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Permit Support Document „ CITY OF TIGARD PLUMBING PERMIT ” g COMMUNITY DEVELOPMENT ;. Permit#: PLM2021-00066 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 2/19/2021 TtC AR.f3 g 3 3 / .i I. Parcel: 2S109AC00600 Jurisdiction: Tigard Site address: 14715 SW 133RD AVE Project: RIETMAN Subdivision: None Lot: None Project Description: 125 ft.of sanitary sewer to connect existing house to sewer. Septic tank to be pumped and filled. 3/3/2021: REPRINT permit to add(1)ejector/sump pump. Contractor: SUPERIOR UNDERGROUND LLC Owner: RIETMAN, SHAWN C&B JORINE 6400 SE 101ST AVENUE SUITE 3 14715 SW 133RD AVE PORTLAND, OR 97266 TIGARD, OR 97224 PHONE: 503-750-0020 PHONE: FAX: FEES Quantity Description Date Amount 125 If Sanitary Sewer 02/18/2021 $100.06 Specifics: 1 12%State Surcharge- 02/18/2021 $12.01 Plumbing Type of Use: SF 1 ea Ejectors/Sump 03/03/2021 $25.02 Class of Work: ALT 0 12%State Surcharge- 03/03/2021 $3.00 Type of Const: Plumbing Occupancy Grp: Stories: Total $140.09 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 Iling 503.232.1987 or 1.800.332.2344. Issued By: /0 ( 7:: Permittee Signature: 0/ he. I ('. 6• 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. g Plumbing Permit Application - b ��` -. .e '- , . ° ':. `,�' , O Site Utilities FOR OFFICE USE ONLY Received /, / �6 City of Tigard d Datc By: �/ SJ f�./ 7f, •emnt No.:ip in, P �`I-c t'` IN a 13125 SW Hall Blvd.,Tigard,OR 97223 / 1 : Phone: 503.718.2439 Fax: 503,598.1960.h ' "„, F Plan pey ew Other Permit No.: Th ART Inspection Line: 503.639.4175 _"" 1 -,-;,ate Ready/By Juris: 21 See Page 2 for Internet: www.tigard-or.gov N Notified/Meth, SupplementalInt-or/nation - TYPE OF WORK .w r <` ., .� /r),' "yl 4 r [FF.° SCHEDULE El New construction CI Demolition For special in�or�nudorr use . to,- Descriptionty. Ea. Total Addition/alteration/replacement ❑Other: ,ti - New 1-2-family dwellings(includes 100 ft.for each utility connection) �l.j.,?1-J' i(:.).r _ - SFR(1)bath 312.70 CATEGORY OF CONSTRUCTION cid 1-and 2-family dwelling CICommercial/industrial SFR(2)bath 437.78 SFR(3)bath 500.32 ❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: r Catch basin or area drain 18.76 Job site address: (4(.1 i S- SiJ (3 `,---- Auk Dt}well,leach line,or trench drain 18.76 City/State/ZIP: %jet t / cii 7.1.,E Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 -�- T -- Sanitary sewer(no.linear It.: Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.:_) Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 - - Backwater valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 Clr✓Z-- u -.j 4.-L _ CO",(e ,- "i?..'`e.✓ (.9d `!Ltrc . Dishwasher 25.02 py,--- r't spar- { ae €,. Drinking fountain 25.02 Ejectors/sutnp tl 25.02 "1...J. rsil tank 12.51 0 PROPERTY VIER i ExpansionTENANT Fixture/sewer cap 25.02 Name: 5 1,,(7.„y a N.Ir y y y Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 ❑ APPLICANT ,2 CONTACT PERSON Interceptor/grease trap 25.02 Medical gas(value:$ ) Page 2 Business name: A it - 6 ;, rr j f',z / L_L._c-- Primer 12.51 Contact name: g �s� R�/'(tL 't 7- 'r"5 t • Roof drain(commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State/ZIP: Solar units(potable water) 62.54 Phone:( ) Fax::( ) Tub/shower/shower pan 12.51 Urinal 25.02 E-mail:Sur7gir toe' d ,.t41ur' r,- :,raC . i,..1--G m..e e>st/. to L Water closet 25A2 ,. - CONTRACTOR - - - - Water heater 37.52 Business name: "S p 0 .- et (-,r„.. t .-I..tW;( Water piping/DWV 56.29 Address: C7 A/00 SE /0/ 5 'Ale-,.-, 5 .. -E ,. Other: 25.02 ubtotal City/State/ZIP: 'Ti Z P ( , _ Minimum permit fee: $72.50 Phone:O 'T J O a_0 0 z Fax:( ) Plan review (25%of permit fee) CCB Lic.: Li,`l hp Plumbing Lie.no.: 103"-t tt(;c, � 0� ✓ State surcharge(12%of permit fee) , Authorized signature: a -PZO -,.. TOTAL PERMIT FEE 2�`, G: �^ This permit application expires if a permit is not obtained within 180 days Print name: e. 1 i,44, Date: 2-/2.-5?4,,( after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. 1:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-46t67(10/02/COM/WEB) a , z .r , ca 1,1F r J "' s a vl , m/re r -v,00 r