Permit •
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00302
Date Issued: 7/15/2021
T f C;A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S136AD06100
Jurisdiction: Tigard
Site address: 11419 SW PACIFIC HWY
Project: Buster's Barbecue Subdivision: None Lot: None
Project Description: Replace 185 ft of sanitary sewer line by means of lining.
Contractor: JACK HOWK PLUMBING/RESCUE ROOTER Owner: SCHOLIBO, GEORGE E JR&
PO BOX 2830 SCHOLIBO, STEPHEN A
CLACKAMAS,OR 97015 12241 SW TERWILLIGER BLVD
PORTLAND, OR 97219
PHONE: 503-850-3100 PHONE:
FAX: 503-491-2932
FEES
Quantity Description Date Amount
185 If Sanitary Sewer 07/14/2021 $100.06
Specifics: 1 12%State Surcharge- 07/14/2021 $12.01
Plumbing
Type of Use: COM
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
Issued By: Permittee Signature:
+f r&J,Jy 1/a r,,De,we O vt,Appl,onion
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 j..-� IVELi FuR ()Hi( I t:�l: •IyL1
City ofW Hall
Blvd
Date/By: ��//H/ 2/ � PL M LC�I - O 3O
Pcrmil Ne.
• 13125 SW Hall Blvd.,Tigard,OR 972 ) Plan Reriew. Phone: 503.718.2439- Fax: 503.598.1960 Date/B . Oilier Permit No.:
I' c :�I:I r Inspection Line: 503.639.4175 pate Ready/By:'7 /l :� t ®See P 2 for
Internet www.ligard-or.gov Notifkdlhod://,'7/Z .4 C 5e r-� � pp4mental Information
TYPE OF WORK 4- [�. d - FEE' SCHEDULE
❑New construction 0 Demolition her Aerial information use checklist.
Description I Qty. I Ea. I Total
/Addition/alteralion/replaccmenl ❑Other: New I-2-family dwellings(includes 100 fl.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling ,'Commercial/industrial SIR(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
'y INFORMATION
,,AND LOCATION ` r Site utilities:
Job site address 11 41 ofY///�1 y{'{ y i� Catch basin or area Chain 18.76
City/State/ZIP:/',�% / �"[�yl/1 9 +'�A,J�'� Drywell,leach line,or trench drain 18.76
/_/J F mg drain(no.linear ft.: Page 2
Suite/bldg lapt.no.: Project name: I/Jy 5n l,{r. f�'�l/i/yj/j�1
rftj �.A`.:/ ba Vr"i anufactured home utilities 50.01
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear tl.:al Page ft 2 j U V, OO l
--- Storm sewer(no.linear .:_) Page 2 "[
Water service(no,linear ft.:_) Pagc 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK
-U Backwater valve 12.51
1 n (a `-'+ CJ n . ,, „ , � Mail)
_ „n --„ Clothes washer 25.02
J r (Jv�//�-`C=J/ �It��(�''11,� Dishwasher 25.02
17 I �� 111 4--`� }4 Drinking fountain 25.02
- - r Ejectorslsump 25.02
PROPERTY OWNER 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
• ' ` ' Mil ---j�1 ,�(-�-' ---- Ftcwrdraini1uorsinkthub 25.02
Address: f I i J')�J(/(Jt Garbage dtsposat 25.02
City/Slate%/,II•`I t
Q Hose bib 25.02
Phone! J - O J U Fax:( ) Ice maker 12.51
P APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
&, ( iQ.o 'y n ijuie..___I-hul„.. h¢edical gas(value:S_) Page 2
Contact namci /I'�nl�t� (Q) ''ll yP'Mel* 12.51
,O Q.
44130
� p_tit �rnin lcommyacial) 12.51
Address: - ,ink/basin/lavatory 25.02
-- ------
City/State/ I': � _ Solar units(potable water) 62.54
P / SD-- 10D Fax:: )1 f -- j j sower/showers n 12.51
E-mat Urinal 25.02
Water closet 25.02
CONTRACTOR -
ppr,/l 1 �r�.�.,�1st� (� �,.�r��� Water heater 37.52
e .1 Volt'`)/ i/ ' 'VliA rpiping/[WV 56.29 -
Address. cr. 25.02
CityrSt. :_l.„0,
i Subtotaly lou GD_ /\ FaC.Ju�2) ' �. ¢ ^. _1Minimum permit frc: 572.50
Phnnc �+ e ! lJ +.+lYG7 '-I 1 -.?'rJ� _-
CCH L -_ PlumLie.rm. Plan review (25°i of permit feel
-- j'' --J�- - , State surcharge(12W of permit fce) (2/0 I
Authorized signatureotaii. t } TOTAL PERMIT FEE {`
piti X/ `/ r }j/rj1 -//s{��//�/� is permit application expires Ito permit if not obtained E46I ys�
11,
P !, tV 'I O� I� "'- diet II y been accepted i complete.
ustry
�,VI •Fee methodology set 6y Tri-County Bwtdmx Industry Service Board
I:Budding Pennts'PLMU•PerrnilApp.doc 10'01'34 440.1a161p002.COx4WE11)
Dianna Ornelas
From: #Building Permit Technicians
Sent: Wednesday, July 14, 2021 10:03 AM
To: sjuden@ars.com
Subject: PLM2021-00302 - Buster's Barbecue - 11419 SW Pacific Hwy
Attachments: PLM2021-00302.pdf
Hello Stacey,
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 PLM2021-00302 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.
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 1503-718-2439 Permits
i