Permit 74 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00312
Date Issued: 7/23/2021
T f CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 1 S135CA01400
Jurisdiction: Tigard
Site address: 11410 SW GREENBURG RD 7
Project: Greenburg Terrace Apartments Subdivision: GREENBERG HEIGHTS Lot: 7
Project Description: Replace sanitary sewer drain line: 20 ft in units 7, 9, 11 &17,and 5 ft in unit 14.
Contractor: MR ROOTER OF PORTLAND Owner: 11410 GREENBURG ROAD LLC
PO BOX 789 BY WONG, KATHLEEN L &ANN
GLADSTONE, OR 97027 2433 NE 11TH AVE
PORTLAND, OR 97212
PHONE: 503-653-5301 PHONE:
FAX: 503-653-5376
FEES
Quantity Description Date Amount
85 If Sanitary Sewer 07/23/2021 $62.54
Specifics: 1 12%State Surcharge- 07/23/2021 $8.70
Plumbing
Type of Use: MF 10 ea Minimum Fee Adjustment- 07/23/2021 $9.96
Class of Work: ALT 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 Cefnter. 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: J1 Permittee Signature: 7��7 Ci�P �7
�f 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'AC IVE[
Building Fixtures !9 FOR OFFICE USE ONLY
City of Tigard 'III 1 3 2021
4 13125 SW Hall Blvd.,Tigard,OR 97223 _e
Date/By' 7/�3/Z_% ,ed Permit No�Lh L,_CO �1-,
IIIII G Phone: 503.718.2439 Fax: 503.598.1960. iJr TluPRu Dan Revie
Date/By: Other Permit No
TIGARD Inspection Line: 503.639.4175 BUILDING DIVISI�f
Dale Rcady/By n lura: 0 See Page 2 for
Internet: www.tigard-or.gov Notifiedd/yMethod/Z2/z',/ .O�t Supplementallnformatioo
TYPE OF WORK ,�-+�r'f,'71 ',,., II X 142 .FEE• SCHEDULE --•
0 New construction 0 Demolition For special inrormaa n usechfcklir
1I1,� I
Description Qty. Ea. I Total
1 Addition/alteration/replacement 0 Other New 1-2-family
dwellings(includes 100 it.foreach utility connection)
CATEGORY OF CONSTRUCTION I SFR(I)bath 312.70
❑ 1-and 2-family dwelling {�commercia1/industrial SFR(2)bath 437.78
Accessorybuilding `` - - I SFR(3)bath 500.32
❑
0 Multi-family
Each additional bath/kitchen I 25.02
❑Master builder 0 Other: I Fire sprinkler(_sq.ft.) I Page 2
JOB SITE INFORMATION AND LOCATION I Site utilities:
Job site address: 7'Y/0 SLS Err -,&..t ea Catch basin or arca drain 18.76
,J Drywall,leach line,or trench drain 18.76
City/State/ZIP: j�7�i-G� OR, G1'722�� Footing drain(no.linear ft.: ) Page 2
ISuite/bldg./apt.no.: Project name: L aZc
t h/ '3(,,,l fe-G�- y Manufactured home utilities � 50.03
Cross street/directions to job site: 1 LL_4-L. / ' J2f 11 L-y.F - Manholes I I 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:c5S) F I Page 2
Storm sewer(no.linear ft.: ) I Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: I Fixture or item:
Tax map/parcel no.: I Backflow preventer 31.27
I DESCRIPTION OF WORK I Backwater valve 12.51
Rep/eta 20 T L each or t/'�� ``� /� Clothes washer 25.02
/ R1pGf��[.Pr/> �YCU/7 U i Dishwasher I 25.02
,P l & 7 r 9rr /� 4 l 7. RePiAce S i2 I Drinking fountain I 25.02
0/ ichei-) C[f a/!) &YLZ , kh 1 [ N. Ejectors/sump I 25.02
;. PROPERTY OWNER I
0 TENANT I Expansion tank 12.51
Name: Creen�U-r9 TerratcQ �-r •l•-h••(�J T.i�, Fixture/seweroordrcap 25.02
`'�-� Floor drain/floor sink/hub 25.02
Address: 1 114 10 l..0 et f,efu,-1 bi.cl Garbage disposal I 25.02
City/State/ZIP: -- 'i 9Q,rc i r")R.. q-77 3 Hose bib I 25.02
Phone:( ) 31 O-37 05 I Fax:( ) Ice maker 12.51
APPLICANT 'I ':❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: M Y, r- N Medical gas(value:$_) Page 2
n_ 1 e' 1 ra.0 L,l ----- ---- - Primer I 12.51
Contact name: t'�lY� vRoof drain(commercial) I I 12.51
Address: '() fX -7 Sink/basin/lavatory I I 25.02
City/State/ZIP: G'0.d Si'd,r-,R 012_ (l-i &"'7 Solar units(potable water) I 62.54
Phone:(( (n. - 530 I I Fax::( ) I Tub/shower/shower pan 12.51
� Urinal 25.02
E-mail: r VP-G,�vr;.,.�,r ti"/'p[> rppy-thad-t r/, Carr" I Water closet I 25.02
-:.' CONTRACTOR +:I
Water heater I I 37.52
Business name: Cf-jy.i.¢ l7_g QL--V,e_ Water piping/DWV I 56.29
Address: Other: I 25.02
Ciry/State/ZIP: I Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7, _s
Plan review (25%of permit fee)
CCB Lic.: egg I Pl ,no.:3_(-8y Pi I State surcharge(12%of permit fee) dP; 741 I
Authorized signature: TOTAL PERMIT FEE Ice'.,-2.di
Print name: RCJ-X:-) va-I oh y1 Date:'-?1 I?)I 21 I This permit appncarion expires if a permit is not obtained within 190 days
after It has been accepted as complete.
J 'Fre methodology set by Tri-County Building Industry Service Board.
IABuddinglPermils\PLMr1-PermilApp dor 10/0009 440-1616T(IW02/COM/WEB)