Permit r ',1:, CITY OF TIGARD PLUMBING PERMIT
4.l
COMMUNITY DEVELOPMENT Permit#: PLM2015 00412
Date Issued: 12/07/2015
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S102BC01102
Jurisdiction: TIGARD
Site address: 12772 SW KING PL
Project: Graceland,Lot 4 Subdivision: NORTH TIGARDVILLE ADDITION Lot: 29
Project Description: Connect existing house:30'of sanitary sewer,8'of storm line&20'of water service. Installation of rain
garden/LIDA box.
Contractor: SCHRAM BROTHERS EXCAVATING LLC Owner: PACIFIC EVERGREEN HOMES LLC
PO BOX 820353 7410 SW OLESON RD#133
VANCOUVER, WA 98682 PORTLAND, OR 97223
PHONE: 360-518-2674 PHONE.
FAX: 360-892-6582
FEES
Quantity Description Date Amount
30 If Sanitary Sewer 12/07/2015 $62.54
Specifics: 8 If Storm Sewer 12/07/2015 $62.54
20 If Water Service 12/07/2015 $62.54
Type of Use: SF 25 Misc Other Fee 12/07/2015 $25.02
Class of Work: ALT 1 12%State Surcharge- 12/07/2015 $25.52
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $238.16
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 ion • !UNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / Permittee Sign. ure:
i./�
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.
Plumbing Permit Applica'A?:f. CEIVED
Site Utilities !,::' : . •• . •. • .!'::... .-,F.PR.::011FICE:.1.3St: eti'NLY.,.:-.'..;t:f.,:,:::::!::::',!;!,•,;,,,!;:1;:,'''::: :,
ijI;.:27,.'.7,::•:•! City of Tigard DEC 7 2015 1 RcceRed ,,,2
i I Permi z N:.,: itilg6V5:-O0 0 9".
., 131,3 SV FiatI Blvd,, Haard.OR R7221 - 1
'IA;., '=,I, phone: 503 7IS 2439
ilh
1:.:2,x 503 errY0OF-MAR 1 Datel3y: .
D .1-'Flan Revieu i
i Other Permit Ny;
! Dzie43y- ...
inspthilon 1.111::: . 39
i 5°3ci6 '4 17:'BUILDING DIVISION i Daze-RcatRiBy, I .1..."- i El Sire l'afte 2 Jim
iTIG'Alta, ,
-,:i..; tnternet• %%WA't.g2r_-or.gix. 1 Nry,ifirci'Nictlyd: : Supplement-3!Informal:lin, .
' -----
TYPE OF
WORI;;;) ,' .- ; 1• ! . -!" .: ..: •, • . , , .4.4':,, t.101t, LE
For special information use checklist
7g!l\evs etsrinletion I 0 Demolition
• --- — Descrmtim i Otv. ! 1:,,t.
Ti: Additionfa'iteraitotalreplacement I 0 Other; : ! New 1-2-family dwellimts tinc!tides!00 it tor cach cut it'L,citith,,t„
_______ — , t
. .
' CATEGORY OF CONSTRUCTION : 1 i SFR i)bath
:-.....
SFR f2.1 bath 1 43!7t1 t
.13:: I•and -iaoh dwelling ! L Cut:whim:hal/industrial .:
i SFR t.3.)bath I i 500 22 1 .
1 Li Accessory bailding I 0 mutti-family ----r ....I-7;-;77 1-- ---
r Each additionai hativititchen
0:vlasit:c bwida CI otiN;r: .._... .
1 - - ' Fire sprinkler( :A
i Patte 2 1
... ..._ •\,
JOB SITE INFORNIATION AND LOCATION •,. , ' Site utilities:
. . .
I
/ Catch basin or area drain I * 1 i 575
I
— !
.!..-tit site address' Z-772, ig_/ACot : --
""!, __ „ I Drywell.leach line.ot trench drain I IS 76 i
I "
' •,'III."`.;IIII3:11.IP. TX649.4) al„,,, 2 :
--- -...... --.- .._-.. I Footing drain(no iinear It, _I 1 _ 1 Pace !
• •stitte!bldgiapt.no.. ! Project name:
I Manufactured home utilities 1 50.0.3 1
(i;t,s street/directions to tort site: N•tanhotes 1 1 18.7h I
------- ---• -1 4 1 I ,,, .. :Rain drain connector .5.f,t,
1- 1 LiSanitary Smet ino,linear ft.,: ) i 1 ! Page 2 I A.5iF 1 yhqZ./OW'
• - ! Smith sin\er tno iiattar ft: t ! . Page'2 ! A4 •
i Water ser:iec(no !mear fi. W.) ; ) Page 2 I.109..611
. -,,j-itsivision: 61/.44_66„,44/VD !I -
1 1..01 MI.:it Fixture or item:
Back flow preventer 1 i •; ^:: ! :
s,at,ipliNtrcei no.. 1 t,_ ,
t---
• ' .
DESCRIPTION OF WORK ' Back-wakl vaive
Clothes vaishe; •
-,5,01
-1- •
- — 1 Di ll .asha ; 2-.';02
)-
Se_aAti- ; Drinking lburnam
--- - . ...._
ectors:stimp ! ! 25 02
_ _..
PROPERTY OWNER • 1 • 0 TENANT . Expansion tank •
, \IIIII4: 17Ac2ac- evetha..f&-Ni Names , Fixturelszv.er cap I
1-(0 1
.. , L-..
I.,Floor draimiloor smklImb i 1 ..5.(1- !
Adj-s- -11110,5tdo ot,c; iJ AD s-re /33i Garbage dispo$al I
- t ,-•,, 1
, ,...-;.,... 1 ..
CttY'SI:lic'.7:11)- P0/9241,4/4D OK, q7ZZ3 ;,.
ilose bib . 1:?.v) 1 7
.---- _
'';1).-;•.1;:-I,503 &Of ,qZ3 I Fitx:( ) I lee maker I i 12 5 i I .
0 APPLicANY . I 0 CONTACT PERSON 1 I Interceptor/grease my
! 1-5,,j2 ;
, - ;
----; ; MoMeal gas vaIue S
_ m: s narAN 6oftw
icote ___ ...-...___-.-...-. „Rno.medrrant(commrial) i!
1 I 12 51 !
',2.tii•ess i
1 Smitibasinilavator, 1 25.02 . 1
!''.,tale,'",LP. 5 AAx-
: i Solar units(p0,--1,1c watort
,_. _............... ___________
Yln•m.,,.! i i Fax: Tabishimscrislitmer nan
, ,
•
2 I_
,,,iii. 4aA e prci ci i';(.. \.N&I-ein otre5• c,4 rn - -1 i t:rinal
...._
---------- - - • i I \,Vater clmet I i 2.5.02
CONTRACTOR . ' I
- ! 1 Water healer
$1,1,11teS1;tiailli,!. ,..,.te,r A pry\ V--x oc-, cYCON(1.4-1,Vet
I 1 Water ptpingiDWV
----- -- •
B&x %2.0.6.S.3. i9y. _ -- i _
1 L other 4, 4 ,, . ,.. i !L.
,t ii - ,i ,,,,,- .,....,.
' ,,'Ily/S,,•417,!i'' \fri al2ily.e.„T t W'ri. CIS(Ac Z.. I ' S'ubtotal ,,,gitd2,44.2
...... ......._._____,.....
.m........ ...... _..........._
- ;,hon..;:t.3:40;518_2111-2q _ I Fax:ky00)S£32,...115;82_ t : Mintmum penult fee S72 50 I ......---•
Han mview (25'A of permit tee)
.ic:2 /7, gh7// Piutzthing I jc,no.. p6i5q2.. I t— .
,i :-.,„i
..„,,._.....___........ ...... /32 V— — Sane surcharge i I 2',,,of perm;t fc;t1 I 40,6-S-D-
. \ lttrt...; Istgrtatttre. 1////7 [
I 'Farm_PERMIT FEE tan (b
--1 Thi,permit 2 pplicalion expires if ti permit is not obrilinrd ri Wan I iii &v.,
c,..,..., Dat..C:/9..1/4..../(‘-- j
ai:ee 1.1 1ms been accepted a.complete.
/ A I en rmamd,`1,,,,.,5e,by Tu-Cozy I iniidtnn Intionry tier,Ice 1.5.!.nzi
. .,...-,.
'co .PIM?•?,,fir.:iAir,i JA., iil.oi.i,
. !
. !
i