Permit Support Document U CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENTIN
Permltu: PLM2020 00165
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04l17/2020
ESS Parcel: 1 S135CD02800
Jurisdiction: Tigard
Site address: 9550 SW LEWIS LN
Project: Nicholson Subdivision::HERS ADDITION TO GREENBURG HE Lot: 6
Project Description: Rough in plumbing toilet and lavatory drains and waters. 6/5/20:REPRINTED permit to include tankless water
heater.
Contractor: DILIGENT PLUMBING LLC Owner: NICHOLSON,JADE M
1023 SE 223RD AVE 9550 SW LEWIS LN
GRESHAM, OR 97030 TIGARD, OR 97223
PHONE: 503-407-7293 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Lavatories 04/17/2020 $25.02
Specifics: 1 ea Water Closet 04/17/2020 $25.02
1 ea Water Heater 06/05/2020 $37.52
Type of Use: SF 1 12%State Surcharge- 06/05/2020 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �` Permittee Signature: ` •
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each Inspection.
Plumbing Permit Application.- --„F - I"-
Building Fixtures ' " FOB OFFICE: 15E ()V1.1
City of Tigard MAY 2 7 2020 Received Permit No.:
13125 SW Hall Blvd.,Tigard,OR 972 ,- Plan ReviewBy: � � �`��
C Phone: 503.718.2439 Fax: 503.598. t)01 (=r 1"•'"''D Plan
Other Permit No.:
Inspection Line: 503.639.4175 BUILDING DIVISION DateRe
71 Ci A It U Date Ready/By: Jere: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF WORK % FEE* SCHEDULE
x
❑New construction ❑Demo r For special information use checklist
Description I Qty. I Ea. I Total
t$Addition/alteration/replacement 0 Other: ' New 1-2-family dwellings(includes 100 IL for each utility connection)
CATEGORY OF CONSTRUCTION SFR(l)bath 312.70
al-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 50032
❑Accessory building 0 Multi-family
Each additional batMcitchen 25.02
❑Master builder Cl Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: gSU �..'c�;S {�,,.. Drywell,leach line,or trench drain 18.76
City/State/ZIP: 1-i t w..1 O1g 74Z`l1
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/d rcctions 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 It.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Back low preventer 31.27
DESCRIPTION OF WORK Backwater valve 1251
tt S t h- Clothes washer 25.02
}.k ,,, nJl'(' (-c-�..t 12rt c,:.-'r¢it- -.-- t"*� 11, (�'G.'..'.1- Dishwasher 25.02
1 trki..h : W.-fr1 2 01 O-0 OI bS, t3' tt Nv- C;ilo-6:a7g1 Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: -
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
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
�,J v� / �i `� Urinal 25.02
E-mail: 6'f t I i✓tom �t COyNTR4 Ci1.r "_"" ( �`, ^
" wry" ` Water closet 25.02
Water heater ; 37.52 3� S2
Business nay:- ';t,ar N , ,--mNw�:U,s LLt„ Water t mS�
WV 56.29
Address: jaZ3 5a '),-rt;,,e Other: 25.02
City/State/ZIP: t_rcl , C+? s}'}o 3'.) Subtotal 315.2
Phone:(SU 3 ) N 0 1--4-z13 Fax:( ) Minimum permit fee: $72.50
CCD Lie.: 2 ‘,1-t 5-3-z. Plumbing Lie.no.:?g.'Z(77
Plan review (25%of permit fee)
State surcharge(12%of permit fee) Li„y`)
Authorized signature:i ,�0 L (:_.� TOTAL PERMIT FEE yA,Uri.
�"S-2 -7'
Prins name:V:�N II This permit application expires if a permit is not obtained within 18a days
,, C,�;-r c.,(LAafter it l os bees accepted as complete.
f `Fee methodology set by Tti-County Building industry Service Bean!
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