Permit CITY OF TIGARD
PLUMBING PERMIT
• 7 4 '' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00310
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/20/2011
Parcel: 2S109ACO2400
Jurisdiction: Tigard
Site address: 13125 SW BULL MOUNTAIN RD
Project: Knudeson Subdivision: 2000 -086 PARTITION PLAT Lot: 1
Project Description: Repair of 100' of sanitary sewer service.
Contractor: PRO DRAIN & ROOTER SERVICE, INC Owner: KNUDESON, KIM & REBECCA
3300 NW 185TH AVE #213 13125 SW BULL MOUNTAIN RD
PORTLAND, OR 97229 TIGARD, OR 97224
PHONE 503 - 746 -9703 PHONE
FAX• 503 - 533 -9376
FEES
Quantity Description Date Amount
100 If Sewer Service 10/20/2011 $62 54
Specifics: 1 12% State Surcharge - 10/20/2011 $8 70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 10/20/2011 $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, . . is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utilit 'otification Cen - • -se rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or •irect questions to OU sy c.Ilin• 503.232.1987 or 1 800 332.2344.
ssued By: I / Permittee Sig .:ture: 4 A 1 C '
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.
Oct 20 11 08:08a Pro Drain „• t ° r • ,c 503 533 -9376 p.1
Plumbing Permit Anulicatio
'CT 202011
Site Utilities FOR OFFICE LSE ONLY
City of Tigard
CITY OF TIGARD Received
DacvBy: /O "20 Aim t �I M
Permit No.:
11 111 q 13125 SW Hall Blvd., Tigard, °BIASING DIVISION Plan Review
C • Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 Daze Ready/By: mom: la Sec Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemeelal Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition • For special information use checklist
Description I Qty. } Ea. l Total
OAddition/alteration/replacement ❑ Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
''and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
III Accessory building ❑ Multi- family SFR (3) bath 399.00
- Each additional bath/kitchen 45.00
❑ Master builder El Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 13 t Z.5 S lA) 13 Yn ix t Catch basin or area drain 16.60
City/State/ZIP: ---\--� q V-8. , (DP- 9 - 7 2:2-11 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: tr(j . n. l Footing drain (no. linear ft.: ) Page 2
• Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear R: ! 61)) 1 Page 2 (0,2 ,59
Storm sewer (no. linear ft : ) Page 2
Subdivision: l Lot no.: Water service (no. linear It: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
.• S :: j ICA• . 81 .. - .., - `L ..1...... 0 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT
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
❑ APPLICANT CI CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business Frame: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) ' Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax: ; ( ) Sink/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name 1 servkzs Water heater 16.60
Address: ? cb 0 0 1 RG)'V / A+ z.12, Other
City /State/ZIP.�-i 4 t 7 Z1.-1
Subtotal
� � � Minimum permit fee: $72.50 jj74 - 50
Phone: ( ) - 1t1(0 -t7 0"27 Fax: a-2) 5733 -937(Q Residential backflow minimum permit fee: $36.25
CCB Lie.: 10 G) Plumbing Lie. no. 4 - 77& Plan review (25% of permit fee)
S t
- ate surcharge (12% of permit fee) g' . 70
Authorized signature , ,, ` g TOTAL PERMIT FEE / . r
Print name: Ka ,
i J Date: f Q �� - This permit application expires if a permit is not obtained within
11 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.