Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00083
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/12/2012
Parcel: 1 S136AD05700
Jurisdiction: Tigard
Site address: 6726 SW PINE ST
Project: Spillum Subdivision: VILLA RIDGE Lot: 2
Project Description: Replace 80' of sanitary sewer line.
Contractor: ENVIRONMENTAL WORKS Owner: SPILLUM, RONN
2634 SE STEELE ST 6726 SW PINE ST
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503 - 719 -6715 PHONE: 503-880-4461
FAX: 503 -482 -7440
FEES
Quantity Description Date Amount
80 If Sewer Service 04 /12/2012 $62.54
Specifics: 1 12% State Surcharge - 04/12/2012 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 04/12/2012 $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 estions to LING by (ling 503.232.1987 or 1.800.332.2344.
Issued y: J`^� Permittee S' nature: Ai
.A0d4R-d-1-/ Call 503.639.4175 by 7:00 a.m. for the next available inspec '.n 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.
09/11/2012 10:07 p TO: +1 (503) 5981960 FROM:5039827990 Page: 2
Plumbing Permit Application
Site Utilities RECEIVED FOR OFFICE 155E ONLY
City of Tigard Rece. ..d If�
Date/By: i P ermit N a.: N / , di ir3
e 13125 SW hall Blvd.. Tigard. OR 9]F 1 1 2012 Plan Review � '
Phone: 503.718.2430 Fax: 503.541t.1 0 1 Date/By. Ohm Permit No.: • TI G A R D Inspection Line: 503.6 39.4175 Date Ready/By: tuns 1 ® See Page 2 for
Internet: www.tigardorgov CITY OF TIGARD Notifieet/Meihod I Supplemental Information
I TYPE oBllialING DIVISION .. FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. I Ea. I Total
® Addition/alteration/replacement ❑ Other: New I- 2-family dwellings (includes 100 0. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath I 112.70
❑ I - and 2- family dwelling _ ❑ Commercial /industrial SFR (2j bath i 437.78-1—
SFR (3) bath I 500.321
❑ Accessory building ❑ Multi- family
i —' I Each additional bath /kitchen , I 2;.02 , 1
❑ Ma builder { 0 Other: Fire sprinkler (_ sq. 0.) 1 Page 2
I JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 6726 SW Pine Street Catch basin or area drain 18,76
I I
Drywell. leach line. or trench dram I I t 18 76
(. ity /State/ZIP: Tigard, OR 97223 — }. - -
I .-- Footing drain (no. linear li_ ) I Page 2
Suite /bldg. /apt, no.: I Project name: Manufactured home utilities I 50,03
L truss street/directions to site: I Manholes j 18.76
Rain drain connector I I 18
Sanitary sewer (no. linear ft.: QQ) 1 Page 2
Storm sewer (no. linear ft.: _ ) Page 2
—'- ... Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.:
Fixture or item: j
Tax utap /parcel no.: flack(low preventer 31,27 1 I
f B ac k wa ter valve 12.51 I - - -�
DESCRIPTION OF WORK
i Clothes washer j 1
25.02
; I line replacement on property
Dishwasher I 25.02
i
__ Drinking fountain 25.02
Ejectors /sump I 25
® PROPERTY OWNER ❑ TENANT Expansion lank 1251 i
I Name: Ronn Spillum FixlurelsewercaP 25.02 I
1 25.02 .4_. —. —a
Address: Same
Floor drain/floor sinkihub �—
Garbage disposal } ,5 I
City/State/ZIP: tlosebib 25.02 j
Phone: (503)880 -4461 Fax: ( ) Ice maker 12.51
I{ —I
I ® APPLICANT [] CONT'ACI PERSON Interceptor/grease trap i 25.02
I
1 Business name: Environmental Works I Medical gas (value: $ ) Page 2
r 1' En
I Contact name: Ntike Runyan Primer 12.51
Roof drain (commercial) 12.51 I
Address: 2634 SE Steele Street Sink /basin /lavatorx
Z5.0_
I_ City /State /Z1P. Portland, OR 97202
Solar units (potable water) 62 54
I Phone: (503) 719 -6715 I Fax:: (503) 482 -7440 Tub /shower /shower pan 12.51
E-mail: mikcaleworksmv.com Urinal 25.02
CONTRACTOR
Water closet 25.02
Water heater 37.52
Business name: Environmental Works Water piping/DWV 56.29
Address: 2634 Si: Steele Street
Otter: 2 5 02
1 City'Slatc / /.IP: Portland, OR 97202 r - Subtotal 1 —
1 j
P hone: (503) 719 -6715 7 Minimum permit fee: 572.50 1
j ( ) I Fax: P
CC B tic.: 185781 1 Plumbing Lie. no.: Plan review (25% of permit (cc) ------ 1
T 1 State surcharge (I 2% of pemtit fee) 1 $ • 701
Authorized signature:
, , - I A
TOTAL PERMIT T'T 1, I g(
I Print name: Lacey Brown — 1 Dale: 4.9.12 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board
I •BuddmgWernvt<U'I Stti -Perms App:kw !u•81.0) 440—lb InTi I(sO ./COM(WEn)
09/11/2012 10:07 p T0: +1 (503) 5981960 FR0M:5034827 Page: 1
- Fax Transmission
To: 5035981960 From: Mathew Lowrance
Fax: +1 (503) 5981960 Date: 4/11/2012
RE: Pages: 3
Comments:
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