Permit CITY OF TIGARD PLUMBING PERMIT
= COMMUNITY DEVELOPMENT Permit#: PLM2020 00457
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/16/2020
T[GAR f7 g Parcel: 2S103AC01300
Jurisdiction: Tigard
Site address: 11245 SW FONNER ST
Project: Oak Subdivision: None Lot: None
Project Description: Replace 35 feet of sanitary sewer.
Contractor: OREGON ONSITE LLC Owner: OAK, RICKY JAMES
13700 SE GREENWOOD CT MILLER, DARCY ANN
CLACKAMASQ, OR 97015 11245 SW FONNER ST
TIGARD, OR 97223
PHONE: 503-488-9876 PHONE:
FAX:
FEES
Quantity Description Date Amount
35 If Sanitary Sewer 11/16/2020 $62.54
Specifics: 1 12%State Surcharge- 11/16/2020 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 11/16/2020 $9.96
Class of Work: OTR Plumbing
Type of Const:
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: 1 , `Q�1�t ,v� Permittee Signature: or ^M,;`et rV
V`�. W,.Jl`J
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 -I\JED
Site Utilities .,, - FOR OFFICE USE ONLY �I
City of Tigard NOV1 2202o D tteefBy 1///3/2.0 4 Permit No.j/ (./1 ZO 7D(/U-//�5-/ry
• 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review,
11 . Phone: 503.718.2439 Fax: 503.598.1 v V l- T 1..O RB D DatefB Other Permit No.:
Inspection Line: 503.639.4175 C r,t Y
1 S K\1,11 p1 11,1 (1'tJr,DIVISION �Ready/By:,r0 3/ 1 �0 hat: 65 See Paget for
Internet: www.tigard-or.gov Notified/Method` 1f Supplemental Information
TYPE OF WORK (;Y7 1)-/� #/3-N,v,9?} FEE SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
NO 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.R.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I a�S S 3 -our ( s� Catch basin or area drain 18.76
I rywell,leach line,or trench drain 18.76
City/5tate/ZIP: "11 /(�{J�' Footing drain(no.linear ft.: ) Page 2
Suite/bldgJapt.no.: U Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
DO
.1 k_a c�nir _ lot S, \ fit i S- Rain drain connector 18.76
ena1' 'Y1GL' 1 I tA (T� W t 1 Sanitary sewer(no.linear ft.:' 1 Page2
✓l 1 1 1 u 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.: Backfow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
2� Clothes washer 25.02
25.02
(V a(Q cN LP SG1 ni �jl)i(ner �n Dishwasher Drinking fountain 25.02
jQ -TI�Yn - c4 Ejectors/sump 25,02
❑ PROPERTY OWNER ❑ TENANT Expansion lank 12.51
Name:. Fixture/sewer cap 25.02
Floor drain/floorsink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT fli CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
`\ Primer 12.51
Contact name: h ���(� v_
Roof drain(commercial) 12.51
Address: PC) 7 a7 �( /�' Sink/basin/lavatory 25.02
City/State/ZIP: �!` CGS. op. t��t `S_ Solar units(potable water) 62.54
Phone:(SA) aS-'g. 7g `c( Fax::( ) Tub/shower/shower pan 12.51
E-mail: n Pi 1 `✓t) l(t t FRS MA•
A` Cbi- Urinal 25.02
Water closet 25.02
CO�NTRACPOR� Water heater 37.52
Business name. oise"p 1 k- ire Water piping/DWV 56.29
Address: 137 oa s� `Gr-u2 fl wobd C L. Other: 25.02
City/State/ZIP: A afy �� L5 Subtotal
Phone: ) Sl . Q 1,7( Fax:( ) Minimum permit fee: $72.50 77, sd
CCB Lie.: r�Ln7 9 ZQ Z i Plumbing Lic.no.: Plan review (25%of permit fee)
r1
State surcharge(12%of permit fee) t 74
Authorized signature '2Z=> TOTAL PERMIT FEE Ili W
Print name: annWA Posh; 04 Date: 11." 2O Tbis 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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