Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00548
Date Issued: 12/03/2018
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S110BD00901
Jurisdiction: Tigard
Site address: 12035 SW BULL MOUNTAIN RD
Project: WHITNEY Subdivision: None Lot: None
Project Description: Replacing 20 ft.of sanitary sewer.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: WHITNEY, PAUL&DIANE F FAMILY T
267 NE 34TH PLACE 12035 SW BULL MOUNTAIN RD
HILLSBORO, OR 97124 TIGARD, OR 97224
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
20 If Sanitary Sewer 12/03/2018 $62.54
Specifics: 1 12%State Surcharge- 12/03/2018 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 12/03/2018 $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 i f
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to fo •w the rules adopted by the Oreg.
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-00•;. ou may obta'• a c.. of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.
Issued By: r • • iee Signature: / 4/,
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 "S s FOR OFFICE: USE ONLY'
City of Tigard ;.4 r II Received _
IL Date'B *Ty--Permit No.: /M
w 13125 SW Hall Blvd.,Tigard,OR 97223 f, i; y: ��� /� `( ` L '���>
9 Phone: 503.718.2439 Fax: 503.598.196 ';K °t )u IC_d Plan Review Other Permit No.:
DatcBy:
Inspection Line: 503 639.4175 Date Read B luri: 0 See Page 2 for
TIGARD Ready,By: t
Internet: www.ttgard or gov t t Notified/Method: Supplemental Information
TYPE OF Wow 4 F )1', C "FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I 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
S! 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑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: Z Catch basin or area drain 18.76
�� 5 W V I �dUh��1l h Drywell,leach line,or trench drain 18.76
City/State/ZIP:`'.1..`n . 0
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufttetured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:a a) 1 Page 2 ( .Sit
Stone 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
a
?e/Y• �� G`t` k.7 LQ eke Dishwasher 25.02
S `W�
-:r .ZD .e.t.-, , bh t t-0 i.A Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER i 0 TENANT Expansion tank 12.51
Name: _ , Q `6 w%()!t./ - Fixture/sewer cap 25.02
r'1 Fl000rrdrain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basinflavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
i
E-mail: Urinal 2.5.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: (�Aa`k 1`�Acs. 0h r �`d\ma'\i�`-� Water piping/DWV 56.29
Address: ed,j 1 N r6�k-' /1`, 1 Other: 25.02
1� Subtotal
City/State/ZIP: 1A` 3��1. 0 Q 4?-.. C71� 1'�(,�1 6,)_5-7/f
Phone:(;$3) -7 9.1 CA 3 1. Fax: permit fee: $72.50 Fax:( ) ?�,5Zt
CCB Lic.: J 1� Plumbing Lic.no.: Y 919 S5 Plan review (25%of permit fee) �--
State surcharge(12%of permit fee) r70
Authorized signature: /1111
1 1`� TOTAL PERMIT FEE / e)
Print name: 0 re_W siAcvel Date:12-11 li $ This permit application expires if a permit is not obtained ss thin 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:'BuildingPennits:PLMU-PennitApp.doc 10'01%09 4404616T(1a02COM WEB
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12035 SW BULL MOUNTAIN RD, TIGARD, January 8, 2019 at 9:41 :11 AM
OR, 97224
Record Type: Record ID:
Residential - Plumbing PLM2018-00548
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor