Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00003
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/06/2012
Parcel: 1 S133CD00100
Jurisdiction: TIGARD
Site address: 11547 SW 135TH AVE, APT#
Project: Sunflower Apartments Subdivision: SCHOLLS VILLAGE CONDO Lot: 17 -5
Project Description: Replacing 10 ft. of sanitary sewer near office.
Contractor: APOLLO DRAIN & ROOTER SERVICE Owner: SUNFLOWER COMMUNITY INC
2208 NW BIRDSDALE #8 2555 HUNTINGTON DR STE A
GRESHAM, OR 97030 SAN MARINO, CA 91108
PHONE: 503 - 239 -8801 PHONE:
FAX: 503 - 669 -9568
FEES
Quantity Description Date Amount
10 If Sewer Service 01/06/2012 $62.54
Specifics: 1 12% State Surcharge - 01/06/2012 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment - 01/06/2012 $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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Perm ittee Signature:
Call 50 .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.
Jan. 5. 2012 4:15PM 1 No. 9942 P. 1
tvw ) 2 iy - 11A
Plumbing Permit Application
Building Fixtures �� \'L FOR cil 1 ICI l) E ONLY
City of Tigard , Re c eived Pell" No.. 3 `I 13125 SW Hall Blvd., Tigard. OR 9 3 P \ J � \ � Q �'may' I/5"/1- T'' / � �� J /s9--(.90d0 Flan Review
Phone: 503,718.2139 Fax: 503.598.1960 , S Datemr. Other Permit No.:
TIGARb Inspection Line: 503,639,1175 � r® Date Ready /By- runs: P1 See Page 2 for
Internet: www.tigard- or.gov \\ ` ':T Notified/Method: / , Su t ilenrentnl I,tforMUtion
' TYPE 'OF WORK\,\
❑ New construction ❑ Demolition FLE'. SCHEDULE
10, p Fors eefal In ormaliO i use check / /sr. • ddition/alterationfre lacement ❑ Other: Description Qry. La. Total
• .: CATEGORY •OP CONSTRUCTION New I- 2- fnnnlly dwellings (includes 100 ft. for each motility connection)
❑ 1- and 2- family dwelling ommercinUindustrial -
SFR (1) bath 312.70
SFR (2) bath 437.78
n Accessory building ❑ Multi - family SFR (3) bath 500.72
❑ Master builder ❑ Other: Each additional bath/kitchen 25,02
JOB SITE INFORMATION AND LOCATION
Fire sprinkler L. sq, ft.) Page 2
Job site address: 4 ' t1i ivl Site utilities:
Au
City/State/ZIP: t D t/� on 22-3) Catch basin c h lin drain 18.76
V E� 1 Drywell, leach line, or trench drain 18.76
Suite/bldg. /apt. no.: Project name: e
tl Al..yr.r aoa f'lowfj Footing drain (no. linear lt,: _) page 2
Cross streel/directions to job site: Manufactured home utilities 50.03
Manholes 18.76
Rain drain connector _ 18.76
Sanitary sewer (no. linear 11.: , /0 ) / ' Page 2 6), ,5--rl
Storm sewer (no. linear ft.: ^ ) Page 2
Subdivision: I Lot no.: Water service (net, linear fl,; ) Page 2
Tax map /parcel no.: Fixture or Item:
•.DESCI:OTIoN Off' „ woRx
Backflow preventer 31.27
t1. __i
1
Backwater valve 12.51
! i a !� r R.-4 4 Clothes washer 25.02
IMML / / Dishwasher 25.02
Drinking fountain 25.02
❑ . .. ... : :. ectors /sump 25.02
.. EJ _
ROp1 =RT'Y OW.NER ..:. TENANT ' ...
Name:
Expansion tank 12.51
Fixture /sewer cap 25.02
Address:
Floor drain/floor sink/hub 25.02
•
City /State /ZIP: Garbage disposal 25.02
Phone: ( ) Fax: ( ) Hose bib
25.02
NEW APPLICANT ' ' 0, CONTACT PERSON Ice maker _ 12.51
I' ' ���1 . !` Interceptor /grease trap 25.02
Business flan e: II
*�� Medical gas (value: $ ) Page 2
Contact name:
Pruner 12,51
Address: l4TR G - `(1.
�0ku ,, - Roof drain (commercial) 12,5)
City /State /ZIP: Yaha K. 611t) Sink/basin/lavatory 25.02
Phone: (Orb 2 Fax: : 0 6 ut e c 1 1 Solar units (potable water) 62.54
E -mail; Tub /shower /shower pan 12.51
. Urinal 25.02
CONTRACTOR �'. . . • Water closet 25.02
_
Business name: J,,! I a • 20 Water heater 37.52
Address: A ` g'ii. 0 Water piping/DWV 56,29
City /State /ZIP: a g j , ey , m Other; 25.02
Phone : ( i Flu . ( � / o a w Subtotal 6)
IS -�
Minimum ptrmit fee: $72.50 7,2
CCB Lic.: r � � , Plumbing tic. no,: -�
Plan review (25% of permit fee)
Authorized sign'lure: i.. fl'r1���
1 ��
�� IV��19h _ State surcharge
Print name: I VER �� . IY,�%�IMIIII Date: E� TOTAL PERMIT FEE ' I, 3.6
r
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