Permit .„ CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00277
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/02/2011
Parcel: 25101 BCO2401
Jurisdiction: Tigard
Site address: 12650 SW HALL BLVD
Project: Snyder Roofing Subdivision: Lot:
Project Description: Connect newly installed pre -fab trailer to sanitary sewer and water service, approximately 40' each.
Contractor: PRO DRAIN & ROOTER SERVICE, INC Owner: JFK PROPERTIES OREGON LLC
3300 NW 185TH AVE #213 12650 SW HALL BLVD
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE: 503 - 533 -0430 PHONE.
FAX: 503 - 296 -2419
FEES
Quantity Description Date Amount
40 If Sewer Service 09/02/2011 $62.54
Specifics: 40 If Water Service 09/02/2011 $62.54
1 12% State Surcharge - 09/02/2011 $15.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $140.09
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 Notif ion CeTi ter. 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 estions to OUNt in 03.232.1987 or 1.800.332.2344.
Issuec B Permittee Signature: 1
Y 9
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.
P l u m b i n g •
g (, .,, ,yfrir, 01/¢ A . •
Site Utilities AUG 2 4 2011 FOR OFFICE USE ONLY
City of Tigard Received q / P ermit No : (
11
• 13125 SW Hall Blvd., Tigard, ORi9'223 S {w & ? �
Dale/By: I �� I. I v'���0
e Phone: 503.639.4171 Fax: 50
..3 t., �9 r Other P ermit No.: Q /��
Inspection Line: 503 b U . 59 ) iLthivU D VISI Ihte/By: O �(p" �-'�! � ` '
T 1 G ARD Internet: www.tl d - Or, v Dale Ready/By: Juris: ® See page 2 for
go Notified/Method: , Supplemental Information
TYPE OF WORK FEE* SCHEDULE
El New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
2 Addition/alteration/replacement ❑ Other: New l- 2- family dwellings (includes 10011. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 24920
El 1 - and 2- family dwelling < Commercial /industrial SFR (2) bath 350.00
❑ Accessory building SFR (3) bath 399.00
rT g ❑ Multi- family
❑ Master builder 171 Other. Each additional bath/kitchen 45.00
Fire sprinkler ( sq. fl.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I 2-o .5-6 5ut) tict a ()4 jc • Catch basin or area drain 16.60
City /State/ZIP: " j GA- r� 4 -f' l 61-7-2_2_. Drywell, leach line, or trench drain 1 6.60
Suite/bldgJapt. no.: I Project name: V g goGc, 11 Footing drain (no_ linear ft.: Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60 //
Sanitary sewer (no. linear ft.; ` ) i Page 2 ll7.+ ,(
Storm sewer (no. linear fl.: ) Page 2 j�"�
Subdivision: Lot no.: Water service (no. linear R:) Page 2 (-1
w2
q /O, je A e ^ _ ` Fixture or item
Tax map /parcel no.: OS C.� Absorption valve 16.60
DESCRIPTION OF WORK
Backflow preventer Paget
1e_c O 11 r1 _ C Rx t S h L rtk44i � -- Backwater valve 16.60
5 LStv t � .�- -i (J Clothes washer _ 16.60
r Dishwasher 16.60
❑ PROPERTY OWNER CI TENANT
Drinking fountain 16.60
Ejectors /sump 16.60
Name:
Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
CI APPLICANT ID CONTACT PERSON Hose bib 16.60
lee maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: � /1 14 y Primer 16.60
City/State/ZIP: � Roof drain (commercial) 16.60
Phone:
( ) Fax :: ( ) Sink/basin / lavatory v 16.60 /
Tub /shower /shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR Water closet .r 16.60 . .. „ 44111
Business name: -- F iv D>`ar,„, _y. 0 Ul t Water heater 16.60 Q
. Address: 3 3 KA 1 6 S -t- 2I 3 Other: D°
City/State/ZIP: ? Subtotal . .
A
rrr4 cc hd G M Q 77 zqi
t Minimum permit fee: $72.50
Phone: (j0; >) 55'3- () (I-3 0 Fax: (503) 2 cl ( �J - 2..t-it �' Residential backflow minimum permit fee: $36.25
CCB Lic.: t 0 504 Plumbing Lic. no.: 210 - 17 T$ Plan review (25% of pemtit fee) Le 0 ii
State surcharge (I2% of permit fee) t J !
0
Authorized signature: , r 2. --- / ? /y TOTAL PERMIT FEE {
I •
Print name: u . 130 t (, Date: e /i j This permit application expires if a permit is not obtainetrir /
hin µ 1 0
ISO days after it has been accepted as complete y(
*Fee methodology set by Tri-County Building industry Service Board. pp
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