Permit p CITY OF TIGARD PLUMBING PERMIT
`''' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00342
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2011
Parcel: 2S101AB00500
Jurisdiction: Tigard
Site address: 7100 SW ELMHURST ST
Project: LAU Subdivision:CONDO SUPPLEMENTAL PLAT NO.1: Lot: 22858 -2.
Project Description: 12 ft. of sanitary sewer for septic tank.
Contractor: GREENWORX CONSTRUCTION INC Owner: LAU, JOSHUA L &
PO BOX 1260 MARCHWICK, SARAH B
BORING, OR 97009 PO BOX 392
BEND, OR 97709
PHONE: 503 - 663 -1923 PHONE:
FAX: 503 - 663 -9712
FEES
Quantity Description Date Amount
12 If Sewer Service 11/10/2011 $62.54
Specifics: 1 12% State Surcharge - 11/10/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 11/10/2011 $9.96
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. :10.332. 4•
Issued By: Permittee Signature: 41IW
Call 513:: •.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.
11/10/2011 THU 15:37 FAX 2001 /002
Plumbing Permit Application
Site Utilities � ��� FOR OFFICE USE ONLY
City of Tigard t°14°9
V� Received 1 Permit No.:
• 13125 SW Hall Blvd„ Tigard, OR 97233 1, 1 Date /By: ' ',II h,. �L/
Plan Review
„ 1 1 Phone: 503.718.2439 Fax: 503.598.1960 ".\I A Il Date/By: Other Permit No.:
TIGARD Inspection Line: 503,639 ''' t
l GN - ate Ready /ey: Juris: - SecPage2fo
Internet: www.tigard or.gov , N. otified/Mefh Supplemental Information
TYPE OF WORK
1 c.) 1 �� ,
❑ New construction ❑ Dei to bon For special information use checklist.
Description I Qty, I Ea. ( Total
Addition /alteration /replacement ❑ Other: New 1- 2 - family dwellings (includes 100 ft. for each utility connection)
. CATEGORY OF CONSTRUCTION ' SFR (I) bath 312.70
1- and 2- family dwelling El Commercial /industrial SFR (2) bath 437.78
El Accessory building ❑ Multi- family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
• JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
w , --
Job site address: - 1 i C) c) ��i ivy) I � t,Q,V�.� � ( _.�
�
Drywell, leach l or trench drain 18.76
City /State /ZIP : •^ I t (] G.Y A € , C:CC1 123
! Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no,: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
.W • q ) V L t Rain drain connector 18.76
Sanitary sewer (no. linear ft.: 19-) Page 2 /),570 (1
Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: ;,,j \ 0 ; ‘1:-)f:1?) �� () C) Backflow preventer 31.27
• . . ' DESCRIPTION OF WORK ..• Backwater valve 12,51
t (( � Clothes washer 25,02
n S4C.LA 1 b 0 C.� 1 C 1D I� (', V�.X:r:1.. 70''t -e C:._...- Dishwasher
25.02
- H AAAL. - Drinking fountain 25.02
* c�1 -tiC ..` \-)\--7-te.v;'.;i 1,5`._;L,.t'r) lV Ejectors /sump 25.02
❑ PROPERTY OWNER . 1 - • - • 0 TENANT Expansion tank 12.51
Name: =
Fixture/sewer cap 25.02
C) C....) f Floor drain /floor sink/hub 25,02
Address: ,�
S. •s L , E :1 i'14.. � V 5i fr''4 Garbage disposal 25.02
City /State /ZIP: 119 Ct rat . 1 -) . '7 7 2 -Z 3 Hose bib 25.02
Phone: (5 )j) 1 73: ) C d i 9 Fax; ( ) Ice maker 12.51
. . ❑ APPLICANT . . • • • :. ❑ CONTACT •PERSON Interceptor /grease trap 25.02
Business name:, n _e a . v - �{ 't C" Medical gas (value: $ _) Page 2
ken U O Y. r/srkartC.�t - 1 t 'r,7 G" t
x "0 Primer 12.51
Contact name: Jc, >. .'-� -' f Lea Roof drain (commercial) 12.51
7
Address: �/
1 �� ' c:� r 1 2. ,; 0 Sink/basin/lavatory 25.02
•
City /State /ZIP: "'7 - > .-• `" `"
� �,�, �!- �tr:+ ,- ( �,��� � � t`� � � / Solar units (potable water) 62.54
Phone: (5) 5) 6,6 3 1 (i. 3 Fax: : 5 )4b 3 -- '77/ '2- Tub /shower /shower pan 12.51
E-mail: .. � . . ( � ) 5 ;/, t�t. (, > L J � j i ... 4 , � Urinal 25.02
J !. Water closet 25.02
. ,CONT R ACTOR
• 1 Water heater 37.52
Business name 1
.y �'�11 1. t/ ��rl`�U�C - -iu n ,\ . E' �` 5 r Water piping/DW V 56.29
Address: 7 , v , 2- -a ) 1 Other: 25.02
City /State /ZIP: ;t lbu j 0 k_. C.,-7 QDCI Subtotal
Phone: lt. T '' ` Minimum permit fee: $72.50 s0
( �3 ) foh / -. Fax : ( 6):3) b - - �/ // 2,
CCB Lie.: / .7 e: 6 ff ,i■ ,, A.t. 2 ban g Lic. no.: (_t p� C/ Plan review (25% of permit fee)
g /f � � J / D � State surcharge (12% of permit fee) C o, 1 10
Authorized si nature �� / l TOTAL PERMIT FEE �` b
-- Date: This permit application expires if a permit is not obtained within 180 days
Print name:
:1. (✓ {` I - � )i �� after it has been accepted as complete.
*Fee methodology set by Tri- Comity Building Industry Service Board.
1 \ Building U'crinitsU'LMU- PernutApp.doc 10 /01/09 440 - 46167(10 /02/COMAVEa)