Permit CITY OF TIGARD PLUMBING PERMIT
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It : COMMUNITY DEVELOPMENT Permit #: PLM2011 00295
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Date Issued: 09/27/2011
Parcel: 2S 104AD03101
Jurisdiction: Tigard
Site address: 12976 SW WALNUT ST
Project: LAYTON Subdivision: Lot:
Project Description: Replacing 100 ft of sanitary sewer.
Contractor: PRO DRAIN & ROOTER SERVICE, INC Owner: LAYTON, ELIZABETH F
3300 NW 185TH AVE #213 12976 SW WALNUT
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE: 503 - 533 -0430 PHONE.
FAX: 503 - 296 -2419
FEES
Quantity Description Date Amount
100 If Sewer Service 09/27/2011 $62 54
Specifics: 1 12% State Surcharge - 09/27/2011 $8 70
Plumbing
10 ea Minimum Fee Adjustment - 09/27/2011 $9 96
Type of Use SF 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 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: , A
Call 503. • 9.4175 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.
Sep 26 11 01:47p Pro Drain & Rooter Srvc. 503 533 -9376 p.1
Plumbing Permit Application
Site Utilities FOR orr c:E .Cl5E , ONLY
SEP 2 6 li ece i ved
City of Tigard Datelsy: `j �O // 67 T nerma 'd11 -
14 No_: pill a-e.4(
• 13) 25 SW Hall Blvd., Tigard, OR 97223 ,,,,, (IF • ; �t .�. P r) Plan Re
C . Phone: 503.639.4171 Fax: 503.598 1960r �y t ¢� y
^, Dale/B Other Permit N
Inspection Line: 503.639.4175
Ins ne: BUILDIN t,1tv ° ii "
TIGARD p
Date Ready/By: Ju^° ® Sec Page 2for
Internet: www.tigard or.gov Notified/Method: ' at, Supplemeu tat Information
TYPE OF WORK
I FEE* SCHEDULE
❑ New construction ❑ Demolition 1 For special information use checklist
Description I Qty. Ea. 1 Total
Addition/alteration/replacement ❑ Other: New 1- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1) bath 249.20
t - and 2- faintly dwelling 0 Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bathlkitchen 45.00
❑ Master builder ❑ Other
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 12. CI 7( 5 (� LOC H A A 97, Catch basin or area drain 16.60
`�� 1 �('l D
Ciry /State2[P: " � �� r>we!I, leach line, or trench drain 16.60
SuitelbldgJapt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: iiPJ 1 Page 2 (J •`i
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
1
II 8 !s...•: L ,n, LA IL . - L.: . A l . _ ! .. ,. a 1 Backwater valve 16.60
1 Clothes washer 16.60
.... A 1
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( )
Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
CitylState/Z1P: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone: ( ) I Fax: : ( )
Tub/showedshower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: b . 1 ` ?Ali ■ . 1 I Water heater 16.60
Address: '?).'7..,00 t )D 1 () l (�, '- 4 Ak J. k 7 l's
Other:
MG ! t � C i q'1 - 7.2 0 /
Subtotal
City /StateJZlP:
,
Minimum permit fee: $72.50
Phone: 3 ' 7 �
) _ q r. 3 Fax: (S63 633 - 97,-7 Residential backtlow minimum permit fee: $36.25 7
-
CCB Lic.: L p .D Alp Iumbing Lie. no.: Zi , iii;, Plan review (25 %of permit fee)
' State surcharge (12% of permit fee) r -7O
Authorized signature: 7 l i f / V TOTAL PERMIT FEE & /_ )-0 Print name: Kar, 4 e C .: Tl S Date: �-- 6 1 T his permit application expires if a permit is not obtained within
l� 180 days after it has been accepted as complete.
' 'Tee methodology set by Tri- County Building Industry Service Board.
Sep 26 11 01:47p Pro Drain & Rooter Srvc. 503 533 -9376 p.2
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