Permit (15) CITY OF TIGARD PLUMBING PERMIT
411
a. COMMUNITY DEVELOPMENT Permit#: PLM2023-00454
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/24/2023
Parcel: 1 S126DC00902
Jurisdiction: Tigard
Site address: 9500 SW GREENBURG RD
Project: Crown Oak Apartments Subdivision: LEHMANN ACRE TRACT Lot: 5
Project Description: Install 275 ft cipp liner through exterior cleanout access point.
Contractor: APOLLO DRAIN &ROOTER SERVICE Owner: WS-JP LLC
853 NE HARLOW RD BY CAMBRIDGE REAL ESTATE SERVIES
TROUTDALE, OR 97060 PO BOX 2968
PORTLAND, OR 97208
PHONE: 503-239-8801 PHONE:
FAX: 503-669-9568
FEES
Quantity Description Date Amount
275 If Sanitary Sewer 10/24/2023 $137.58
Specifics: 1 12%State Surcharge- 10/24/2023 $16.51
Plumbing
Type of Use: MF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $154.09
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: -}. Utr?
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.
Plumbinz Permit Application
Building Fixtures RECEIVED FOR OFFICE 1,[SF c»1.\
City of Tigard Received
Ill Date/By: (0 �O 23 ). Permitl �K13mt+5/
r 13125 SW Hall Blvd.,Tigard,OR 97 'T 0 2023 f\
C Phone: 503.718.2439 Fax: 503.598.1960 Plan Review Other Permit No.
By:
Inspection Line: 503.639.4175
TIGARD CITY O DatF TIGARD Date Ready/By: kris: El See Page 2for
Internet: www.tigard-or.gov BUILDING DIVISION NotificdJMcthod: Supplemental Information
TYPE OF WORK FEE* scatoULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
` ddition/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 q Site utilities:
Job site address: s,/Nl, 4-;_ e (1 bvx et Catch basin or area drain 18.76
pb(A
`t dtt q11L C1� Drywell,leaoh line,or trench drain 18.76
City/State/ZIP: �/ (nVJ
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft. ( Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: ( Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK '. Backwater valve 12.51
f t Clothes washer 25.02
`�,7, ,,�,. U 2-1 (.� L{ Ive(� Dishwasher 25.02
i s C tt- t1 G„l i 1 c(cfizss Drinking fountain 25,02
Ejectors/sump 25.02
I 0 PROPERTY 0 TENANT Expansion tank 12.51
e (�(\t1 V1� Fixture/sewer cap 25.02
Nam
`h 1 * Vt(S ` 1 Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) lcc maker 12.51
APPLICANT ONCACT PERSON Interceptor/grease trap 25.02
Business name: ,r`` �n ) / Medical gas(value:$ ) Page 2�LJ 1 �f�l�t'1 ae "t t Primer 12.51
Contact name: t i1 Roof drain commercial 12.51
6 . )
Address: ,� N�A ��,/ Sink/basin/lavatory 25.02
City/State/ZIP: 'I A.1}-{)C � C�C Solar units(potable water) 62.54 '
Phone:(F u' ��t"'---) i Tub/shower/shower pan 12.51
�'}}Z`�J�{ � 1 Fax::( )
mail:C> t Urinal 25.02
E
��_ C 1l o5 ti lCP 'C am Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:••ift � 1,) vz,� C.� rj Water piping/DWV 56.29
Address: J2 S(\, f `` � A, Other: 25.02
City/State/ZIP: h) Subtotal
Phone: )'?3Ct ( tc 11 Fax:( ) Minimum permit fee: $72.50
Plan review
CCB Lie.: e 4 `1 Lt 1 C3 Plumbing Lic.no.:'Z_Lo"5 21'j�' (25%of permit fee)
1
State surcharge(12%of permit fee)
Authorized signature: /' ) TOTAL PERMIT FEE
Print name: (i l-0\„L /' Lt A Date: l U(-30/? 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.
1^3uiding\Permits\PLMU-PeimitApp.doc 10/01/09 440-4616T(10/02/COM/WED)