Permit Support Document CITY OF TIGARD PLUMBING PERMIT
: 1 . ' COMMUNITY DEVELOPMENT I, Permit#: PLM2019-00249
1
Date Issued: 06/14/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ♦' ., ' r Parcel: 2S 111 CA04100
Jurisdiction: Tigard
Site address: 9760 SW LAKESIDE DR
Project: 19R043 Subdivision: SUMMERFIELD NO.12 Lot: 661
Project Description: Move auto washer,water heater. 6/17/19: REPRINT to add(1)tub/shower pan.
Contractor: POWER PLUMBING CO Owner: SIMRELL, MICHAEL L&MELODY J
PO BOX 19418 9760 SW LAKESIDE DR
PORTLAND, OR 97280 TIGARD, OR 97224
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
1 ea Clothes Washer 06/14/2019 $25.02
Specifics: 1 ea Tub/Shower/Shower Pan 06/17/2019 $12.51
1 ea Water Heater 06/14/2019 $37.52
Type of Use: SF 1 12%State Surcharge- 06/17/2019 $9.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $84.06
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling I .232.1987 or 1.800.332.2344.
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Issued By: w / /� 1, Permittee Signature: '
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Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approve4t-py^Ciro ro'}utre4 Op the j'b s'.at the time Of coach in$pec ion
Plumbing Permit Application __
Building Fixtures
City of Tigard J U i'! 1 7 C 0 l 9 Received
13125 SW Hall Blvd.,Tigard,OR 97223
Date/By: Permit No.:
I Phone: 503.718.2439 Fax: 503.598.1960 1,
Plan Review
Date/By: Other Permit No.:
Inspection Line: 503.639.4175
TIG='R D i .�a C•t ,,, Mate Ready/By: Juris: ®See Page 2 for
Internet: www.tigard-or.gov
Notified/Method.
Supplementallnformation
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0 New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
�` 4 CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other:
Fire sprinkler( sq.ft.) Page 2
. '' JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9760 SW LAKESIDE DR Catch basin or area drain 18.76
City/State/ZIP:TIGARD,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:19R045
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
'.w Backwater valve
,r . , .. ., .: e D,SiCRI)?TION OF.,',., ' , . . 12.51
ADD TO EXISTING PERMIT PLM2019-00244 Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
:`: 0 ?'ROP R .. `" ''' :`, 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: Hose bib
25.02
Phone:( ) Fax ( )
Ice maker 12.51
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�,. .-i.x'l 4a , „ )' Et ow, sem; $. y
Interceptor/grease trap 25.02
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Business name:POWER PLUMBING CO Medical gas(value:$ ) Page 2
Pri
Contact name: mer 12.51
Roof drain(commercial) 12.51
Address:P.O.BOX 19418
Sink/basin/lavatory 25.02
City/State/ZIP:PORTLAND,OR 97280 Solar units(potable water) 62.54
Phone:(503)244-1900 Fax::(503)244-8825 Tub/shower/shower pan 1 12.51
E-mail:SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
" <` ' 1 . ' a >?'' #' g' x` " x sr,,,'" Water closet 25.02 Water heater
Business name:POWER PLUMBING CO 37.52
Water piping/DWV 56.29
Address:6611 SW MULTNOMAH BLVD. Other: 25.02
City/State/ZIP:PORTLAND,OR 97223 Subtotal
Phone:(503)244-1900 I Fax:(503)244-8825 Minimum permit fee: $72.50
CCB Lic.:52378 Plumbing Lic.no.:34-115�/0PB Plan review (25%of permit fee)
��C�� C State surcharge(12%of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name:KRISTIE B' ELL Date:6-17-19 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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