Permit q CITY OF TIGARD PLUMBING PERMIT
1 COMMUNITY DEVELOPMENT Permit#: PLM2020-00254
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/25/2020
Parcel: 1S136AD04102
Jurisdiction: Tigard
Site address: 10735 SW 69TH AVE 9
Project: Gettysburg Apartments, Building 1 Subdivision: VILLA RIDGE Lot: 2
Project Description: 20 ft.of water service and interior plumbing for units 9-12:(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: 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 •
Building Fixtures ralz OFFICE LSE ON1.1
City of Tigard {� ! /� �� Permit Na
t, 13125 SW Hall Blvd.,Tigard,OR 9 7223 E �` V �: n Amick.,is k. Cl
r' a Phone: 503.7181439 Fax: 503.598.aggg(((bbb mega + Other Permit No.: � -�a`)
Inspection Line: 503.639.4175 fI Datc Read/By lure: ® Sec Page 2 for vL
Tl G,i:D Internet: www.tig ov ard-or. ��U N 2 3 2O2 y
g Nonfied,'Mettrod! _...4 ,,. 5uppiemewtal Information
TYP£ 9F IGORL' • g FEE 'SCIIEDLFLE -
❑New construction ❑DcEtntl1MK INU III1.. For special information use checldisL
Description j Qty. 1 Ea I Total
XAddition/alteration/replacemen[ 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
' : ti_g� „ . r. '*.- `r SFR(I)bath 312.70
❑ 1-and 2-family dwelling 0 ColrutlerciaUindtlstrial
SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building X Multi-family Each additional bath/kitchen 25.02
0 Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
J�5 ritirQ Asnp�i >I,:el@ifitif Site polities:
Job site address: 1)13,5 E- Catch basin or area drain 18.76
�E 1 � q /72 Drywall;leach line,or trench drain 18.76
CiIStaWZIP:
Footing drain(no.linear ft.: ) � Page 2
Suite/bldg.apt.no.: op-o, Project name: t it l-i- ' ' -I__.. Manufactured home utilities 50.03
Cross street/directions to job site: !rs 60 ) Manholes 18.76
Rain drain connector 18.76
s Sanitary sewer(no.linear ft.:,) Page 2 -
Storm sewer(no.linear ft.: 1 Page 2
Water service(no.linear ft.: .
Al.)) i Page 2 4A,
Subdivision: Lot no.: La Fixture or item:
�'17n
Tax map/parcel no.: f Backflow preventer 31.27
x , ;, Backwater valve 12.51 s�
}k Fes:•: larx itirx- : ti iii 4.iA7D8: tir %' BackClothes washer f 12.51 00
n• Cr ) JN5P W > 'ZOO S Dishwasher 25.02
N L7-S '-' ,Y'onkk 1.-?_• Drinking fountain • 25.02
Ejectors/sump 25.02
k "!r :g '. 5 n'2;,g44 anrr Expansion tank 12.51
fixture/sewer cap 5.0_
Name:� 6p PflL�1, tC� 25.02
Floor e/sewer cap
sink/hub 1
Address:'1..,-1SO��,-.,N,q.,, � I /�•-� Garbage disposal 25.02
City/State/ZIP: P _r U l•JO O'2- ' /l Hue bib 25.02
( )�� 3�1 C� I Fax:( Ice maker 12.51 i
Phone: ,I
•'';,d 1ILCAN.t.`x��.t ,a,f o'rrA I-"`l* Interceptor/grease trap 25.02
Business name: r`
Pu A, -.y , _ r7 Medical gas(value:S_) Page 2
a a�i�V
Primer 12.51
Contact rname: t 1 OP.-11E Roof drain(commercial) 12.51
Address: 3.0 . b)L_ 5-Lc 5 �j Sinkkbasinnavatory 'g 25.02 .)ip
City/State/ZIP: D ,��" Q le, Q/ -( 8 Solar units(potable water) 62.54
Phone:�y/j"3) 42)3- '5C)5 Fax: :( ) Tub/shower/shower pan 14- 12.51 60_pa}-
�� ( -,- Urinal 25.07 M
E-mail: slimy f �(' �iicyUDIYili CDI� Water closet 225.022 /W. De
J C1 /�/ .., .J Water heater 37.52 �.0e
Business name 1v � PhV,&4.J ( Xi- , Water piping/DWV 56.29
Address: P.o. -BOA_ SI,5 I Other: 25.02
p `/ Subtotal 66.lid/-
City/State/ZIP' ,�]�"(..(,-F)S 5�� -/�7J3 S Minimum permit fcc: 572.50
Phone:(Q0)+�Z3 -�j�j Fax:( ) Plan review (25%of permit fee)
CCB Lic.: rry Plumbing Lie.no.:Pet 2-1e74 pa
State surcharge(12%ro of permit fee)
Authorized signature:
I signature: TOTAL PERMIT FEE 711/2,
e i t v L �j`_7 f ,.,t,sb This permit application expires if a permit is not obtained within 180 days
Print name: /J(JlJ 1e- (J I /�(Jf#J after[t has rt-o unty uil as complete.
Industry
-.-1 !// *Fee methodology set by?n-County Building Industry Service Board.
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