANING Owner: ARBOR HEIGHTS VENTURE LLC
PO BOX 495 BY SECURITY PROPERTIES INC
LAKE OSWEGO, OR 97034 ATTN BOB KROKOWER
701 FIFTH AVE STE 5700
SEATTLE,WA 98104
PHONE: 503-894-8241 PHONE: 503-624-8200
FAX: 971-255-1965
FEES
Quantity Description Date Amount
25 Misc Other Fee 03/09/2020 $25.02
Specifics: 1 12%State Surcharge- 03/09/2020 $8.70
Plumbing
Type of Use: MF 47 ea Minimum Fee Adjustment- 03/09/2020 $47.48
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 503.232.19872 or 1.800.332.2344. / ^y�
Issued By: /.`C/��"j/�f2� /� Permittee Signature: /�(�� f/D�-r
� c h '/6/l ���---CCC
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 Annlicatio ° ,ri..
1 -t,,,
BuildingFixtures
FOR OFFICE !.'St; O\Ll
City of Tigard MA :) Received / '
13125 SW Hall Blvd,Tigard,OR 9722,4 may` '� /�' P � -A`L
Phone: 503.718.2439 Fax:'503.596i1 00 ';;_-' Plan _o`v Other Permit No.:
Inspection Line: 503.639.4175 �'' °' n r
T I G A K 1) i Dare Ready/By: hair El See Page 2 for
Internet: www.tigard-or.gov
Notified/Method: Supplemental Information
TYPE OF WORK FEE' SCHEDULE
0 New construction 0 Demolition For special information use checklist
Addi[ion/alteration'replacement ❑Other Description I Qty. I Ea- I Total
New 1-2-family dwellings(includes I00 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
❑ I-and 2-family dwelling ❑Commercial industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
i c' 15' JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: ON �.o Li A�Tti (46 I Catch basin or arcs drain 18.76
City/State/ZIP: `f f f 1 ft-0) r' 0 '1 112 DcYwell,leach line,or trench drain 18.76 '
Y I p /'74
Footing drain(no.linear ft.: 1 Page 2
Su ite/bldgJapt.no.: ..1 Project name: A k I 1( Manufactured home utilities 50.03
Cross street/directions to job site: �1 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear R: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backtlowpreventer 31.27
DESCRIPTION OF WORK Baeklu'atertatve 12.51
(J/ � ll� �/ .ter ` Clothes washer 25.02 ----
Clothes f l!!1 U t't�i L s r Oc v vL Dishwasher 25.02
r1.-1 uT Drinking fountain , 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT "_ Expansion tank 12.51
Name: di.lu'J 0 rz- 1.I-Gi4Gf. "'�' Fixture/sewer cap 25.02
Flf 5t 1 r,A(�l n04�LT n0(4 Garbage
drain/floor sink/hub 25.02
Address: J i V iL r" Garbage disposal 25.02
City/State/ZIP: Tf 11J -ig) O It. 11ZZ�,� q� t Hose bib 25.02
Phone:(.5UU'ij) tag riO0 Fax:( ) Ice maker
12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease nap 25.02
Business name: tit w ifj"YYI 4 fiA4 rill ei pl I Medical gas(value:$_) Page 2
Contact name: A S hey ill L 4- �I Primer 12.51
Address: (JO box �� Roof drain(commercial) 12.51
�11/! �1 ( q�f �( Sink/basin/lavatory 25.02
City/State/ZIP: LYt l V svv �. 0 l 0 f '1 10 "� Solar units(potable water) 62.54 .
Phone:(S) ) DGILI-- g24 I Fayyx::(�j) 25-'r I itf so Tub/shower/shower pan 12.51 `
E-mail: tS i It Pi Anl --1-i t?8 pi um 1/tit. US Urinal 25"02
J CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:0 YYI PU4rrl iN� Waterpiping/DWV - 56.29
Address: !po pox /y ti-as /� `I other s ri Vlr o'Yl' f 25.02 2 Di
City/State/ZIP: K--' O$WI D, Da_ q''f 074- Subtotal 5",oZ
Phone:(S02j) g A4- glil-f Fax:(q1 f) 255- 1405 Minimum permit fee: $72.50 'f 2,
CCB Lie.: I On/ 1 Plumbing Lie.no.: get 4� e Plan review (25%of permit fee)
` ^ ^ State surcharge(12%of permit fee) ,10
Authorized signature: ` 1 TOTAL PERMIT FEE g'j,2,0
Print name: AS 41411 rn 1 i t Vt Date: 92 Up()( This permit application expires Ita permit is not obtained widths 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I-Building`Permas'PLYN-PesmisApp.doc 10/01,99 440-4616f(10/02/:OM'WEB)