Permit n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 00023
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/15/2013
Parcel: 1 S126BC01700
Jurisdiction: Tigard
Site address: 9050 SW WASHINGTON SQUARE RD
Project: Georgetown Manor Subdivision:: CONDO, THE SUPPLEMENTAL PLAT Lot: 25 -4
Project Description: (1) 650' Storm sewer
Contractor: PRO DRAIN & ROOTER SERVICE, INC Owner: JANZEN, TIMOTHY P & RACHEL A
3300 NW 185TH AVE #213 DOUGLAS, BRUCE C & DEBORAH L
PORTLAND, OR 97229 REINHART, STEVEN E & CYNTHIA S E
7831 SE LAKE RD #200
PORTLAND, OR 97267
PHONE: 503 - 533 -0430 PHONE.
FAX: 503 - 296 -2419
FEES
Quantity Description Date Amount
650 If Storm and Rain Drain 01/15/2013 $287.66
Specifics: 1 12% State Surcharge - 01/15/2013 $34.52
Plumbing
Type of Use: MF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $322.18
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: St Permittee Signature: c4 4 PP / e - j fD & L
Call 503.639.4175 by 7:00 a.m. for the next available inspection date. (1
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.
01- 14- 13;12:12PM;From:ProDrain & Rooter Srvc. To:5035981960 ;5035339376 # 1/ 3
Plumbing Permit Annlic '
Site Utilities CE VED rota or'ICE USE ONLY
City Of Tigard Hacaiv�M
25 g � 4 Dat 1 i
I 'I 3 PennitNo.PLI -� 13 _ 000.13 1312s sw halt Blvd ,Tigard, OR 1 2013
Phone: 503.718.2439 Fax: 503.598.1960 De Review
tc/By: Other Permit No.:
TI G A It D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: . ' • BI Sec Page 2 for
Internet: www.tigard- or.gov V Notified/Method: . Supplemental Information
,: TYPE:0'. !' 1 6 1. }/ ..'. v 7 ..; ,.•.7.; :,......, . >.. . • : EE" SCHEDULE
ULE
❑ New construction ❑ Demolition For special information use checklist
D I Qty. I Ea. I Total
® Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
• :.:. CATEGORY OF. CONSTRUCTION ; : ;'; ? '
SFR (I) bath 312.70
I- and 2-family dwelling y 8 ❑ 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 s nnklt5r
p ( sq. ft.) Page 2
./ JO>3:' ' SITE i::INFORMATION:; ,LOCATIO ° :.:. "' :::1:: ..; r Site utilities:
Job site address: t?b5D 5(,3 ' in uer Catch basin or area drain 18.76
City/State/ZIP: ` 1 Q "� Drywell, leach line, or each drain 18.76
1 U' A/ � \ Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: rProj pg.
name: I (jfc) t7zjp,) Manuthclured home utilities 50.03
Cross Street/directions to job site: M i ) 012 Manholes 18.76
• Rain drain connector 18.76
Sanitary sewer (no, !incur 11.: ) Page 2
Storm sewer (no. linear ft.: (.. , Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventcr 3127
DESCRIP•IION . OF" WORK . Backwater vhlve 12.51
Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
; ❑:PROPERTY' OWNER: :::.::. :.:::. ::, ❑ TENANT : Expansion tank 12.51
Name: Fixture/sewer cap 25.02
_. Floor drain /floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
: : : : : : : ;❑ , ; A P P L I C A N T ' : ; : : : : ;:. ;':,;: • :.:. :.:. ;.. ;:.;;❑.;.CONTACT.:PERSON ..:.<::: - :.: Interceptor /grease nap 25.02
Business name:
Medical gas (value: S ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 1 2.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax :: ( ) Tub/shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
_ . ..CONTRACTOR ..
Water heater 37.52
Business name: ProDrnin and Rooter Service Water piping/DWV 56.29
Address: 3300 NW 185' Ave #213 Other. 25.02
City /State/ZIP: Portland, OR 97229 Subtotal
Phone: (503 -) 746 -9703 Fax: (503) 269 -2419 Minimum permit fcc: 572.50
CCB Lie.: 108504 i Plumbing Lie. no.: 26 -776pb Plan review (25% of permit fcc)
State surcharge (12% of permit fee) Q
Authorized signature• , 6,/ , / l TOTAL PERMIT FEE 3 ! D
Print name: Raehael I Nys ' Date: / ///�� q This permit appllcatlon expires I a permit is not obtained within 160 days
G rn
after It has been accepted as mpktc.
*Fee methodology act by Tri- County Building Industry Service Board.
I:u lulldtngJ Ynnhe\PLMU- PermhApp,dcc IW01I09 440•1616T(I0,02JCOM/WGB) 3192.
01-14-13; 12: 12PM;From:ProDra in & Rooter Srvc, To:5035981960 5035339376 # 2/ 3
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