Permit CITY OF TIGARD PLUMBING PERMIT
' 2, Permit#: PLM2021-00306
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 7/15/2021
Parcel: 2S103DA01900
Jurisdiction: Tigard
Site address: 10845 SW DERRY DELL CT
Project: Downs Subdivision: DERRY-DELL NO.2 Lot: 20
Project Description: 146 If sanitary sewer line to connect existing dwelling to public sewer.
Contractor: 3 MOUNTAINS PLUMBING Owner: DOWNS, SUSAN &JASON
5304 N ALBINA AVE 10845 SW DERRY DELL CT
PORTLAND, OR 97217 TIGARD, OR 97223
PHONE: 503-670-1342 PHONE:
FAX:
FEES
Quantity Description Date Amount
146 If Sanitary Sewer 07/15/2021 $100.06
Specifics: 1 12%State Surcharge- 07/15/2021 $12.01
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
/• r
Issued By: 1/ . ' e, Permittee Signature: ; 1
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit ApplicatioC� I� /e
Site Utilities C 1 V G 1OR OFFI('L: I Sl. ONLY
City of Tigard J U L 1 4 2021 Date/By:
Received 7//$/
; • 13125 SW Flail Blvd.,Tigard,OR 9722374
Date By: Z d Permit N `/�Ztt �L73��(P
t Phone: 503.718.2439 Fax: 503.598.1960�Y OF I IGARD Plan Review Other Perm l f��/
Date/By: zei Lf-DQ
T I G AR D Inspection Line: 503.639.4175 f i r'/fl fl l\/ICI{l N Date Ready/By^+ /l Suns: El See Page 2 for
Internet www.tlgard-orgov Notified/Method:�// Z( . Supplemental Information
TYPE OF WORK : , { 4, _ 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
® 1-and 2-family dwelling ❑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.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10845 SW Derry III Ct Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard OR 97223
Footing drain(no linear ft.. ) Page 2
Suite/bldg./apt.no.: Project name:Jason Downs Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:146) 2 Page 2 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
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Installing sanitary sewer from home to main to create a new connection Dishwasher 25.02
via directional drilling. 146ft Drinking fountain 25.02
Ejectors/sump 25.02
El PROPERTY Expansion tank 12.51
P OWNER � TENANT -
Fixture/sewer cap 25.02
Name:Jason Downs
Floor drain/floor sink/hub 25.02
Address:Site Address above Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( 206)473-2828 Fax:( ) Ice maker 12.51
® APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:3 Mountains Plumbing Medical gas(value:$_) Paget
Primer 12.51
Contact name:Andrea Basile Roof drain(commercial) 12.51
Address:2304 N Albina Ave, Portland OR 97217 Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( 503)455-8838 Fax: :( ) Tub/shower/shower pan 12.51
E-mail.install@3mountainsplumbing.com Urinal 25.02
,,;. .P ., Water closet 25.02
CONTRACTOR
Water heater 37.52
Business nine.Applicant Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal JQti,9'kj
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie,:169499 Plumbing Lic.no.:pb 99 Plan review (25%of permit fee)
State surcharge(12%of permit fee) /.2. 0 /
Authorized signature: 44,44a, guh. TOTAL PERMIT FEE �`�rA`7
Print name:Andrea Basile Date:07/14/2021 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.
1:1B9i1ding\Permas\PLMU.PernuiApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Dianna Ornelas
From: #Building Permit Technicians
Sent: Thursday,July 15, 2021 10:24 AM
To: Install
Subject: PLM2021-00306 - 10845 SW Derry Dell Ct - Downs
Attachments: PLM2021-00306.pdf
Hi Andrea,
This permit is ready to issue and the balance due is$112.07 (see attached invoice).
The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record
number PLM2021-00306 under the Building tab. Payment can be made by`card' for a 3% service fee or select the
'check' payment option and there is no service fee.
The home owner has already paid the sewer connection fees for this project. A /2 /SSA
Please email the permit technicians at TigardBuildingPermits@tigard-or.gov once the fees are paid so that we can
issue the permit and email a copy.
Thank you.
Dianna L. Ornelas
Building Division Services Supervisor
City of Tigard I Community Development
13125 SW Hall Blvd I Tigard, OR 97223
503-718-2430 Direct ( 503-718-2439 Permits
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