Permit CITY OF TIGARD PLUMBING PERMIT
1,1 •
COMMUNITY DEVELOPMENT Permit#: PLM2020-00007
ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/06/2020
Tf " Parcel: 2S102BA02800
Jurisdiction: Tigard
Site address: 9801 SW JOHNSON ST
Project: ARNDT Subdivision: JOHNSON &GRANT Lot: 4
Project Description: (1)new rain drain pump and 90 ft.of storm sewer piping.
Contractor: DRAINAGE MASTERS LLC Owner: ARNDT, LOUISE S
2801 E 5TH 9801 SW JOHNSON ST
VANCOUVER,WA 98061 TIGARD, OR 97223
PHONE: 360-694-5847 PHONE:
FAX:
FEES
Quantity Description Date Amount
90 If Storm Sewer 01/06/2020 $62.54
Specifics: 1 ea Ejectors/Sump 01/06/2020 $25.02
1 12%State Surcharge- 01/06/2020 $10.51
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $98 07
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 a e.
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
Building Fixtures RECEIVED FOR OFFICE USE ONLY
Received
City of Tigard DateBy: //G+ -'�Ain/' /_
� -,Permit No.: /J 1-ti7
III ■ 13125 SW Hall Blvd.,Tigard,OR 97223 tf� 6 2020 Plan Review
I Phone: 503.718.2439 Fax: 503.598.1961A PI Date/By: Other Permit No.:
Inspection Line: 503.639.4175 OF C p`e(�pt` Date Read/B orris: VI See Page 2 for
TIC;A it n Internet: www.tigard-or.gov CITY i 7('f"ti-1'L1 Y Y: K
�i�� r. t�` B Notitied/Method: •7 Supplemental Information
TYPE OF waidd_DING UIVISIOt . FEE* SCHEDULE
El New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
6-011 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
' SFR(3)bath 500.32
❑Accessory building 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:
Job site address: ( `gp l S�j 1 0 �)•j�, 17 Catch basin or area drain 18.76
Job
site address:
\ p J �I Drywell,leach line,or trench drain 18.76
TJ O T,qZ Z Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: IA-r n d'F" 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.: 70 ) Page 2 (0),.511
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
ff t Clothes washer 25.02
ivt54-tl\\ cio.aJ pony1-av- i2allnikrcv(VI Syliew\ 1 Dishwasher 25.02
rot,k p'1 pe }-o C c+r h 5 d aV 1I 5 1-1 4- r I lie 4 etd Drinking fountain 25.02
�e✓�b . Ejectors/sump ! 25.02 J,rj,;yam
Ill PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:L iu 1 5- I,�rA ci Fixture/sewer sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
gel'
d 5 C J U 1/1 N 5 Q>? 5+ Garbage disposal 25.02
City/State/ZIP:-f I� ,� 1 a 67 1 ZL 3 Hose bib 25.02
Phone:( 2 e1‘- 15 r6,4/0q Fax:( ) w I ik Ice maker 12.51
APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Oyu; e I)(aS/.p�j - PrimerMedical gas(value:$ ) Page 2
Contact name: `v1' bt J I et,, as Roofd 12.51
drain(commercial) 12.51
Address: 243c/ 6% 5 Sj- Sink/basin/lavatory 25.02
City/State/ZIP:\ Oj ccufit"/ 4,4, 4-- 9s"be( Solar units(potable water) 62.54
Phone:(3 ') -��Z__ aC/`gr '..Fax::('P,(a.�)(,9q. �5Z Tub/shower/shower pan 12.51
E-mail: (n0/18 -ep4 jt £?1a1#y � ,a5,4,sd Gp�,Ii Urinal 25.02
�v}' � Water closet 25.02
CO CTOR
y'/ /�l Water heater 37.52
Business name: 1 , Y(�, ��A � �/ �'1'7��.5 zC� , Water piping/DWV 56.29
Address: 2"D U f C.-- c-4, 574. Other: 25.02
CiTy/State/ZIP: V C6cJ� �� ! 3 ( P ( Subtotal T7 5,
Minimum permit fee: $72.50
Phone:(3 Otip CO 9 y-1-4i Y1- Fax.(5 ,•A l' '�
q",S3 2
Plan review (25%of permit fee)
CCB Lic.: f 3 Plumbing Lie,no.: ,17`1' - 0 State surcharge(12%of permit fee) /V_5i
Authorized signature: - TOTAL PERMIT FEE C I(Q 7
Print name: I1. ) Q v2 r Date: 1 (J 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\PermitsuPI.MU-PermitApp.doc IONI/09 440-4616T(10/02/COM/WEB)