Permit INCITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit#: PLM2022-00047
Date Issued: 2/17/2022
TiCAg D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S103AA00900
Jurisdiction: Tigard
Site address: 11000 SW WALNUT ST
Project: KEPHART Subdivision: ECHO HEIGHTS Lot: 6
Project Description: Sewer connection for an existing dwelling.Septic tank to be pumped and filled.
Contractor: ROSE CITY HOMEWORKS LLC Owner: KEPHART, DAVID A&KIMBERLY D
18975 ADDIE ST 11000 SW WALNUT ST
GLADSTONE, OR 97207 TIGARD, OR 97223
PHONE: 503-621-7828 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 02/17/2022 $62.54
Specifics: 1 12%State Surcharge- 02/17/2022 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 02/17/2022 $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
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 Applicatio ���l� _ 3
Site Utilities FOR oh1'ICE USE ONLY
Datehsd it i' -a 7
City al Tigard L. rrnna Rn.:
,,.• 13125 swrII!Rlvd.,Tigard,OR M2.'_3 'rim 6y: �/ t� y)
Plume: 503.718._430 Fax'5R3.59x,i960 C q y qq Plan Review /' p�
' FE915 GULL IIatoRy: ^,/,� pies Pnmil No.:er i/9-.at -CVLI tY
Inspection Line:503.639.4175 Doc Readyasy. y. ) _ l el San Page 2 favor 11
IIGAHO Internet:wvw.Rgarrl-ar gar f•a'P1 YIgrl; / / , / '7�('r� supplemental lnfarmalien
TYPE OF WORKp CITY
l.p of i iGrut .�F56„ �RL�. •91CQEDULE
❑Newcun=tnletiw ❑BIIJ ING DIVISI Or Farsp ioM,,lorlaalinn use checklist.
Detaiption i Oly, i Ea. ( 'total
14 Addition✓uhcrgliontreplutwnet ❑Other: Neu 1-2-family dos rim(includa IOU IL furcaeli utility connection)
b�,s CATEGORY OF CONSTRUCTION SEE(I)bath 312,70
Iy I-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bah 500.32
❑Accessory building 0 Muili•family
Each additional buMkitchcn 25.02
❑Master builder ❑Other: Fire sprinkler( sq.II.) Paget
JOB SITE INFORMATION AND LOCATION SIR uWid o:
Catch Job site address: i(O O J e''l! (,)e.3(h T I- Drywall,
18.76
\ a7 � a. Drywall,leach line,or trench drain 1(A76
C'ily/Slatcr/.IP: �\ fix . r e (f 'c. 07 72....-a-c Footing drain(no.linear R.:_1 Page
SuiRJbldgJapl.no.: J `I'rojoet ones 1r1
-hp.�j3:(.-/l9- kr�,fili ea✓. M:uwGw cadlumis aiWies I ROI 1 .
Crass erceirdirections to job site: - 7 lmdrules 18.76
Rain drain wnmetor 18.76
Sanitary sower(no.1.near It:_Q)fil / Paw 2
Sturm sewer(no.linear R.:_) Page 2
Water service On.linear R.:_) Page?
Subdivision: Lot no.: fixture or item:
Tux map'purccl no.: Racknow province 31.27
DESCRIPTION OF WORK Backanter valve 12.51
Clothes washer 25.02
ice onv4 't -Ai'/' 6/ cPyi-J c t-anr Dishwasher 25.02
otoci tiaa k t1 p to ‹a 04)( thinking fountain 25.02I/ 1(jcctnrx/xumn 25.02
...$( PROPERTY OWNER ❑.:TENANT ExPmisiml lolA 12.31
I lam.I 4 Lis k" Fivhrrjscwcr cap 25.02
Name: J F IL Floordrein/Boor sink/huh 25.02
Address: 11 t('f 0e' ._' n 7,d l 1 el pit Garbage disposal 25,02
City/Slate/ZIP: 7"l'Gl'C A 4"a r 17 a a 3 nose bib 25.02
s'd Phone:( �ksZ-Ii. S ecrP 91a Fax:( ) ice maker 12.51
tC1C APPLICANT ❑CONTACT PERSON Inlerreplarlgretlsa leap 25.02
Bnsince.5 name: Mauicat v6431bt<.b 5 Puts?.
Pruner 12.51
Caner m nle: Roof drain(wnmcrviall 12.51
Address: SinkJbasin/lovaory 25.02
City/Stale/ZIP: .Solar units(potable water) 62.54
Phone:( ) Fax::1 1 Tub/Wmwer/shuwcr pan 12.51
Urinal 23.02
f.-nmih Winer closet 25.01
CONTRACTOR I, Walla heater 37.52
t.Dusinem name: K OS eU,aI� (y d'(eyi'Yi' c.iork -LL Water pipingaIWV 56.29
C'
Address: / q 7,r HO. f'e 5f C_' Odw2: 25.02
City/State/ZIP: �I j ke7Pie Subtotal
Phone:(SCR 5°'75'L76u Pax:( ) Minimum permit fee: 572.50
lB�;, Plan review(15Y u1'permil fee)
CCB Lis.: f>0y07(j '2/ Plumping Lie.na: 5 State surcharge(12%of permit feel
Authorized signaltn / .,-.Y TOTAL PERM IT FEE 7E1,
Prins name;
( DsR: 1t:pil 'c4 ja Tbls permit application expires if*permit b am obtained anion a)'s
after h ha beta aaepned a cantata.
(1c•-..JI /fe 4. 'Pcc m:tlxxbinyy sct by Ttscoutty Iulldinx litlmtry lniei Otani,
ta
11butild ethrmllWLMI:.Pmnn.\rndh•In 410,6lfiT111Mmsaytw51)
Glil,Y0l�- 316. IAj, 3:
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