Permit a CITY OF TIGARD PLUMBING PERMIT
':'' a COMMUNITY DEVELOPMENT Permit #: PLM2009 -00331
.T1 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/17/2009
Parcel: 1S136AD05901
Jurisdiction: Tigard
Site address: 11455 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Tigard Regency
Project Description: Repair /replace up to 100' of sewer line.
Owner: FEES
MERRILL, STEVEN D & SUSAN J Quantity Description Date Amount
C/O GOPAL LLC, 11455 SW PACIFIC HWY
TIGARD, OR 97223 100 If Sewer Service 11/17/2009 $62.54
PHONE: 1 12% State Surcharge - 11/17/2009 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 11/17/2009 $9.96
Contractor: Plumbing
PRO DRAIN & ROOTER SERVICE, INC
3300 NW 185TH AVE #213
PORTLAND, OR 97229
PHONE: 503 - 533 -0430
FAX: 503- 533 -9376
Type of Use: COM
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ,n /I � R Permittee Signature:
A y \!I I lll �� ft_t_ App
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Nov, 13 09 03:27p Pro Drain 503 533-9376 p.1
Phmbin Permit Application
U
Site Utilities NOV 1.3 2 "r' r alt " t* 0 °
zm' City of Tigard Received Permit No.
4 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIG tel8y:
C Phone: 503.639.4171 Far: 503.598.1%0 n Review
Inspection Line: 503.639.4175 BUILDING DIVI Y: Other Permit No.:
u a e eady/By: retie: 121 See Pa 2 for
Internet: www.tigard-or.gov NotifiedMtethod: Supplemental information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolit.ion Fars eciol information use checklist
-7
Description Q Ea. Total
Additionlalteration/replacemcnl ❑ Qtlrerc New I-2-family dwellings (includes 100 ft. for each utility connceticn)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ I -and 2-family dwelling Commercialiindustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi-family SFR (3) bath 399.0
❑ Master builder ❑ Other: Each additional bath kitchen 45.C0
Fire sprinkler sq. ft.) Page 2
_ JOB SITE INFORA9AT[ON AND LOCATION Site utilities
Joh site address: S~ Catch basin or area drain 1660
City/State/ZIP: Drywcll, leach line, or trench drain 16.60
Suite /bldg.lapt_ no.: Project name: ' Footing drain (no. linear 11.: Page 2
Manufactured home utilities 110.00
Cross stmeddirections to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear 1.106~ Page 2 r
Storm sewer (no. linear ft.: Page 2
Subdivision: Lot no.: water service (no. linear fl.: Page 2
Fixture or itern
Tax mapfparcel no.:
Absorption valve 1 fi.60
DESCRIPTION OF WORK Backflow preventer Page 2
t C3x Backwater valve 16.60
Clothes washer 16.60
Dishwasher ` :6.60
❑ PROPERTY OWNER C3 TENANT Drinking fountain 16.60
Name: Ejectors/sump 16.60
Expansion rank 16.60
Address: Fixture/sewer cap 16.60
City/Stale171 P: Floor drain/tloor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
]cc maker 16.60
Business name. f { Interceptor/grease trap 16.60
Corlact tame: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/StatciZlP: Roof drain (commercial) 16.60
Sink/basin/lavawry 16.60
Phone: ( ) Fax:: ( )
Tubishower/shower pan I 16.60
E-mail:
Urinal 16.60
CONTRACTOR Water closet I}
16.60
Business name: i eQ. Water heater I6_60
Address: ~Ljo - t 3 Other: - -
City/StatciZlP: Subtotal
Minimum permit fee. 572.50
Phone: ( ) j Fax: ( 3" Residential backflow minimum permit fee. S36.25 l SO
CCB Lie.: Plumbing L' . no.: Plan review (25%ofpermit fee)
State surcharge (12% of permit fee)
Authorized signal ~
"TOTAL PERMIT FEE 2
Print name: Date: i . + This permit application expires if a permit is not ohtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building 1nduStrv Service Board.
e dr-cz~_ . '2 i ~ n rna