Permit CITY OF TIGARD PLUMBING PERMIT
IIIII
COMMUNITY DEVELOPMENT Permit#: PLM2020-00201
Date Issued: 05/15/2020
T i 6 A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S 111 AD02100
Jurisdiction: Tigard
Site address: 14545 SW 88TH AVE
Project: Lawton Subdivision: PINEBROOK TERRACE Lot: 18
Project Description: Replacing 100 ft of sanitary sewer.
Contractor: ON DEMAND EXCAVATION Owner: LAWTON,JEFFREY&SUZANNE
PO BOX 1192 14545 SW 88TH AVE
TUALATIN, OR 97062 PORTLAND, OR 97224
PHONE: 503-516-7174 PHONE: 503-686-4717
FAX:
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 05/15/2020 $62.54
Specifics: 1 12%State Surcharge- 05/15/2020 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 05/15/2020 $9.96
Class of Work: ALT Plumbing
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
I or direct questions to OUNC by calling 503. 2.1987 or 1.800.332.2344. Y
Issued By: �� - Permittee Signature: r�
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. e-/p-
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 RECEIVE I I U U k ill(-I. .1. WO. 1 G
City of Tigard RECEIVE ReDaceived
By: ,r p i jy,n
1111 13125 SW Hall Blvd.,Tigard,OR 97223 Iti)AY 1 5 2020 Plea Res >i) "" lE/�j`Q j(�J/
. Plan Review
V
• Phone: 503.718.2439 Fax: 503.59L 19 Date/By: Other Permit No.:
i 1.I LtspectionLine: 503.639.4175 CITY OF TIGARD DatCReadyBy: lure: 0 See Page 2for
Internet: www.tigard-or.gov � ,., �,i Notified/Method: Supplemental Information
BUILDING DIVISION
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
gAdditionialtemtion/rep13cemsnt ❑Other New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
.,r4 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 ❑Other:
Fire sprinkler(_sq.Ii.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14 545 5 yV 8 A tic. Catch basin or area drain 18.76
,I Drywell,leach line,or trench drain 18.76
City/State/ZIP: ?i c rt l J O R -1 p 7 2..Z cf Footing dram(no.linear IL:_) Page 2
Suite/bldg./apt.no.: I Project name: 1„Qtk,r}Oil "SeW€ Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
"PIIIG 3riiok A^. Ruin drain connector 18.76
Sanitary sewer(no.linear IL:i(V) Page 2 (4s.5/
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.: Backilow prcventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
3eWer fe.p(oretuenf -Peawt - i.uv .a4f6V 1 1 v Dishwasher 25.02
M CC%A l i 11e__. Drinking fountain 25.02
Ejectors/sump 25.02
pr PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name: 3 .,..p.' (� on FixtureJsewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 14545 SVU 6(16A11`C_ Garbage disposal 25.1)2
'TRrd
City/State/ZIP: 1g I OK- Q'72Z4 Hose bib 25.02
Phone:(5D3) 60362 -4 7/-7 Fax:( ) Ice maker 12.51
SI APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: 0 n poma to t x'I V a.�y r(-,F1 Medical gas tvaluc:S_) Page 2
Contact name: ivt4honyn a()(-rhoV e 1 Primer 12.51
Roof drain(commercial) 12.51
Address: pc, Box tei Z Sink/basin/lavatory 25.02
City/State/ZIP: I A ia.4-rn ( a e q^T 010 Z Solar units(potable water) 62.54
Phone:(5O3) Silo-1 17 44' Fax::( ) Tub/shower/shower pan 12.51
E-mail: s CC O Luy#5 @ ad exr;Q.Ua.41 an. cem Urinal 25.02
Water closet 25.02
CONTRACTOR
�?� Water heater 3 7.52
Business name: C7a-YT1"¢. a /m7Ve_ Water piping/DWV 50.29
Address: Other. 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
CCB Lie.: et i le 3 S Phmbing Lie.nu.: Plan review (25%otpemit fee)
State surcharge(12%of permit tee)
Authorized signature �� igeLinsf„4,`) TOTAL PERMIT FEE
This permit application expire.if a permit is not obtained within 180 days
Print name: b h t rfL eG l k/$P l Date: 5.��r after it has beta accepted as complete.
*Fee methodology act by Tel-County Building'aduatry Service Board.
1:1Building\Permiu PLMU"PermeApp.doe I n/01/09 440-4616T'I 0/02/COM/WEBI