Permit CITY OF TIGARD PLUMBING PERMIT
114COMMUNITY DEVELOPMENT
Permit#: PLM2021-00030
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 1/20/2021
T!GAR 1] Parcel: 2S104AD02400
Jurisdiction: Tigard
Site address: 12925 SW WALNUT ST
Project: sewer install Subdivision: None Lot: None
Project Description: Install sewer from house to city main via drill/trench. Decommission cesspool on property. Install future line to ADU.
Install two clean outs on property.
Contractor: SANITECH LLC Owner: HYDER,ALISSA&BRYCE
201 SHIRLEY ST 13455 SW HYLAND PARK CT
MOLALLA, OR 97038 BEAVERTON, OR 97008
PHONE: 503-803-1207 PHONE:
FAX: 503-303-8238
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 01/20/2021 $62.54
Specifics: 1 12%State Surcharge- 01/20/2021 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 01/20/2021 $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
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
Building Fixtures RECEIVED FOR OIFIC USE ONLY
Cityof Tigard I Racened Permit No.:
n 131 SW Hall Blvd.,Tigard,OR 97223 Date/By:
,y��r}t ��'} �l13�)
q Plan Review
74
= Phone. 503.718.2439 Fax: 503.598.1960,AN 2 7ZDY1 Date/By: �IA- Other Permit No.: a i- ,:l0
TIGARD- Inspection Line 503.639.4175 Datc Rcady/By `` lun cc Page 2 for 1/
Internet'. w�^.v.Ugard or.nov �-�/ R° Not cdMetlsod ' �1 Supplemental Information
TYPE OF' WORK- ''' �t rI I { r � C:HL^DUY.E=.,
0 New construction I:DeDemobb ion
For special information use checklist
Description I Qty. I Ea. 1 Total
X Addition/alteration/replacement ❑Other: New 3-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(l)bath 312 70
Yl1-and 2-family dwelling 0 Commercialindustrial SFR(2)bath 437.78
❑Accessorybuilding
SFR(3)bath 500.32
g 0 Multi-family
t.,,
Each additional bath kitchen 25.02
❑Master builder DI Other: Fire sprinkler( sq.ft.) Page 2
R. JOS SITE INFORMATION AND LOCATION Site utilities:
''N• Job site address N ''t r A,.r Catch basin or area drain 1 B-76
: �' .. (a 1 _
�` - Drywell,leach line,or trench drain 18.76
�.�'�City/State/ZIP: , I 1 g",O
Suite bldg./ap[.no.: ` I7 Project name: Footing drain(no.linear ft.: )
Manufactured home utilities 50.03
Cross street/directions to job site; Manholes 18.76
Rain drain connector Page 2
18.76
Sanitary sewer(no.linear tl.i \ Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: 1 Page 2
,Subdivision: I Lot no.: Fixture or item:
'S:3 Tax map/parcel no.: Backflow preventer 31.27
' .DESCRIPTION OF WORK Backwater valve 12.51
1ti y� ('• _ Clothes washer 25.02
_ ry` . 1[C..U.Ye dr��JIwL 5 AiAiNt.a2 'in ril .i Dishwasher 25.02
' ' ALI\ \� 1)1 \A-- ''S(r`('r`_-�C�y' t�,J) Drinking fountain 25.02
j \, („0 rr,1,, -sue '- Ejectors/sump 25.02
Q PROPERTY OWN I ❑:TENANT Expansion tank 12.51
r,} Nante.y�'�I F Lr t\,� Fixture/sewereap 25.02
1lll��� J'[Vl c77cL f Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
h tate/ZiP:Pone Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
i.APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
-- Business name:5 0„. LLe....) Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Qt r //��
`�� vlcik.Q.Ai
Roof drain(commercial) 12.51
10 Address:
C.k.. � Sink/basin/lavatory 25.02
�, City/State/ZIP: I.J`v\I! t be_ an Solar units(potable water) l 62 54
Phone:6t -.,1 DI)-%-I`11S'' I Fax::5/. - - Tub/shower/shower pan 12.51
r Urinal 25.02
E-mail: .7Q �,i.. e .w. ri IA-if Water closet 25.02
CONTRACTOR
/'� - Water heater 37.52
Business name: i Ir� Water pipinWD
WV 56.29
Address: 42� (4\ Other: 25.02
City/State/ZIP: . t. ' 1 On6S'?�� '
1 Subtotal
Phone:64 7 , K Fax:( '' ?."` Minimum permit fee: $72.50
CCB Lie.: \ U4/ Plumbing Lic.no.: p .,`q).r"S Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature. TOTAL PERMIT FEE
Print name: A t1t��''{ c- C + -' Date: This permit application expires if a permit is not obtained within 150 days
i v`5,,,�4'`t.. rf +i v� after it has been accepted as complete.
'Fee methodology set by TB-County Ba)ding Industry Service Board.
1;lBuildmolfcrmas'd'LMtJ-PermitApp.dot it stag 440.45161(10/02.'COMIWEB)