Permit 'e etatu✓ atetfuAe. tutiA.» utsx3xuMftefxex xuxxWx». lxutWWWPNt xK s»! xxaWWei nn.»diluAxbNixtP34Di1NANxetAiMFFIIwt lxato«. ., ...e, are evrr rF,l eafl{t•f r(t • NA + .:aNx 1!Mten,t e.x✓ r»rrr tle 34tt trdane•a.e.,x.. •
CITY OF TIGARD PLUMBING PERMIT
$. COMMUNITY DEVELOPMENT Permit#: PLM2021-00345
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/25/2021
Parcel: 1S135CA01400
Jurisdiction: Tigard
Site address: 11410 SW GREENBURG RD
Project: Greenburg Terrace Apartments Subdivision: GREENBERG HEIGHTS Lot: 7
Project Description: Replace 120 ft of exterior main water service.
Contractor: JACK HOWK PLUMBING/RESCUE ROOTER Owner: 11410 GREENBURG ROAD LLC
PO BOX 2830 BY WONG, KATHLEEN L&ANN
CLACKAMAS, OR 97015 2433 NE 11TH AVE
PORTLAND, OR 97212
PHONE: 503-850-3100 PHONE:
FAX: 503-491-2932
FEES
Quantity Description Date Amount
120 If Water Service 08/17/2021 $100.06
Specifics: 1 12%State Surcharge- 08/17/2021 $12.01
Plumbing
Type of Use: MF
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: Ia"lYVan De We -e Permittee Signature: 0V►iq
YY
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 Applica CE1VED ei)
Building Fixtures AUG 1 2 MI fDR on 1( .. I ,,r O11.1
City of Tigard Receivedt y: V/f / ',Da , 4 a Permit No.p L 11 to 24.- /1/t ,/..5
IN • 13125 SW Hall Blvd.,Tigard,OR 97 TY OF TIGARD Plan Review
/ C' J V vVJ
Plan Review
Phone: 503.718.2439 Fax: 503. Dale/B Other Permit No
Inspection line: 503.639.4175 ���`�ING DIVISION e /
1 I c;:�I.I t Date Ready By: ", L� fur Ei See Page 2 for
Internet: www.tigard-or.gov Notifed/Method. / I _ _Supplemental Information
TYPE OF WORK 679+ L-- S7 - EE* SCHEDULE
❑New construction 0 Demolition For sipecial information use checklist.
Descnption I Qty. I Ea. I Total
,' Additionfalteration/replacement ❑Other: New I-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
buildingSFR(3)bath 500.32
❑Accessory ❑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:
Job site address: !I {pl iY �,{ / Catch basin or area drain 18.76
City/State/ZIP: 1111 V V 7��.J Doting leach line,or trench dram 18.76
{a Footing drain(no.linear fl.: ) Page 2
Suite/bldg./apt,no.: 3 Project name: LS 1 1 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear 11.:_) Page 2
Storm sewer(no.linear ft.: /� Page 2 /
Water service(no.linear ft.TL.)�� Page 2+(00 DI/
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK
1 Backwater valve 12.51
1 _ O O ( i ', / Clo 25.02
L r¢"�'"�`) W�r ( Dishwasher 25.02
Z. 1 Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Namer.„4.),„„,„,, Floor dram/fl cap25.02
Fbor dramlOoor sinklhub 25.02
Address: lla111�C xA 1OUV Garbage disposal 25.02
City'State/Z1P: 1. V s`^--... ' Hose bib 25.02
Phone:G .. Q 113 Fax:( ) Ice maker 12 51
�t�� �APPLICANC 'p fit'' 0 CONTACT{ ` PERSON Interceptor grease trap 25 02
A �`�f`-ED I d j I��I -R0,1J Medical gas(value:S ) Page 2
C _A Primer 1251
OM etU
Contact name. 1,vWA
Roof drain(commercial) 12 51
Address 3'`r) Sink/basin/lavatory 25 02
City'Statee//ZIIPP: Mika Solar units(potable water) 62.54
✓,/ j'Phone. 0.'3 I I li Fax: :E;023 4.441 _gem 2..., Tub/shower/shower pan 12 51
E-mail , j_i AA e�4 . (3 iC�l1/l Urinal 25 02
rrSJv • `�'`r Water closet 25.02
CONTRACTOR
Water heater 37.52
n Water ptping/DWV 56.29
Address A JO jY1n 1...:kQy) Other: 25.02
City'Statc/Z1P: vJl,"U t Subtotal,. wo � /
_, Cry`_'. i��
r^ n,Q SO �,0 O, j 01/ r1�er,9-1 Minimum pennit fee: S r2.50
Phone-�JV J V Fax:( �1,L�3 ""�'�f G�"1 VG'e'_
) Plan review (25%of permit fee)
CCB Lie.: [gri ss- Plumbi g Licino.: 3 L I 1 ) State surcharge(12%of permit fee) 1 i 2,(}
Authorized signature: 0 9 ei'7 TOTAL PERMIT FEE$``�., i
T s permit application expires if a permit is not obtained nil/in-1 a/
Print name. •N 0 Date ,� 12 after it has been accepted as complete.
I Fee methodology set by TriCount'Building Industry Service Board
i Bu.tdmg P.-',*s'PLMU-PertnnApp.duc 10 01 00 440.4416T11002 COM WEB)