Permit CITY OF TIGARD PLUMBING PERMIT
i COMMUNITY DEVELOPMENT Permit#: PLM2014-00201
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/16/2014
Parcel: 1 S136CD02200
Jurisdiction: Tigard
Site address: 7850 SW DARTMOUTH ST
Project: Costco Subdivision: PALMER ACRES Lot: 3
Project Description: Replace approximately 80'of exterior sanitary sewer line.
Contractor: EVOLUTION PLUMBING LLC Owner: COSTCO WHOLESALE CORPORATION
7715 NE 33RD DR SUITED PROPERTY TAX DEPT 111
PORTLAND,OR 97211 999 LAKE DR
ISSAQUAH,WA 98027
PHONE: 503-655-3388 PHONE:
FAX: 503-305-8373
FEES
Quantity Description Date Amount
80 If Sewer Service 06/16/2014 $62.54
Specifics:, 1 12%State Surcharge- 06/16/2014 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 06/16/2014 $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 . -. -• enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or d' -ct questions to •o by s• 503.232.1987 or 1.800.332.2344.
Iss ed By: • /`I. Permittee Signature:
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.
Plumbing Permit Application
Site Utilities FOR OFFICE USE ONLI
RErEIVFD City of Tigard
�. RDa0B1`e: G? /(p /y / Permit No.: ,Ll'Ote/ c0a6/
;
� at 13125 SW Hall Blvd.,Tigard,OR 971.2 7 Plan Review
= Phone: 503.718.2439 Fax: 503.598'. ':I 1 6 2014 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 TIGARD Date Rea Ready/By: luris 0 See Page e 2 for
Internet: www.tigard-or.gov C)j nGAR Notified/Method: Supplemental Information
-.TYPE RIi!QI 1
1 FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description 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(1)bath 312.70
'1-and 2-family dwelling kommercialindustrial 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:7850 SW Dartmouth Street Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:80) 1 Page 2 62.54
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 preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replace exterior sewer line
i CI) Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
�� a� Floor drain/floor s ink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Pax:( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: : ( ) Tub/shower/shower pan _ 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Evolution Plumbing LLC Water piping/DWV 56.29
Address:7715 NE 33rd Drive Suite D Other: 25.02
City/State/ZIP:Portland OR 97211 Subtotal 62.54
Phone:(503)655-3388 Fax:(503)31 : 73 Minimum permit fee: $72.50 72.50
Plan review (25%of permit fee)
CCB Lic.: 189876 Pal ,'n;. ic. o.:PB834
�����// State surcharge(12%of permit fee) 8.70
Authorized signature:j/ ,�� Jf' eY ,IOW TOTAL PERMIT FEE 81.20
Print name:Denise C.Pine I Date:6/13/14 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.
I:\Building\Pamits\PLMU-PermitApp.doe 10/01/09 440-4616T(10/O71COM/WEB)