Permit (109) CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2018-00500
T[CARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/25/2018
Parcel: 1 S135DB07600
Jurisdiction: Tigard
Site address: 9330 SW NORTH DAKOTA ST
Project: HAUGEN Subdivision: O'NEEL ACRES Lot: 16
Project Description: Repairing 2 ft.of sanitary sewer.
Contractor: SYGNET SOLTIONS LLC Owner: HAUGEN, BRADLEY A&BRITTANY E
PO BOX 2508 9330 SW N DAKOTA ST
GRESHAM, OR 97030 TIGARD, OR 97223
PHONE: 503-882-2104 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 If Sanitary Sewer 10/25/2018 $62.54
Specifics: 1 12%State Surcharge- 10/25/2018 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/25/2018 $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 1.800.332.2344.
_
Issued By: a
. Permittee Signature: -j
��". � � IC'N'1Wlbl25 6001INVIO
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 ONLY
Cl of Tigard r "any �` :1,-. Received
`J g ,' ��j° piane Date/By: /004311r - Permit No.:iat i�tY
il 13125 SW Hall Blvd.,Tigard,OR tJ
• Phone: 503.718.2439 Fax: 503. .1 ��(,'\`6 Date/By:Plan Other Permit No.:
Inspection Line: 503.639.4175 '' Date Ready/By: Juris: See Page 2 for
[I( ARD `Internet: www.tigard-or.gov U� vist o-' Notified/Method: '/„ Supplem ntal Information
TYPE O "E * s�-,
❑New construction (jrl For special information use checklist.
Description Qty. Ea. Total
'Addition/alteration/replacement d Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
} '. T* ! " !Q , 1.it. ON SFR(1)bath 312.70
-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
' , , h Q 'D ' ON Site utilities:
Job site address: q �11 ` ',,_1....:. _Catch basin or area drain 18.76
`�`Icf �J � �,�' .rQ ���� D well,leach line,or trench drain 18.76
City/State/ZIP: J 1a('-d 1 7/72, -3 Page 2
I ! Footing drain(no.linear ft.:_)
Suite/bldg./apt.no.:L' 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.: 2.. ) / Page 2 6)..S-11
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
Backwater valve 12.51
p 1 o�;
( t Clothes washer 25.02
O(1 ?cC��2C�`I •°-..:)(c-;n3, ve�3,c- }n,� BGG it^‘ CUS.[On _Dishwasher 25.02
Ui3 -Lc 0 C1 , L1/( l`PVC . /g 0. (fin Lit
'� Drinkingfountain 25.02
Ejectors/sump 25.02
,1:1 , _L 4** ❑ _. Expansion ank 12.51
Fixture/sewer cap 25.02
Name:
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
'114, �, -* �A PERSON . Interceptor/grease trap 25.02
I ,-" J f /,/ r / / Medical gas(value:$ ) Page 2
Business name: 7. ,0 1 :.,,,,Ii'+yf� % t- L.... Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: rp, .,, "1..y, /7t 7 _Sink/basin/lavatory 25.02
City/State/ZIP: / '`5 G Solar units(potable water) 62.54
Phone:(EDZ) 51// Tub/shower/shower pan 12.51
L� r���1� Fax ( )
C 1 , / /'! / /7 Urinal 25.02
E-mail: O JyTtali 4f�� (
' ' j
,, ,/ Water closet 25.02
OcT .
Water heater 37.52
Business name: c1C et,..1 �,�'.) 1 n V' , L_ / n Water piping/DWV 56.29
Address: C20 ri v 25.02
lf�3f�' ���� Other:
7'1 t : (/-7, r, Subtotal -Szj
City/State/ZIP: -,r , '` `,,1 , 1 ( .) L j
y i r �� r Minimum permit fee: $72.50 7) 72
Phone:(�(���,') ��� ��/ /O1,/ Fax:( ) Plan review (25%of permit fee) -�
CCB Lic.: / i 1- 7/ Plumbing Lic.no.: 1 e
/f1 State surcharge(12/e of permit fee) �c
( „'jr!/.71t .• / TOTAL PERMIT FEE
Authorized signature: � s,, v g-i
Print name:A.1,„,+/J�4, ,L t n , . Date: /D�2 // This permit application expires if a permit is not obtained within 180 days
1 eI"k ! ., 1('};r r 7Z5, l.. t i 11- ' 1`Y`'/ after it has been accepted as complete.
IJ *Fee methodology set by Tri-County Building Industry Service Board.
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