Permit Support Document CITY OF TIGARDPLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2019-00192
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 ViA /' rAill
Date Issued: 05/06/2019
' Parcel: 2S 104AB 12600
Jurisdiction: Tigard
Site address: 12410 SW 133RD AVE
Project: 19R029 Subdivision: MORNING HILL NO.7 Lot: 154
Project Description: BATH REMODEL. 8/1/2019: REPRINT permit to add(2)lays.
Contractor: POWER PLUMBING CO Owner: DUEWER,THERESA 1994 TRUST
POBOX 19418 12410 SW 133RD AVE
PORTLAND, OR 97280 TIGARD, OR 97223
PHONE: 503-244-1900 PHONE:
FAX: 503-244-8825
FEES
Quantity Description Date Amount
2 ea Lavatories 05/06/2019 $50.04
Specifics: 1 ea Tub/Shower/Shower Pan 05/06/2019 $12.51
10 Minimum Fee Adjustment- 05/06/2019 $9.95
Type of Use: SF Plumbing
Class of Work: ALT 9 12%State Surcharge- 05/06/2019 $8.70
Type of Const: Plumbing
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 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
0A/1—,„\icE
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 RECEIVE FOR OFFICE USE ONLY
City of Tigard Received
Date/By: Permit N jj� fCf
13125 SW Hall Blvd.,Tigard,OR 97223 JUL 2 9 2019 y'���/ f /y -
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
TIOARD Ins•pection Line: 503 639.4]75
CITY OF TIGARD Date/By: Other Permit No.:
Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov BUILDING DI VI SIOVNoufied/Meurod
Supplemental Information
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0 New construction 0 Demolition For special information use checklist.
1:4Addition/alteration/replacement 0 Other: Description I Qty. Ea. ] Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF COISSTRUCTION" SFR(1)bath
312.70
CI 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION= Site utilities:
Job site address:12410 SW 133RD Catch basin or area drain 18.76
City/State/ZIP:TIGARD,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: 19R029
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
DESC 1PTION O ��WOR. . '' Backwater valve 12.51
ADD TO EXISTING PERMIT PLM2019-00192 Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump
25.02
❑ WE ` p
�a a PROPE. RTY O-qNR , '�� � h !❑ TENANT ,_ Ex ansion 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
PLI
5 � �' ,1 °' ' ❑ CONTACT"PERSON?,- 4 Interceptor/grease trap 25.02
Business name:POWER PLUMBING CO Medical gas(value:$ ) Page 2
Contact name: Primer 12.51
Address:P.O.BOX 19418 Roof drain(commercial) 12.51
_,
Sink/basivatory ' 2 25.02
City/State/ZIP:PORTLAND,OR 97280 Solar units(potable water) 62.54
--- __ pax!:(a03)244-8823 TuTilslliowerlihowerpan 12.51
E-mail:SERVICE@POWERPLUMBINGCO.COM Urinal 25.02
9
qWater closet
25.02,�. "t -� A,p n7R � � F p m,t w, .1,, �il
,_ ..t ,' "-,,,,,..4,,,,,,,- -i i0 --ob -« ,,my
Business name:POWER PLUMBING CO Water heater 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 Fax:(503)244-8825 Minimum permit fee: $72.50
CCB Lic.:52378 Plumbing Lic.no.:34-150PB Plan review (25%of permit fee)
Authorized signature: I -�
State surcharge(12%of permit fee)
l TOTAL PERMIT FEE
Print name:KRISTIE BRAMWELL Date:7-29-19 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.
i:lBuilding\Pennits\PLMU•PennitApp.doc 10/11/19 440-4616T(t0/02/COMIwEB)