Permit CITY OF TIGARD PLUMBING PERMIT
l! . COMMUNITY DEVELOPMENT Permit#: PLM2019-00046
Date Issued: 4/2
02/ 10 09
T[G R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103CB04100
Jurisdiction: Tigard
Site address: 12290 SW MARION ST
Project: BERINGER Subdivision: WILLAMETTE NO.2 Lot: 20
Project Description: 100 ft.of sanitary sewer to connect existing house to sewer.
Contractor: HOLLENBACH&HURD INC Owner: BERINGER, BRIAN J&ANN L
5291 NE ELAM YOUNG PARKWAY SUITE 180 12290 SW MARION ST
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503-591-5987 PHONE:
FAX: 503-848-6832
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 02/04/2019 $62.54
Specifics: 1 12%State Surcharge- 02/04/2019 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 02/04/2019 $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 e rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
lirIssued By: Permittee Signature:
J
Call 503.639.4175 by 7:00 a.m.for the next available i -ction 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 tSF. O\L\
s u Received permit No.:
City of Tigard ,�+ �" } l
01 13125 SW Hall Blvd.,Tigard,OR 972{Y 5 DateBy: /y/Y �/ .s- �Lj� ��j-�tr /(�
Plan Review /� 6
: C Phone: 503.718.2439 Fax: 503.598.1960 ,01(� Other Permit No.:(?4" CIL r �11
� r.
Date/By:
J j
T 1 G A R D Inspection Line: 503.639.4175 1 j Date ReadyBy: Juris: El See Page 2 for
Internet: www.tigard-or.gov R r` Notified/Method:
Supplemental
ental Information
TYIE of wowCITY tit' isiC � FEESSCHEDULE,
❑ �Lpt4(3C)4\ii; For New construction ❑' 1special inf checklist
Description r-Q-6,7I Ea. 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 El Commercial/industrial SFR(2)bath 437.78
El Accessory buildingSFR(3)bath 500.32
0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION:: Site utilities:
Catch basin or area drain 18.76
Job site address:12290 SW
W Marion St.
Drywell,leach line,or trench drain 18.76
City/State/ZIP:97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site:SW 121st Ave Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:100) 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
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Abandon septic and connect to public sewer Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
0,1'PIt "ERT�';OWNE)lI :. TENANT A xp
Name:Brian Beringer Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:12290 SW Marion St. Garbage disposal 25.02
City/State/ZIP:Tigard,Or.97223 Hose bib 25.02
Phone:(503)789-43452 Fax:( ) Ice maker 12.51
13 APPLICANT ' C} CONTACTrERSo Interceptor/grease ease trap 25.02
Business name:Hollenbach&Hurd Inc. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Joe Hurd
Roof drain(commercial) 12.51
Address:5291 NE Elam Young Pkwy.Ste 180 Sink/basin/lavatory 25.02
City/State/ZIP:Hillsboro,Or.97124 Solar units(potable water) 62.54
•
Phone:(503)591-5987 Fax::( ) Tub/shower/shower pan 12.51
E-mail:handh20@juno.com Urinal 25.02
Water closet 25.02
CONTRACTOR:
Water heater 37.52
Business name:Hollenbach&Hurd Inc. Water piping/DWV 56.29
Address:Same Other: 25.02
City/State/ZIP: Subtotal 62.54
Phone:( ) j
Fax
( ) Minimum permit fee: $72.50 72.50
CCB Lic.:121807 Plum n ic.no.:34-421PB Plan review (25%of permit fee) -
State surcharge(12%of permit fee) 8.70
Authorized si TOTAL PERMIT FEE 81.20
iThis permit application expires if a permit is not obtained within 180 days
Print name Joe H rd Date:1-25-19
\ 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:
12290 SW MARION ST, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2019-00046
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Connect existing house to public San Sewer, inspection by camera- approved
Violation Summary:
Inspector Contractor