Permit p CITY OF TIGARD PLUMBING PERMIT
11111 C COMMUNITY DEVELOPMENT Permit #: PLM2013 -00192
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2013
Parcel: 251080002901
Jurisdiction: TIGARD
Site address: 15087 SW 161ST AVE
Project: Martin Subdivision: NORTH PLAINS Lot: 2
Project Description: Installation of 16' of sanitary sewer line to connect new septic tank to existing house.
Contractor: SPEEDY SEPTIC & ROOTER SERVICE Owner: MARTIN, DANIEL & ELIZABETH
PO BOX 1260 15087 SW 161ST AVE
BORING, OR 97009 TIGARD, OR 97224
PHONE: 503 - 663 -2807 PHONE: 503-309-6220
FAX: 503 - 663 -6712
FEES
Quantity Description Date Amount
16 If Sewer Service 06/18/2013 $62.54
Specifics: 1 12% State Surcharge - 06/18/2013 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 06/18/2013 $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 'cation Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -00.0 You may obtain a copy of the rules
or di ct questions to OW ' • g 503.232.1987 or 1.800.332.2344.
Is� ued By: / i / Permittee nature:
_ ,) A.
Call 503.639.4175 by 7:00 a.m. for the next available insp• on 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.
06/14/2013 FRI 12:56 FAX 0001/004
•
Plumbing Perm Applica
IVED
Site Utilities FOR OFFICE USE ONLY
City of Tigard JUN 7 2013 Received Coe te Pt.d ol3-xiq�.
Dntc /13 LEj Permit No.:
a 13125 SW hall Blvd., "fi OI � 3r �c�G ADn Plnn Review
Phone: 503.718.2439 Fax: SO TAN C1AV Other Permit No.:
Date /By:
•
TIGARD Inspection Line: 503.639.4175n .ILDINGDNISION Date Ready /13y: Ju -.. ® See Page 2 for
\w\
Internet: v.tigard- or.gov 13 Notified/method: f'` Supplemental Information
.TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information Ilse checklist.
Description I Qty. I Ea. 1 Total
4 Addition/alteration /replacement ❑ Other: New I -2- fancily dwellings (includes 100 Il. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
1- and 2-family dwelling SFR (2) bath 437.78
)' g ❑ Commercial /industrial
building SFR (3) bath 500.32
❑ Acccssol
y g ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler (_ sq. II.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: q C I S'C_EJE Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: 'V;C��g.,0 oz, 1146 Page Footing drain (no. linear n.: �) 1 a c 2
Suite /bldg. /apt. no.: I Project name: Manufactured home utilities 50.03
Cross street /directions to job site: Manholes 18.76
CA - ,./ 3 -1111 ETIV1 II RO Rain drain connector 18.76
L Sanitary scwcr (no. linear fl. II ) P age 2 GC .51.1
Storm sewer (no linear R.: _) Page 2
N. Water service (no. linear ft.: _) Page 2
Subdivision: I Lot no,: Fixture or item: _
( Tax map /parcel no.:
Back flow preventer 31.27
N- DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
`����' r t �� �. , � 7 r _ (
�O W 1 2 �llY- t1tia-- 0.f- 747' v, Dishwasher 25.02
I ..xilu lliW. VIVA I - .1_ • QA `i • Drinking fountain 25.02
M i'EW ,9 e.- tJ Ejectors /sump 25.02
a PROPERTY OWNER I 0 TENANT Expansion tank 12.51
■ Nante:� m. f I� Fixture/sewer cap 25 -02
R
Floor drain /floor sink /hub 25.02
. Address: 15 Rol I VI- y E
�J Garbage disposal 25.02
City /State /ZIP: Tj( a - 9� t Lt (lose bib 25.02
Phone: (5) spQ Coaa I ax: ( ) Ice maker 12.51
\ �J \ ( APPLICANT 0 CON PACT PERSON Interceptor /grease trap 25.02
I3usiness name: C a,oy s.PTl a SQjtc_ _ Medical gas (value: $ _) Page 2
V Contact name: ,n fl(\ Primer 12.51
v k - (0Q Roof drain (commercial) 12.51
Address: - Sink /basin/lavatory 25.02
City /State /ZIP: --- 6(2.1
0y) cc a"��� Solar units (potable water) 62.54
Phone: () (D( - 2P' Fax: : (50 )6k0.3- 9 Tub /shower /shower pan 12.51
J N p SPee `, 4 .CQ 1 Urinal 25.02
� J \ Water closet 25.02
CON' 'R CT
Cn of Water heater 37.52
Business tame: t Q j cilkSei -t. Water piping/DWV 56.29
Address: • ' boy( (a() Other: 25.02
` City /Stale /ZIP: -609__I nc-7 02. " L -) ( Subtotal (12.64
\� Phone: (6,5;) (Q(,p3�.'a, k,. Fax ( ) Minimum permit fee: $72.50 72 , 50
VVV I Plan review (25% of permit fee)
CCB Lic.: 1q t. unit 7 /;t5-45 Plumbing Lic. no.:
n State surcharge (12% of permit fee) $ , '70
Authorized signature: C C ,
Print name: } TOTAL PERMIT FEE 7 EI. 2O
1 ci tL,� • C
( V f Date: f f/ 0 7 r / //3 This permit application expires if n permit is not obtained within 180 da Q /
r J after it has been accepted as complete.
'Pee methodology so by Tri- County Building Industry Service Board.
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