Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2021-00258
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 6/21/2021
TIGARDg Parcel: 2S111 CD00600
Jurisdiction: Tigard
Site address: 15905 SW 98TH AVE
Project: Dickenson Subdivision: ALDERBROOK FARM Lot: 21
Project Description: 95'of sanitary sewer line to connect existing dwelling to public sewer.
Contractor: SIERRA CONSTRUCTION & EXCAVATION LLC Owner: DICKENSON, JON
PO BOX 30642 KARRAKER, SARA NICOLE
PORTLAND, OR 97294 15905 SW 98TH AVE
TIGARD, OR 97224
PHONE: 503-492-9242 PHONE:
FAX: 503-252-9808
FEES
Quantity Description Date Amount
95 If Sanitary Sewer 06/21/2021 $62.54
Specifics: 1 12%State Surcharge- 06/21/2021 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 06/21/2021 $9.96
Plumbing
Class of Work: OTR
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: Permittee Signature: ILI/ elj4,4G
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.
t.,wen _ r. _ u ._
RECEIVED
Plumbing Permit Application L- - (O 1) 2
Building Fixtures JUN 1 4 2021
City of Tigard CI OF TIGAR� c +n f i /7J fir) t ,wPLr1 2.;-, L)ZSf
• 13123 SW Han Blvd.,Tip.ard,0 972_.
Plan Review
a Mime: 503.7182439 Fax G DIVISION' teuY Other P amit 3 lk i ps-Z G)-( )
Inspection Line: 503639.4175
t t . I tNwuute Ht ,% 0 ill ac SkiisePartii2111.arf *nos
Internet www.tigud-orSw'TYPE OF WORN Li FEE' SC H£DIi1.E
❑New construction 0 Urnwlition For special befoe e.rtee.srthecAllu
Description I Qtv. I Fa. ) Total
iFfAddition/alteration/replacement 0 Other: New 1-2damlly dwellings(include%10(1 t1 for each utility connectionl
�/ crCATEGORY OF CONSTRUCTION SIR(1 I bath 312.70
/ 1-and 2-family dwelling 0 ComncialruuhWrinl Sf'R(2)bath 417.78
(!❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bathAdtchen 25,02
❑Massa builder 0 O( : Fire sptinkla( ,sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site'trilbies:
Job site address: l t/ r e rk tr(4 . Catch basin area drain 18.76
CiylStatcfTlP: �% t S?�t Drywven,leach brie,or trench drain I11.76
1 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt no.: Project name: iegz-N/tea Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 114.76
Rain dniin ctnmertve 111.76
Sanitary sewer(no.linear ft.:i) IS' Page 2
Storm sewer(no.linear ft.: ) Page 2
Water aerriec(no.linear R.: I Page 2
Subdivision: 1 Lot no.: Fixture or Item:
Tax map/parcel no.: Ilaeictlaw preverwer 31.27
am Backwater raise 12.51
DESCRIPTION OF WORK Clothes washer 25.02
fY f~ -;yI. . u 1A " I v L.511 ly412 Dishwasher 23.02
24. 1Uv Vr7 CJ A/
611 , Drinking fountain _ 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 1 0 TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Ciadsapc disposal 25.02
City/State/ZIP: Itoce bib 25.02
Phone:( ) Fax:( ) lee nukes 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/pease trap 25.02
Business name Medical gas(value:S_) Page 2
'� -- - Primer 12.51
Contact name:
Root drain(cnmmen:ial) 12.51 '
A 'ter: Sink/hasinJlavetury 25.02
�City/State/7.IP: Solar units(potable water) 62.54
I'home:( ) Fat::( ) Tub/shower/shower pan 12.51
1;-(mil: Urinal 25.02
�^ Water closet 25.02
W
CONTRACTOR /VS7 , t/7DA/
Business name: .1---
Water heater 37S?
)� vr�r ( Water piping/DWV 56.29
Address: P, 0 . -�jp7 3 6 Other. 25.02
Ciy/Statc Z1P: LO, ((2 � �' Subtotal
Phone: jJ3)) L11 c7 ��Ile. Fax 5(!3) 0 , Minimum permit fee: S72.50
CCB C -/Lie.: J / "I - •L .bit, kali '' Pbn review (25.s of paint*fa;)
State surcharge(17,of permit feel _
Authorized signature/ I ^ TOTAL PERMIT FEE e7, Zv
Print name: CA n ,- Or
�,���� Tnb permit application esplem If a permit knot obtained within UM day*
�+� after it has bera accepted as complete.
lj •I tc mcth.rkdogy set by Tri-Clumy ttuiktong Indu.Ir.Ker.r.c lean!
1 biohing Prime.II MII.l4..ntarp8x I11Ytt in 116.4tI t(1Wit1H1 Will,