Permit n CITY OF TIGARD PLUMBING PERMIT
III a -- COMMUNITY DEVELOPMENT Permit#: PLM2013-00284
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2013
Parcel: 2S 103BC01300
Jurisdiction: Tigard
Site address: 12121 SW LANSDOWNE LN
Project: Fyre Subdivision: 2004-026 PARTITION PLAT Lot: 2
Project Description: Repair of 65'of sanitary sewer line.
Contractor: ROYAL FLUSH PLUMBING Owner: FYRE,MILTON F REV LIV TRUST&
PO BOX 507 FYRE, PAMELA S REV LIV TRUST
BEAVERCREEK,OR 97004 426 FAIRMONT
LAKE OSWEGO, OR 97034
PHONE: 503-657-3919 PHONE:
FAX: 503-657-3940
FEES
Quantity Description Date Amount
•
65 If Sewer Service 08/15/2013 $62.54
Specifics: 1 12%State Surcharge- 08/15/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 08/15/2013 $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 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 dire =.- ions • e NC by - ''g 503.232.1987 or 1.800.332.2344.
Is ued By: . / , / Permittee Signet y
Call 503.639.4175 by 7:00 a.m.for the next availablei spection 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.
Aug 15 13 04:16p Royal Flush Plumbing 5036573940 p.1
Plumbing Permit Applie ' EIVED
Building Fixtures AUG 15 2013 FOR OFFICE USE o\L\
City of Tigard Received 6' i 5 /3 �, i Permit No.: ��,f/gD/3_47„,,:2?
�
!� : + 13125 SW Hall Blvd.,Tigard,Ni; �. TIGARD Plan Review
Phone: 503.639.4171 Fax . J D�gv, i Other Permit No.:•
rte R v ]nspection Line: 503.639.41�[J (`� DIVISION 'Dare Ready/By: Awls. ® see Page 2 for
Internet www.tigard-or.gov Notified/Method: I Snppkmeatallnformatian
TYPE OF WORK FEE* SCHEDULE
❑New construction ':, ❑Demolition For special information use checklist
Description I Qty. I Ea. I Total
gAddition/elteration/replacement ❑Other: New 1-2-family dwellings(mcludos 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
!l-and 2-family dwelling ❑Commcrciallindustrial SFR(2)bath 437.78
�
SFR(3)bath 50032
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(_sq.ft.) I I Page 2 I
JOB SITE INFORMATION AND LOCATION Site utilities:
lob site address: atch basin or area drain 18.76
I I '.7).1 S.Si k: L-nl r�S(-/6 iA:1'\ Lim
Drywc11,leach line,or trench drain 18.76
City/State/ZIP: T i C) C r / (J 1� Footing drain(no.linear R: ) Page 2
Suite/bldg./apt.no.: / I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
1 Rain drain connector 18.76
Sanitary sewer(no.linear ft.:L) 'I Page 2 i
Storm sewer(no.linear ft.:___,) Page 2
Water service(no.linear ft.:_) _ _ Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: i Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
lothe washer
25.02
,c::�'.. �`'.t•. t St_. L..-c v- t L.L 'ti 7C: -
\Ni\ Dishwasher 25.02
I. l +
z 7 5 J`. Drinking fountain 25.02
1 Ejectors:sump 25.022
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
j Fixturclsewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
CitylState/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:S ) Page 2
Business name:
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02 1
City/State/ZIP: ' Solar units(potable water) 62.54
Phone:( ) ' Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail:
Water closet 25.02
CONTRACTOR Water 37.52 •
Business name: C_^-`t!` :- \_,_,7 :�l� `-)L,\\,.._.\ \N,--1 CC' Water piping/DWV 56.29
Address: ..7L_-__-., '- f ST:-..-1 Other: 25.02
City/State21P:\--:72)c c C ..-1.._t.... tC_ , .."\4::_ C i- 1(. ' Subtotal V
Phone:( ) l.Os )-- 39 k Fax:( ) lC� f'37� Minimum perrrnitfre: $72.50 c�5``
< /. o/i g 3.6.3,, ,--6121
Plan review (.(25%of permit fee) )
CCB Lic,: / / Plumbin Lic.no.: c
111 I / e� State surcharge(12/o of permit foe) ��,
Authorized signature: ���`�� //��1-- 7/l/// TOTAL PERMIT FEE ,
Prins Hartle' :"...1
/` L; Date: 7 + T�permit application empires if a permit is not obtained within t8n days
1, N,,,Ici ,..l ,j n,,;{_. •(t -1.s-" 13 after it ha,been accepted as complete.
C
*Fee methodology an by Tri-Counry Building Industry Service Baud.
1:18uildiaalPCmitsTL AMU-Perms..p.d6c 10/01519 440.46167(10101COM/WEBI