Permit CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit #: PLM2011 -00344
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/17/2011
Parcel: 2S103CA02800
Jurisdiction: Tigard
Site address: 11855 SW JAMES CT
Project: Avolio Subdivision: TRAVPORT PARK Lot: 8
Project Description: 100' of sanitary for sewer connection.
Contractor: A AFFORDABLE SEPTIC SERVICE Owner: AVOLIO, MARGARET E
PO BOX 1130 11855 SW JAMES CT
WILSONVILLE, OR 97070 TIGARD, OR 97223
PHONE: 503 - 969 -9548 PHONE: 503-780-7123
FAX: 503 - 570 -0779
FEES
Quantity Description Date Amount
100 If Sewer Service 11/17/2011 $62.54
Specifics: 1 12% State Surcharge - 11/17/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 11/17/2011 $9.96
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
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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.
11/15/2011 08:24 5035700779 WTP PAGE 02/02
Plumbing Perm Applicatio /(/7 / APfr - n4 . - 'Al to 2s .e - . - Sirvals
Site Utilities VP FOR. OI FIC i: INF ON IA
City of Tigard .��� $ /i/i O Aa re 7// r�n N°1/, SW 3
1111 I fall Blv. 1'igard. Olt '�� Phone; 503,718.2439 Fax: 503.598.I96r) j - view '�� 0 � i
�� t)atc✓B _ Otter Permit Nu kiJdee4 / � DO ��/
Inspection Linc; 503,639,4175
'1' I ci A 21) ltts N AAR Date Retld /g : R?
r Y Y turf
Interact: www.tigard- or.guv l( �j Sec Page 2 for
`� O Netlrfed /Netted:
' • : TYPE OF WO' ,7 Supplemental information
�� _ G FEE* SCHEDULE
0 New construction psi s - g l u on For special information use checklist
Description 1 Qty. J Fla, ! Total
0 Addition /alteration /replacement ❑ Other: l' w 1- 2- family dwellings (includes 100 ft. for each utility connection)
.. 'CATE OF CON$TIUJCTION .. , , SFR (1) bath 312,70 __..
0 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building 0 Multi-family W SFR (3) bath 500,32
Each additional bath /kitchen 25.02
❑ Master builder 0 Other:
Fire sprinkler ( sq. ft,) Page 2
i 1 40 ., I71 ;.;1woRMATioN.AND LOC8TION...i' Slteu tilities:
Job site address: 11855 SW .lamas Ct Catch basin or area drain 18,76
City /State /ZIP: Tigard OR 97223 Drywell, leach line, or trench drain 18,76
Footing drain (no. linear ft.: �) Page 2
Suite/bldg. /apt. no.: Project name: Sewer Connection
Manuf ietured home utilities 50.03
Cross street /directions to job site: SW Howard Dr Manholes — 18.76
^
�, Rain drain connector �� 1 8,76
().c.._
Sanitary sewer (no. linear ft.: 1E
) ) P age 2 (4,02 (4,02 y
4 wl r Storm sewer (no, linear ft,; _ ` ) Page 2
i\ i Water service (no, linear fl.; , `) Page 2
Subdivision: Lot no.: Fixture or item: -
Tax map /pared no,: 2800 $ackflow prcvcnter 31.27
. a valve DESCRIPTION ;'OF � ORK :' Backwater val _ 12.51
Clothes washer 25,02
pp -- Dishwasher 25,02
—
- k t \ e_ r4 !k ` Nom- ' . Drinking fountain 25.02
_ Ejectors /sunup 25.02
.. I i"lI' I tT 'OW ❑TENANT Expansion tank 12.51
Name: r (. u * 1; v , ,,,,,, Fixture /sewer cap 25.02
Address: -4 - cSw A�� P � ; # 1 Floor drain /door sink /huh 25.02
• �Z CI a I / ' Hose bib disposal 25,02
City/State/VP: 0' 1 r-,, er La Hose bib 25.02
Phone: (� ) Q W t '
Ice maker
12.51
' ' 1 ApPILICAN't .
CONTACT ARSON Itttcrccptor /grease trap _ 25.02
Business name: A- Affordable Septic Service Medical gas (value: $ Page 2
Contact name: Primer 12.51
Address: PO BOX 1130 Roof drain (commercial 12.51
Sink/basin /lavatory 25,02
City /State/ZIP: Wilsonville OR 97070 Solar units (potable water) 62.54
Phone: (503) 682 -1929 Fax: : (503) 570 -0779 Tub /shower /shower pan 12,51
E -mail: aaffordableseptieservicc yahol ►.con Urinal 25.02
CONI7RACTo Water closet 25.02
Business name; A Affordable Septic Service —
Water heater 37 52
_____ .. Waterpiping/DWV 56,29
Address; PQ BOX 1130 Other:
25.02
City /State/ZiP: Wilsonville OR 97070 Subtotal
Pho .'(503) 682 - 1929 Fax: (503) 570 - 0779 _ . M Minimum permit fee; $72.50 17d• D
CCI3 L,ic.: 158246 Plumbing Lic_ no.: r'13 Plan review (25 %ofpermit fee)
State signature;
r ate surcharge (12% of permit fee) �/ 70
'TOTAL PERMIT FEE e Pt 20
v /
Print name: Rick Jonas Date: 1 J J This permit appheatinn ex pires if a permit is not obtained within iSO drays
4 after it has been accepted as complete,
..i'Se methodology set by Tri- County Building Industry Service Board.
1 :\auildicR\ro nitsPLMU•PrnniLApp.doc I0/01h)9 44 0. 4 6Ita(10/02/COM/ ea)
11/29%2011 14:14 5035700779 WTP PAGE 02/02
DECEIV ' A- AFFORDABLE '
.. SEPTIC',S:E`RA /ICE II, D
NOV • 2 9 2011 r . o a30x 1b30' � "
• D . 1WILSO.NVILLE, OR;37O70 .. ..
C OF TIGAR a
*03)..4824929, FAX (503) 5 O 0779
BUILDING DIVISION www aai'fordiibiesepticSVC cdrri
CUSTOMER'S ORDER NO PHONE DATE 11--/7--/ /
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NAME �7
ADDRESS _ �� • S g ^ /I
I SOLD BY CASH r, 0.0.0. • ON ACCT. MDEe.RET'D. PAlO OUT
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1 - QTY. DESCRIPTION PRICE AMOUNT
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. ; °''l It's the purchaser's obligation to clearly mark underground utilities and underground
"' irrigation systems. AAffordable Septic Service Is NOT responsible for unmarked
F `, utilities and /or irrigation systems.
c: SIGNATURE DATE ,
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i; ': All claims and returned goads MUST be accompanied by this bill.
r,:. THANK YOU.'
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MIME FOR BUSINESS (•800•888
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