Permit (192) r� CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018 00111
TfGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/20/2018
Parcel: 1S 134DA04000
Jurisdiction: Tigard
Site address: 10569 SW NORTH DAKOTA ST
Project: NELSON Subdivision: VENTURA COURT
Project Description: 20 ft.of water service. Lot: 5
Contractor: PIPELINE PLUMBING Owner: NELSON, CASEY S
333 S STATE ST SUITE V-108 10569 SW NORTH DAKOTA ST
LAKE OSWEGO, OR 97034 TIGARD, OR 97223
PHONE: 503-624-1906 PHONE:
FAX: 503-624-1926
FEES
Quantity Description Date Amount
20 If Water Service 03/20/2018 $62.54
Specifics: 1 12%State Surcharge- 03/20/2018 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 03/20/2018 $9.96
Class of Work: ALT Plumbing
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:
• tures
`s _
f.i
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 completi• of-the.....15roject.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application :.,, ,
Building Fixtures If
,,.- FOR OFFICE USE ONL\
City of Tigard -.;,,-A,,iir.. Received Permit No.:
Date/By: �,�
III 13125 SW Hall Blvd.,Tigard,OR 97223 a l�� i =��O �G� J r - i ]
_ plan Review
Phone: 503.718.2439 Fax: 503.598.1960 ti 1�ateBy: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 , � E te,Ready/By: Juris: Fa See Page 2 for
Internet: www.tigard-or.gov :=r r ,,i tY ed/Method:
� � i'''��� ,/,try Supplemental Information
TYPE OF WORK ' � ' 'till FEE* SCHEDULE
❑New constructionidti
6-
❑DeiNfion For special information use checklist
Description Qty. Ea. Total
®Addition/alteration/replacement 0 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 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:10569 SW N DAKOTA ST Catch basin or area drain 18.76
City/State/ZIP:TIGARD,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 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.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:20) 1 Page 2 37.52
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
INSTALL NEW WATER SERVICE
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER 1 0 TENANT Expansion tank 12.51
Name:CASEY NELSON Fixture/sewer cap 25.02
Address:10569 SW N DAKOTA ST
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:TIGARD,OR 97223 Hose bib 25.02
Phone:( )N/A Fax:( )N/A Ice maker 12.51
lAPPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:PIPELINE PLUMBING Medical gas(value:$ ) Page 2
Contact name:SAMANTHA HILL Primer 12.51
Roof drain(commercial) 12.51
Address:333 S STATE ST V-108 Sink/basin lavatory 25.02
City/State/ZIP:LAKE OSWEGO,OR 97034 Solar units(potable water) 62.54
Phone:(503)624-1906 Fax::(503)624-1926 Tub/shower/shower pan 12.51
E-mail:SAM@PIPELINEPLUMBING.NET Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:PIPELINE PLUMBING
Water piping/DWV 56.29
Address:333 S STATE ST V-108 Other: 25.02
City/State/ZIP:LAKE OSWEGO,OR 97034 Subtotal 37.52
Phone:(503)624-1906 Fax:(503)624-1926 Minimum permit fee: $72.50 72.50
CCB Lic.:158260 Plumbing Lic.no.:3-510PB Plan review (25%of permit fee)
•
State surcharge(12%of permit fee) 8.70
Authorized signature: Se,
IL1CI
(j7.2 ' `0- l' TOTAL PERMIT FEE 81.20
This permit application expires if a permit is not obtained within 180 days
Print name:SAMANTHA HILL Date:03-19-2018
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10569 SW NORTH DAKOTA ST, TIGARD,
OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2018-00111
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor