Permit (4) CITY OF TIGARD PLUMBING PERMIT
14 u
COMMUNITY DEVELOPMENT Permit#: PLM2019-00407
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/08/2019
TIGARD Parcel: 2S103DD00402
Jurisdiction: Tigard
Site address: 10605 SW FAIRHAVEN ST
Project: WHALEN Subdivision: FAIRHAVEN COURT Lot: 2
Project Description: 90 ft. of sanitary sewer to connect existing house to sewer. Septic tank to be pumped and filled.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: WHALEN, MICHAEL W
267 NE 34TH PLACE 10605 SW FAIRHAVEN ST
HILLSBORO, OR 97124 TIGARD, OR 97223
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
90 If Sanitary Sewer 10/08/2019 $62.54
Specifics: 1 12%State Surcharge- 10/08/2019 $8.70
Plumbing
10 ea Minimum Fee Adjustment- 10/08/2019 $9.96
Type of Use: SF 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: Permittee Signature: —.4k villik
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 UtilitiesFOR OFFICE. USE ONLY
of Tigard RECEIVED Received PermitN
a 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: �(��� ' o.:��� -( L
III I Phone: 503.718.2439 Fax: 503.598.1 Plan Review '
T 8 2019 Date/By: Other Permit No.:��f,' "�'7'!, 9-cay'}3/
T IG A RD Inspection Line: 503.639.4175 Date Ready/By: Juris:� El See Page 2 for
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Internet: wwtigard-or.gov CITY OF TIGARD Notified/Method: i.yG- Supplemental Information
TYPE OF wolEtIILDING DIVISION FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. Total
. SINAddition/alteration/replacement Ty 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 ElCommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
, 0 Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 1 0 Go ID 61x) -q\,rAe\a\V eh 5A- Catch basin or area drain 18.76
' Drywelt,leach line,or trench drain 18.76
City/State/ZIP:
000e-sok Footing drain(no.linear ft.:_) Page 2
4Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
t�1 Cross street/directions to job site: Manholes 18.76
v ,t v2' e r /, a i,� Rain drain connector 18.76
TSanitary sewer(no.linear ft.:410 ) 1 Page 2 62-
`� Storm sewer(no.linear ft.:_) Page 2
`�• Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
1� Tax map/parcel no.: Backflow preventer 31.27
`4 ) DESCRIPTION OF WORK Backwater valve 12.51
` \ et) Clothes washer 25.02
i. c c'CGL�w '%\ \Am.%\\ \in 51S 0,.'\ AGV\) fJ, G�V��"lt eDishwasher 25.02
LWCPS' tq� cC \ TDow '-k 1R0_)/'se.' c 'ref. rre Drinking fountain 25.02
OM'
C.. M�\SS�ONC, '3.e t k\C. .1j -. Ejectors/sump 25.02
VI ❑ PROPERTY OWNE ❑ TENANT Expansion tank 12.51
-Name: Fixture/sewer cap 25.02
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
❑ APPLICANT
0 CONTACT PERSON Interceptor/grease trap 25.02
�` _ \& r\ Medical gas(value:$ ) Page 2
Business name: G pCr v���� t(`OJV
Contact name: �^ \' Primer 12.51
'�(�21►� 1'r,�'Y� Roof drain(commercial) 12.51
Address: a( _�7 `1 .aq fi� v1 Sink/basin/lavatory 25.02
City/State/ZIP: %1 s\Do ye o _ 0 Solar units(potable water) 62.54
Q' Phone:(L' ) $'1, ,1"101 o Fax::( ) Tub/shower/shower pan 12.51
`_ Urinal 25.02
E-mail: 1\A0 G1C.� coc,VvAler O\Y'Qvw1• Low\
W v Water closet 25.02
CONTRACTOR
` /� 4Water heater 37.52i Business name: 1�`� v, Vk �G Water piping/DWV 56.29
Address: \\ Y'"� Other: 25.02
City/State/ZIP: Subtotal 6,),__5--ti
Phone:( \) Fax:( )
Minimum permit fee: $72.50 `7
CCB Lie.: \6\(YJ ` 1`A Plu sing Lic.no.:f lb '(.� S5 Plan review (25%of permit fee)
+++ State surcharge(12%of permit fee) 0 r
Authorized signature: /AI TOTAL PERMIT FEE ( .)„\
\ �+
Print name: p�,`.` ge; s Date: I I11 Z\ V\ 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.
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I:1Building`Permits\PLMU-PernntApp.doc 10/01/09 440-4616T(10/02/COM/WEB)