Permit CITY OF TIGARD PLUMBING PERMIT
II 1 • COMMUNITY DEVELOPMENT Permit#: PLM2013-00366
T[G ARID 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/17/2013
Parcel: 2S104AA01300
Jurisdiction: Tigard
Site address: 12300 SW BELL CT
Project: KIRBY Subdivision: BELLWOOD Lot: 62
Project Description: Repairing 3 ft.of sanitary sewer.
Contractor: ENVIRONMENTAL WORKS Owner: KIRBY,TIMOTHY R&TRACY L
2634 SE STEELE ST 12300 SW BELL CT
PORTLAND,OR 97202 TIGARD,OR 97223
PHONE: 503-719-6715 PHONE:
FAX: 503-482-7440
FEES
Quantity Description Date Amount
3 If Sewer Service 10/17/2013 $62.54
Specifics: 1 12%State Surcharge- 10/17/2013 $8.70
Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment- 10/17/2013 $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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ' Permittee Signature: fzZ,.
Call 503.639.4175 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.
10/17/2013 4:06 PM From: Environmental Works/503319.6715 To: 15035981960 2 of 2
Plumbing Permit Application
Site Utilities RECEIVED . . . .. . . , . . .,. . .. .. .
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OCT _ ,, I
1 7 2013 . -
Phone: 503.'IS.2439 I'm: 503.398.106r.- -
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!Mallet: MA 41.‘11211rd-ilt-_:n0V CITY OF TIGARD , ,,,iiiiaNi,h.i. 1 : ...6 Supplemental Information
_ TYPE OF
wV-ILDINGDIVISION FEE* SCHEDULE
......
D Nov construcrion I Li Demolition 1 Far special infirrirration use checklist
- - ---- --. I DescripfiNS I OLY. ! Fa. .i___ to,,,i
0 Addiiionirilveratiori;replavenicat 1 Other. I Nes< I-2-1-aniiI.dwellings I lilt:ludo 100 R.tor each uti[if.,..-onm-ction,
-- .-- ,
CATEGORY or coNginucTioN 1 SFR ill bath i 312 70
1 SFR(21 bath
1,12-lantilv i.fi(elling OCommereiarind«strial I -12,1 78 -
--' SFR(3)bait( 3010.32
O Acce:isor• biliklitig 0 1%.401ti-famil) ! i
Each additional bath:I:40km 1 25.02
El
'ii:i\ler builder 0 Other:
Ii ir e spnnk ler i sq It) Paue 2 '
-
JOB SITE IN FO Ft141 A I ION AND I DCAT I 0 I SIN u cili iie-si
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' - [ Catch basin ci.r area drain 18.76
lob sill:addrcss: i j cf.. .. ---i..., ,„„ ,
C.A4-- --- : Drv1Aell.leads line._or trcrich drain
18,715
---- r
ii.•Stateil.IP: 1 5 1/4,A;pt..1(i... '
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._ ......... , Foaling drain i no linear 0.: ) ! Pace 2
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-siiiie,b1dg...lipt.my.: ( Projjject riaine: PrArb,... .
r l<1.inurrietured home(mimes Si)03
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< street:directions to joh site: I Manholes 18.76
... . _ .•
Hain diiiin ciAllICCTOr 1 8.76
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! 1 Sanitary sover(no.linear tj ) i Page 2
j Storm sewer(TIO.linear Ii..:_i Paz:2
'
%Amer service(no_linear:a.. ,.) P3gC 2 .
ciubdivisloti: Lilt an.: Fixture or item:
i
Bach:flow arnica ler 31.77
■
I Xi rItapiparCCI 110.:
------ Flack«ater valve 12.51
D ESC:R.11 PT ION OF WORK .„
0(1 Pe.L.-)p
. p Clothes washer
Dislm:ashe.r 25 02
25 ti2 .
. . _
Dunking fountain 25_02
Ejectors:sump . 23 02
______ - • - . _
0 PROPERTY OWNER 0 T EN A NT F.vansion tank 1 1 2 5 I
. -
Fixture'sewer cap ! 23.02
\ame. ••
i
limy drainAMor sink huh 25.02 .
i
Axlilre7-..s:
Garbage disp•isal 25.02
Cif%'Sialel.11): 'lose bib 25 01 1 •
.7_ .... ■
Ia\:
i'11,1111e"t ) i r ( ) Ice maker 12.31 i i
....... 1 __
APPLK:ANT 1
1 OLCONT.-ACT PERSON I Ilierceptorigrcase trap 7.....02 ■
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. --- :
Medicnt gas(value:S 1 Page 2_ I
11i vii FIC'NS mime: •-%1/4 \,if• Ly-"Latt 1 il:1;Ci f.K5, _...-...,_-_-_
Pnnter 12.51 1
(ant al n:lrnci,S , , I L i'\.,\,u, li in S knordroin(coMmercial) 12 51
-
ddros •-ct U? tA, C)t, , -t-r_e I C C:y- , SA/basin/lavatory 25 02 !
__-_-_____. _-I
•SI elle,/I I'.70 f •'••\ . ,fAL:k. ■ Z_ c-)\1.3(,.i.D._, 1 Solar units(potable((alai 62.54 i
ion :e.:)-52 1! 1 ICI. i i ic.,--- ; Fax::(a:3i 9.---0 j 1 tik, ! Tubsbcro.co'sholter pim
12.51 .
1
i lirinal
ater clocl 23 III I
li-inail. 7j-zA-t4).V:\Lk.i•1\'IL. 61') ff:\;;J:-).(tt__. _,,c--\\,).(.,0rn _.....,.
■Ns ,5 112 i
C ONT RA CTOR
- - Water katcr 37 31 1 .
Iiii<iness IlliElle: ca rA 1, . 6 c)\--\CS
Water pip.ing..1)WV 36.19
______................
Vidress:lth.:. Otheri j 2.5_02
it I
e•-• r\i'6< ....;
( ■.-lisi ../i[b; j()\.,\ Su htntal ' 3-7„%--6E
: .... I Minimum permit fee: 572.30
Plume;i ) 1 Fox:( )
1 i
i-- Plan review (23%iii perm it feel -
1
I C R I ii..: \ *t.'Sr)S \ j Plumbilm I le_nil:
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Stare surcharge(12%of permit fa) ti•-1•0
ri.
Aiallorizcd signmure: ‘‘,..iisi <A.,<SX,:cj.jCV--, TOTAL PLRS.11T F Ili
s i.,---11_13 i I hi l pernaapplication.espireN If a permil is 11111 obtained siiihia ISIY thy.;
Print. tarn s3)cc4)V\ s,..,1.-\) (..., f\i'm t I 0,as Datelj jc‘..ji 0 r i after d has:been accepted as ennipIeTe.
'RN.;me.chodololrl,:et h'.1 ri-Cnanit fli,i1:1Ing.Indusir,-Ser,.1,c Hoard
4.1.-41,1"i1i..ii•zi.rnio wrai