Permit CITY OF TIGARD PLUMBING PERMIT
IN a COMMUNITY DEVELOPMENT Permit#: PLM2021-00146
Date Issued: 4/13/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S111CA14400
Jurisdiction: Tigard
Site address: 15105 SW 98TH AVE
Project: WAMALA Subdivision: ALDERBROOK FARM Lot: 8
Project Description: 50 ft.of sanitary sewer to connect existing dwelling to sewer. Septic tank to be pumped and filled.
Contractor: JTR PLUMBING INC Owner: WAMALA, RONALD&ELIZABETH
4272 NE BEAUMEAD ST 15105 SW 98TH AVE
HILLSBORO, OR 97124 TIGARD, OR 97224
PHONE: 503-209-4290 PHONE:
FAX:
FEES
Quantity Description Date Amount
50 If Sanitary Sewer 04/13/2021 $62.54
Specifics: 1 12%State Surcharge- 04/13/2021 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 04/13/2021 $9.96
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total S81.20
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: Owl �ICGL�1aYl
}fatly Vanv1)e�Wefe pp
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.
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Site Utilities FOR OFFICE USE ONLY
City of Tigard Received
;I 13125 lB SW Hall Blvd.,Tigard,OR 972Q CEIVED Dale By y/3/?I Permit INo.: /f,/_(Dfib
Review
a Phone: 503.7182439 Fax: 503.598. 9 Other Permit No.:
Date/By: ``--
Inspection Line: 503.639.4175 N Ea Se P g 2 for �tkl
T t(;A K[7 Date Ready/By: .. s 1. runs:
Internet: www.tigardor.gov MAR 2 `i 21121 Notified/Method: '! p//l (r �1�,
�y� Supplemental Information
TYPE OF WORK t a,i•.! U ,r,�.SEE" SCHEDULE
❑New construction ❑Detlf�+gtid�y o TIGARD For special information use checklist
ILDING DIVISION Description I Qty. I Ea. I Total
Addition/alteration/replacement ❑ er. New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
11:14(a7rrd 2-family dwelling ❑Commercialindustrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
El Master builder Each additional bath/kitchen 25.02
❑Other Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: w Catch basin or area drain 18.76
City/State/ZIP:
17 ' h �u C t Drywell,leach line,or trench drain 18.76
1r p 1A__.. O a- 9/4 2 ki Footing drain(no.linear R: Page 2
Suite/bldg.apt.no.: Project name: c 1A `yt`rev.1 S.t�t,r Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector ( 18.76
p Sanitary sewer(no.linear ft.:.,0 ) Page 2
✓ i tee env ` � ` '' . B% . /c/� ' Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: ( Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 3127
DESCRIPTION OF WORK Backwater valve 12.51
i Clothes washer 25.02
%1\S 4 cr. 1 U r Cc+J C u.:PJ/ Li in t- c"t t Dishwasher 25.02
C rt vs.C a'` -V1n p S,f 1 i c. k4:01‘k K. Drinking fountain 25.02
Ejectors/sump 25.02
..,.: 0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
1 X k f_ _
Name: �,OYIq a qvv I � , i ?r 1G Endure/sewer cap 25.02
Address: I S I OS Floor, 1 g} A-1,/Qy1.0 Floor drain/floor sink/hub 25.02
City/State/ZIP: I ( Gt v-c� / 0 R. (1, �.224 HGobibse
disposal 25.02
cj
Hose 25.02
Phone:('3) 333 -/t I} 1 Fax:(9 5) 419 - bo8 i Ice maker 12.51
(APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
V�V C 1h�t yl��i el Ae C u C.2S Primer 12.51
Contact name: l r 9 l�1 i t C . t
v Roof drain(commercial) 12.51
Address: p �
p• D L3 p Y, 1 Z O Q- 1-i/ry(0 t i ii1 012 Sink/basin/lavatory 25.02
City/State/ZIP: --1-V q k U i iii, (' 0. q 90 (j 9 Solar units(potable water) 62.54
Phone:(So3) .43 t_ Q ?q q Fax::( ) Tub/shower/shower pan 12.51
y Urinal 25.02
E-mail:
RULEt fttInPra1 CnA rad-or ( aN 00 ' Co La Water closet 25.02
CONTRACTOR I
Business name: Water heater 37.52
Business
�f r /u 7 /''f �77�' Water piping/DWV 56.29
Address: Gy9 7 /e -3 e.„_ l '43// 3 I. Other: 25.02
city/State/ZIP: l7//y5 O p.. ' C: '2,• 7771 v �/ Subtotal
Phone:( i -y�_ye,. Fax:( ) 4 / Minimum permit fee: $72.50 7,?rye
CCB Lic.: r S 5 4r / Plumbing Lic.no.: _ 2.t p1� Plan review (25%of permit fee) •
State surcharge(12%of permit fee) y, 7>
Authorized signature: TOTAL PERMIT FEE D,
Print : i Date: 3 Q 3/2 This permit application expires if a permit is not obtained within 180 days
f C^'iOPs�._ / after it has been accepted as compkte
*Fee methodology set by Tor-County Budding Industry Service Board.
(74,t40^'1 iV, 64' p>,. 4,4?,c6t-)