Permit CITY OF TIGARD PLUMBING PERMIT
III COMMUNITY DEVELOPMENT Permit#: PLM2014-00177
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/02/2014
Parcel: 1 S134CA00503
Jurisdiction: Tigard
Site address: 11205 SW 119TH AVE
Project: STRICKER Subdivision: PANORAMA NO.2 Lot: 14
Project Description: 75 ft.of water service.
Contractor: PRO DRAIN& ROOTER SERVICE, INC Owner: STRICKER, PAUL K AND TERESA J
3300 NW 185TH AVE#213 11205 SW 119TH
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE: 503-533-0430 PHONE:
FAX: 503-296-2419
FEES
Quantity Description Date Amount
75 If Water Service 06/02/2014 $62.54
Specifics: 1 12%State Surcharge- 06/02/2014 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 06/02/2014 $9.96
Plumbing
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 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspectio 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.
Plumbing Permit Application
Building Fixtures � � FOR OFFICE USE ONLY
C� Received
City of Tigard r�O�� Date/By: , Iv( ��7 Permit No.: .Eif�,n'1�)(�
• 13125 SW Hall Blvd.,Tigard,OR 9 23 !. Plan Review Review LL / t-/ [/ (_�J 1 77
Phone: 503.718.2439 Fax: 503.598.1960,‘\� Qp Date/By: Other Permit No.:
T I GARD Inspection Line: 503.639.4175 CVl`j�PP`O�te Ready/By: ® ® See Page 2 for
Internet: www.tigard-or.gov `` ` 14otified/Method: �s'� Supplemental Information
TYPE OF WORK `, 41 FEE* S HEDULE
❑New construction ❑De 1`Y _ For special information use checklist
Description I Qty. 1 Ea. I Total
4-Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
101-and 2-family dwelling ❑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 sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 112 S w i i-t-1 - '- v Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: 'r a et -ci ' O 2 017g...2,3 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: J I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: O( .,11-+114 K.4)r - Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.:_) Page 2 LO Water service(no.linear ft.:?X) f Page 2 tY 1+54
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
t Clothes washer 25.02
-_ t S .1 I /el'6U) w[O-'_f 1 1 ne• -From
u (( Dishwasher 25.02
Upaok- r v r .- -- r +D h btA5 _ Drinking fountain 25.02
Ejectors/sump 25.02
lig PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: ?a.4,I 54't��C�(,er Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Sot jyy.C, Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
'pro brz } n I', 5 Medical gas(value:$ ) Page 2
Business name: ► Wtl °* {L()(JT(
et ��� Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: 3300 I 2�j2.4 3 Sink/basin/lavatory 25.02
City/State/ZIP:Pp1/-. y 012_ 91 q Solar units(potable water) 62.54
Phone:(5)3) 53-3-ptt 3D Fax::(503 Z9(o -2. f l9' Tub/shower/shower pan 12.51
` Urinal 25.02
E-mail: p(um bl Y!9®I ' i E'1 pJ)6 •L(i'Vl
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:."-Pie-r) 'bad vi _1- Q4C�/ 5t-v Water piping/DWV 56.29
Address: 33bb N W C g Ste" Ai . 213 Other: 25.02
City/State/ZIP:pa1.4-I4d 02. cli 9.�°1 Subtotal tez 5q
Phone:63)533 oLf Fax:(5t23)2:14.p -2.)-1+1 Minimum permit fee: $72.50 72,....ST
Plan review (25%of permit fee)
CCB Lic.: i p .t.--/c`/r Plumbing Lic.no.:2-7 710 p u
State surcharge(12%of permit fee) U t 7D
Authorized signature: 711/1 7 TOTAL PERMIT FEE 81,)
Print name: l. Date:
This permit application expires if a permit is not obtained within 180 days
�� `��'" after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
t:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10102/COMAWEB)