Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT11111
Permit#: PLM2019 00463
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/19/2019
Parcel: 2S103DB00600
Jurisdiction: Tigard
Site address: 11025 SW PARK ST
Project: CURLEY Subdivision: MIRA PARK Lot: 2
Project Description: Replacing 40 ft.of sanitary sewer lateral.
Contractor: CHEHALEM RIDGE EXCAVATING LLC Owner: CURLEY, JOHN G&ROSEMARIE
38649 SW FERNWOOD DR 11025 SW PARK ST
GASTON, OR 97119 TIGARD, OR 97223
PHONE: 503-709-3254 PHONE:
FAX:
FEES
Quantity Description Date Amount
40 If Sanitary Sewer 11/19/2019 $62.54
Specifics: 1 12%State Surcharge- 11/19/2019 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 11/19/2019 $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 the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: -` 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 ONLY
City of Tigard E. Received
Phone: 503.718.2439 Fax: 503.598.1960
11111
13125 SW Hall Blvd.,Tigard,OR 9722BECE�� Date/By: ii//q/iii 6�T Permit No.: /cam i9d 0-c1 zt 4
3
Nov 19 2019 DPlan Review Other Permit No.:
ateBy:
I G A P Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
Internet: www.tigard-or.gov OF TIGARD Notified/Method: Supplemental Information
G1TY /
1, 1 aiLDING DIVISIGN
TYPE OF WORK FEE* SCHEDULE
0 New construction ❑Demolition For special information use checklist.
Description I Qty. 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
IcKl-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder El Other: Fire sprinkler(_sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: Catch basin or area drain 18.76
Z �� �' Drywell,leach line,or trench drain 18.76
City/State/ZIP: r'i -0 r Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: etick, Y1c7ii. rect ojTo 1 I Li rµ TU Manholes 18.76
64A IZQE T'o i i 0 T-14' 4. c--)e.+1.)C,-z. d C PA?.l:: Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) 1/0 Page 2 6Z,5y
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
gN4(.., }At 1-i n/V r vJ L Z i-2, c.iZk L F ii c n-\ 1-i 0 u SC: Dishwasher 25.02
T O pus L i�, M.i,,n) L i a/V Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: ✓ „v,:. LIrA I Gc..4.t.y� Floor drain/floor sink/hub 25.02
Address: t7
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:CNEf'� LEAA ,&rt.: C;>ecd,v<}Z't.1cr- t-t__L
Primer 12.51
Contact name: C.7413- So H LE 1Z Roof drain(commercial) 12.51
Address: c L/9 S IUD I C 1Z✓wU v t Sink/basin/lavatory 25.02
City/State/ZIP: 6-4.S T(.)kJ , 01Z 7! I / Solar units(potable water) 62.54
Phone:( 3) 7479 - 3z t f I Fax::(503)37z - 6'y y Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:04 Eli rT(C M -R..,b LTC, EXC A i'\-t-I ki& 1--1-C Water piping/DWV 56.29
Address:3E3(2L/q ce--,g4 joct.o DR, Other: 25.02
City/State/ZIP:v As j oo, OR. 9-71 j 9 Subtotal
Phone:(5o3)707- 3Z59 Fax:(503)31 C-67 y y Minimum permit fee: $72.50
CCB Lie.: Z 13 I-4 2. N e) Plumbing Lic.no.: 4- Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature:�� TOTAL PERMIT FEE ri•it,
Print name: � 3L S�,-�( tZ Date:/OA //9 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\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)