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Permit p CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2016-00051 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/03/2016 Parcel: 2S103CC00500 Jurisdiction: Tigard Site address: 12259 SW PLANTATION TER Project: Plantation Estates,Lot 1 Subdivision: 2012-001 PARTITION PLAT Lot: 2 Project Description: Installation of approximately 50'of sanitary service and 50'of water service to be done prior to issuance of building permit. Contractor: RENNER TRUCKING&EXCAVATING INC Owner: KKNW LLC 228 SW WALNUT ST BY CRANDALL, MARK L HILLSBORO, OR 97123 1800 NW 167TH PL STE 150 BEAVERTON, OR 97006 PHONE: 503-846-1512 PHONE: FAX: 503-846-1354 FEES Quantity Description Date Amount 50 If Sanitary Sewer 02/03/2016 $62.54 Specifics: 50 If Water Service 02/03/2016 $62.54 1 12%State Surcharge- 02/03/2016 $15.01 Type of Use: SF Plumbing Class of Work: NEW Type of Const: Occupancy Grp: Stories: Total $140.09 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 cop of the rules or direCquiOUNC bycalling 503.232.1987 or 1.800.332.2344.Issued Permittee Signature: / 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 Application Site Utilities Received City of Tigard Date/By: 8' 3 /(p Permit No.: let-d(,Yj 5j 13125 SW Hall Blvd.,Tigard,OR9722 Plan Review • ■ Phone: 503.718.2439 Fax: 503.59 1 h Other Permit No.: !, Date/By: STt�K5�aJ Inspection Line: 503.639.4175 Date Ready/By: tuns: O See Page 2 for Internet: www.tigard-or.gov , i.c Notified/Method: Supplementallnformation TYPE O New construction ❑Demolition For special in ormarlon use checklist Description I Qty. I Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 J 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ElAccessory building ElMulti-family SFR(3)bath 500.32 Each additional badvbtchen 25.02 ❑Master builder ❑Other: Fire sprinkler(_sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: I Z ZS 1 5 ✓ F/QPLA-Eh i trt -&i gra C g Catch basin or area drain 18.76 City/State/ZIP: u. R 3 Drywell,leach line,or trench drain 18.76 � OK Footing drain(no.linea ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: �' Page 2 Storm sewer(no.linea It.:_) Page 2 Water service(no.linea 11 Jn) Page 2 Subdivision: y Q� 1 pyr �� e Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 OESCRIPMN OF WORK Backwater valve 12.51 Clothes washer 25.02 Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 P1P9ER ' © !ITXANT,.. Expansion tank 12.51 // Name: S Z_L/ Fixture/sewer cap 25.02 �STtiv6 e Nt,•Q Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 APPLICANTS © CONTACT PERSON Interceptor/grease trap 25.02 / ' L cS��a c o S L Medical gas(value:$ ) Page 2 L Business name: Primer 12.51 Contact name: a rt Roof drain(commercial) 12.51 Address: 12,76? A11./ 6or"1� Sink/basin/lavatory 25.02 City/State/ZIP: C r-� q,t Q Z' Solar units(potable water) 62.54 Phone:(VI ) 6n- 5019 Fax::( ) Tub/shower/shower pan 12.51 Urinal 25.02 E-mail: a�' /n�5{b✓o a►'t1s S L.�,(.,C-G/n Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: m Q., vc k,h fi C q'AL Water piping/DWV 56.29 Address: Z Zg <,W b/e I,u, Other: 25.02 City/State/ZIP: Subtotal Phone:(S('i3) _ Z Fax:( ) Minimum permit fee: $72.50 CB Lic.: 3 3 Plumbing Lic.no.: 63 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: • TOTAL PERMIT FEE o9 L°c? l ''r Print name: ' Date: i </ This permit application expires if a permit is not obtained within 180 days S \ ^ ' after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I:\Building\Pcrmmits\PLMU-PermitApp.doc 10/01/09 440.4616T(10/02/COM/WEB)