Permit CITY OF TIGARD PLUMBING PERMIT
°` Permit#: PLM2020-00255
COMMUNITY DEVELOPMENT
-FIG ART) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/25/2020
T
Parcel: 1 S136AD04102
Jurisdiction: Tigard
Site address: 10735 SW 69TH AVE 18
Project: Gettysburg Apartments Subdivision: VILLA RIDGE Lot: 2
Project Description: 20 ft.of water service and interior plumbing for units 18-21: Replacing(4)clothes washers,(8)sinks,(4)
tub/showers, (4)water closets,and(4)water heaters.
Contractor: FORBES PLUMBING Owner: CHATTANOOGA LLC
PO BOX 565 14250 NW MCNAMEE RD
DALLAS,OR 97338 PORTLAND, OR 97231
PHONE: 503-623-8595 PHONE:
FAX:
FEES
Quantity Description Date Amount
20 If Water Service 06/25/2020 $62.54
Specifics: 4 ea Clothes Washer 06/25/2020 $100.08
4 ea Sink 06/25/2020 $100.08
Type of Use: COM 4 ea Lavatories 06/25/2020 $100.08
Class of Work: ALT 4 ea Tub/Shower/Shower Pan 06/25/2020 $50.04
Type of Const: 4 ea Water Closet 06/25/2020 $100.08
Occupancy Grp: 4 ea Water Heater 06/25/2020 $150.08
Stories: 1 12%State Surcharge- 06/25/2020 $79.56
Plumbing
Total $742.54
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: `�// ��;;S,7 Permittee Signature: 1,
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 Futures :1EE( - rc OFFICE, lSl. ONLY :, ; .
City of Tigard Received Pertmt l
JUN 2 Da,prOV- l t
13125 SW Hall Blvd,Tigard,OR 97223 3 20, /� 't/fJ Y'�- "`'"'"'- W
Datc/B'Plan vicu I Other Permit Noitm obi?) l
Phone: 503.7182439 Fax: 503.598.1960 CITY y Ors
,7512
Inspection Line: 503.639.4175 OF TIGA•'li ate Read B smm H See Page 2 for
Internet: www-tigard-or.gov BUILDING DIV! 0114ged/Method: /�(p Supplemental Information
TYPi OF WORK FEE*SCHEDULE
❑New construction ❑Demolition For special information use chedaiv.
Description [ Oty. L Ea. ] Total _
,Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CAIIEGORI(E'eCO R, tT F' ;- SFR(I)bath 312.70
tt-
❑ 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR
❑Accessory building t,4 Multi-family (3)bath ,
Each500.32 additional bath/kitchen 25.02
❑Master builder ❑Outer: Fire sprinkler( sq.ft.) Page 2
,I0IPSEEKtINFORMATIOPPIAND LOCATION` Site utilities:
Job site address: Y J U
r2'� C,W '
Catch basin or area drain 18.76
Drywell.leach line,or trench drain 18.76
City/State/ZIP: E .$ 0 et- 72. Footing drain(no.linear ft.: ) 1 Page 2
Suite/bldg./apt.no.: G Project name: ,
�'( ���CZ-�,p f Manufactured home utilities 50.03 ii
Cross street/directions to job site: (� 5 Ir, Manholes 18.76 k
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
t Storm sewer(no.linear ft.:" 1 Page 2
' Water service(no.linear ft.:A ) ` I Page 2 42-5
Subdivision: Lot no.: Fixture or item: 1
Tax map/parcel no.: Backflow prcvcnter - 31.27
Backwater valve 12.51
-':•z j .11.2 {,r y&31F3sR 'IIONOF R'ORI( ;
. .r.i�li,.. 1 ,5 Clothes washer 25.02ico oS
l' elDishwasher
UN 1„ S "-t ►r W O4lT, ELL Thinking fountain 25.02
EEjectors/sump25.02 1
.. . k'Bt7�y:If�isfill, ..=fyi 3 TENANT, Expansion tank 12.51
-,:.., . s �..-- �, � . ,ra'.: --,sit ..
Name�(� Fixture/sewer cap - 25.02
3-", D PA-CA `r Fluor drain/floor sink/hub 25.02
Address: t.� L5p IQ t 1 J � i2....0 Garbage disposal 25.02
I City/State/ZIP: Q)Q, j 25.02
e/ Hose bib 1
Phone:(C,F/j)(oz J- '32„4.p• Fax.( Ice maker 12.51
_
f�[i)lfilf GOVTAGT'YRSON Interceptor/grease trap 25.02 I
Business name: /'1 f ,)A, -� _ /-7 Medical gas(value:S ) Page 2
n�'GJ- i7C.�Y.)`a•{,,')t../vi Primero 12.51
1I Contact name. �'�+l Roof drain(commercial) 12.51
1 Address: ,0
,(:)Y___. 51.,5 SinFJbasin/lavatory. $ 25.02 fa lip
City/State/ZIP: 7.,)Jf' L..t-.• (-- D 12_, ' 3 Solar units(potable water) 1 62.54
Phone:(563) 4,2_3.-F6q 5 Fax::( ) Tab/shower/shower pan w if
12.51 �( c4
4 E-mail: `0a-r)4.Q. Tbe.SP�t1-I'vt3at.r7� •CAyY) lima! 75.0? ,hh
GO_FCRACTOR Water closet _5.0_ W t ae1
h� • Water heater l 3752 fs� d f(
Business name: Y /4t 1ll Waterpiping/DWV 56.29
Address: P•0• eau 56 5 Other. 25.02
City State/ZIP. Zvi-L(,•fTZ ,Y q 'j --• Subtotal (goo,W
Phone:(. --)1e2-3 1 Fax: 1 Minimum permit fee. S72.50
Plan review (25%of permit fee)
CCB Lie.: C/ ('91 Plumbing Lic.no.:P8 2.4A24�,
�-gn ra 1^` State surcharge(12%TOTAL
PERf MIT
fee)
Authorized signature: 'G 1/ y //fir TOTAL PERMIT PEE I
l l�rif`t c f)l' ( / /shn 1.,, This permit application expires If a permit is not obtained within Ito days
Print name: f j Date: (�/JJ/ f(J�f after it has been accepted as complete.
*Fee methodology set by In-County Building Industry Service Board.
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