Permit q CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2013 -00022
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/15/2013
Parcel: 2S105DA17500
Jurisdiction: Tigard
Site address: 14560 SW CATALINA DR
Project: Bunkofske Subdivision: PACIFIC CREST Lot: 63
Project Description: (1) 100' storm sewer replace storm drain
Contractor: MR ROOTER OF PORTLAND Owner: BUNKOFSKE, RAYMOND J &
PO BOX 789 BROOKS - BUNKOFSKE, MARY M
GLADSTONE, OR 97027 14560 SW CATALINA DR
TIGARD, OR 97223
PHONE: 503 - 653 -5301 PHONE: 503 - 590 2649
FAX: 503 - 653 -5376
FEES
Quantity Description Date Amount
100 If Storm and Rain Drain 01/15/2013 $62.54
Specifics: 1 12% State Surcharge - 01/15/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 01/15/2013 $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, 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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: , ' Permittee Signature: D l ( PP& t f O
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.
Jan, 14. 2013 11:10AM RECEIVED No. 6878 P. 1
Plumbing Permit Application
Site Utilities JAN 14 2013 I.OIt OFFICE USE ONLY
City of Tigard CITY , ' 1 sat 1 /i S /3 yr Permi,No.P(,1? 40 /3_ &
;� -
n 13125 SW Hall 131vd., Tigard, OR 97272 - _ n Review
Phone: 503.7182439 Fax: so3.s9s.I ILDING DNISI wi tty. Other Permit No.:
Ti G A n D Inspection Ling 503.639.4175 Dare ReadyiBy: 0 See Page 2 for
I nternet: www.dgard- or.gov Notified/Method:
6 So. plemcatal Information
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❑ New construction ❑ Demolition For special information use checklist.
Description
21 Addition/alteration/replacement ❑ Other: New w 1 1- 2 Qty. I Ea. 1 Total
dwellings (includes 100 ft. for each utility connection)
iott)
c� .- o c1 d o .N p off-- - SFR(1)bath 312.70
$(1- and 2- family dwelling ❑ CommerciaI/industrial SFR (2) bath 437.78
El Accessory building SFR(3)ba[h 500.32
ry g ❑ Multi-family
Each additional bat /kitchen 25.02
❑ Master builder ❑ Other.
-- --- � =:. - T �� -•. ,� - - --- --- Fire sp[inklcr sq. !f.) Page 2
-, ,�Col . 1i1 ° l_� ?�� Site utilities:
Job site address 1 SW Cakali niik Dr. Catch basin or area drain 18.76
City/State /ZIP: 7% a�� � �,.�•�� Drywall, leach line, or trench drain 18 -76
Footing drain (no. linear Ii: ___) Page 2
Suite/bldgJapr. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job sic: Manholes 18.76
cdArrl Rain drain connector 18.76
Sanitary sewer (no. linear A: ) Page 2
Storm sewer (no. linear IL: la% l Page 2
Water service (no. linear 11.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
Backwater valve 12.51
Clothes washer 25.02
Q4 ptfik - 1 " ,e 1 GA.V th Dishwasher '
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
1 MA "e ' ? l" < ; '- t Expansion tank 12.51
_ .. ..a.- .111•1 'm cv ^. 1 -'17:.7 . :r. ..:b..._ rr_:r ....i -
Name:
(1 n t Fixn,re/sewer cap 25.02
' J I ��� �� Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State /ZIP: _.Q.Q ip l
Hose bib 25.02
Phone: ( 9?,) Q -4G9 Fax: ( ) Ice maker 12.51
ygb "a t-- ,- r 3 : i e , Interceptor/grease trap 25.02
L r e ` .€, ..
Business name: Medical gas (value: S _) Page 2
Primer 12.51
Contact name:
1 Roof drain (commercial) 12.51
Address: ,Q, (.O�t D r Sinkrbasin/lavatory 25.02
City/State /ZIP: _ Solar uniis (potable water) 62.54
Phone: ( ) I Fax: : ( ) TLb /shower/showerpan 12.51
E -mail; Urinal 25.02
r Water closer 25.02
1 .Y _n 1 Water heater 37.52
Business name: Mr Koote r plums Water piping/DWV 56.29
Address; PO Box, 7z(-1 Other: 25:02
City/State/ZIP: (1C s)V. OK py1O2.1 Subtotal
Phone: (5(ES) 053 _ SPCI I Fax; (5(53) 653 - S-3 -1(p Minimum permit fee: 572.50
CCB Lie.: 0(01_1 t Plumbing Lie. no.: 343 - p Plan review (25 °,0 of permit fee)
j � '-, C)� State surcharge (12 %ofpermit fee)
a
Authorized signature: tALs$ J TOTAL PERMIT FEE 5-t., !)-J
Print name: A r,,,x Th � V _ _- f _ • - �e�� Date: l Ilk4 /13 This permit appt n expires if s permit is not obtained ....idle 180 days
Oo
after It bar been oceepted as complete.
'Fee methodology set by Tri- County Building Irwustry Service Board.
r: rBUilGmgTermuskPLVn PermnAppdoc 1001,09 T40- 1616Taa,0z,COK'w6a1
Jan. 14. 2013 11:11AM No.6878 P. 2
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PL U Y t I N O
Sewer Lateral Diagram
Addendum to Contract for Services
Mr. Rooter Plumbing
Contractor License 138941
15033 SE McLoughlin Blvd. 6344
Mliwaukle, OR. 97287 451 Owner. /496e: Rai/ 4
Address: /r54 0 , 19/
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City & State:
zip: 9A2 3 Date: 3 /
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