Permit A) CITY OF TIGARD
PLUMBING PERMIT
�i DEVELOPMENT SERVICES PERMIT #: PLM2006 -00072
,.� I DATE ISSUED: 2/8/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 103CB -03000
SITE ADDRESS: 12265 SW MARION ST ZONING: R-4.5
SUBDIVISION: WILLAMETTE NO.2 LOT: 034 JURISDICTION: TIG
Project Description: New sewer connection.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
NICHOLAS SHEPHERD
12265 SW MARION ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 2/8/2006 $72.50
[TAX] 8% State Surcha 2/8/2006 $5.80
Phone : 503 -419 -5191 Total $78.30
Contractor:
•
OWNER
REQUIRED ITEMS AND REPORTS
•
Contact # :
Reg #:
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: / �J s �� Permittee Signature: _IL(. \‘'I■
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
02/08/2006 13:01 5032245266 GATEWAY FINANCIAL PAGE 01/03
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13125 SW T d ` 1005 it o' - 6. . CI 1►__ I0.7 167,
Phone; 5 03.639.4 Tigard, 903 9 E G. O
Yt®ttr:rtc 9
Inspection Liao 503 . 1 l ? : J' { Or1aa rye Ne: '. _ /Q 1 /
2 termi r OF ( \G ,�., +- /g &19aP+�ee3fbe •
Intermit waw.ti�d�r.gev 1rw.. ..��., �(
. odAltatba� t e liar ,
❑ New construction 0 Demolition _ - For a>leelallr{font plelWeekac rnt
ID Atldition/a1t�s�ionhzphtcameutt [] Other: De r r ' I QM I S$ _ I TO
Newt- 344t1t0y dwenlege (nahtdea 100 ft for each utility comaxdoa) •
° ' $Ft (L) bath 249.20
❑ 1- and 2- family dwelling 0 Commercial/industrial SFR (2) bath 350.00
❑ Accessory building 0 MUlt - y 81tR (3) bath 399.00
Other
additiotml tiatblkiteben 45,00
❑ Master builder ❑
- _. Fa"sprintl F 2
• "::� � .: • :• '° ' -: .. . 414130 > 6, ON-41W 1C 0CMITON • ':•••:' '' • ° . Site idlides
J o b s i t e a d d r e s s : 1 2 2 4 S S W M A Sr. Caleb basin or area drain , 16.60
Ciry/State/Z1P: TrArtD R 9 2 . 2 3 Dowell, leach er n a n d 16,60
Suite/bldg./apt. no.: J Project name:
Fo+rtiad drain (no. linear R; ,^�) Page 2
Cross street/0(t ons to jab site: A6�,t0eeAuned 1 utilities 11 o.nb
- Manholes 16.60
I 2 Sr Rain drain ._tor 16,60 '
Sanitary sewer (no. linear L: (9 ( P ane 55 OD
Steen sewer (no. linear fiz ,._) laaga 2
Subdivision: _ 1 Lot na _ Wane aavlGa (no. linear _� > 2
Tax maplperoel no,: E"ata.e or item
1 - ' M1 D , Absorption valve 16.60
,. .•:-::•:.-;;;;,.::,::,.::;.,,....'. tyNT fi,:•Al+O1RZ , '^ '' . . .!• Ba�idbw eoler
1 ' pTCV Page 2
1
11001 u P Hau To S6wg LIN Ha3=watm-valyr 16.60
Clones washer 16.60
Dltlrwgsher 16.60
14: '11'�'O�Vl0 ... •'; ;(;. Dunking 6nuotsist I6.60
Name: N ILA -AS_ 5146`PHAD E ° 6 tank 16.64
Ex�arealoa ta60
Address' 1-2 4.b 5 rLJ r AfL1n*J Si:. • Filuere/sewer 16.60
. City/Stirtell ; - T jr, D, A 412/3 nor dramlOoartdeak/inib 16.60
Phone: ( 3 ) Li - sit Fex: (So 3) 1- I,Iq- $ 29 I Wage drsposal 16.60
h :. •, ... • .. ' ' a [�6i!rj' > 1N, a .., Rene bib 16.60
Ice maker 16.60
B+rsfnaa n�c:
lid nlgr�e n
P
16.60
Contact °tee: Medial sae (value S ) Page 2
Address: Primer 16.60
City /State - ZIP: Root** (commercial) 16.60
Phoac ( ) P : ( ) SielebasIndavatory 16.60
>rmat7': - Tunshowerlhirov er pan 16.60
Urinal 16.60
�, ... `a vQil'!'$Atla0$ • , • Wean' deem 16.60
Basin is name: f(OM B1 N Water beater - 16,60
AQdre4v: Others '
a�ity/State/ZEP: Bebto>ral .55,00
Phone: Minimum permit fee: $72.50
Phon
( ) H Fax: ( ) Residential Make= minimum permit the: $36.25 0
GCB Lic.: • Plumbing Lie. no.:
Plan review (25% ofi,.rn r^t fee)
Authorized signature: State_outhargc(896of S .$D
TCrfAL PERMIT FEE - It .•0 '
Print name f� s . L .. Date ^ , „ d C Ilia permit r;pbfeatioo expires if n permit is not obtained *tiha
188 days after it has been accepted as complete.
"Fee methodology sat by T'ri•C000ty Building tndoetey $avian Board
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