Permit CITY OF TIGARD PLUMBING PERMIT
11111 '<` -- COMMUNITY DEVELOPMENT Permit #: PLM2009-00170
Date Issued: 06/29/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 parcel: 1 S 29/200 2300
Jurisdiction: Tigard
Site address: 11870 SW BURLCREST DR
Subdivision: BURLWOOD Lot: 5
Project: Dobson
Project Description: Sanitary sewer line repair.
Owner: FEES
DOBSON, ALEXANDER D & MALINDA R Quantity Description Date Amount
11870 SW BURLCREST DR 40 If Sewer Service 06/29/2009 $55.00
TIGARD, OR 97223
1 12% State Surcharge - 06/29/2009 $8.70
PHONE: Plumbing
18 ea Minimum Fee Adjustment - 06/29/2009 $17.50
Plumbing
Contractor:
SIERRA EXCAVATION & CONSTRUCTION
P.O. BOX 30642
PORTLAND, OR 97294
PHONE: 503 - 492 -9242
FAX: 503 - 465 -8261
Type of Use: SF
Class of Work: ALT 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: DA/ lfl°/°G/69- /0/
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
. ^
.. .FROM :SlERRA EXCAVATlON FAX NO. :503 465 8261 Jun. 25 2009 10:52AM P1
ri ,1 . .P2maitAps.kalitaa RECEIVE.PU .
. City of Tigard . P IN 2 5 2009 7.1%;7::_", _ 29/0 .#a I i--104-Poy.2007 - e a/ 7
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CD Master Witicr
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Cross gract/diractians to Job aitx;
,' ` 030"atien valve _ 16.60
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Tutithmeriahawat pal 1“0 1
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