Permit (24) �� CITY OF TIGARD PLUMBING PERMIT
g COMMUNITY DEVELOPMENT Permit#: PLM2016 00137
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/15/2016
Parcel: 1S136AD05500
Jurisdiction: Tigard
Site address: 6710 SW PINE ST
Project: Hathaway Subdivision: None Lot: None
Project Description: Repair/replace 100'of sanitary sewer line.
Contractor: ROYAL FLUSH PLUMBING Owner: HATHAWAY, DANNY LEE
PO BOX 507 6710 SW PINE ST
BEAVERCREEK, OR 97004 TIGARD, OR 97223
PHONE: 503-657-3919 PHONE:
FAX: 503-657-3940
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 03/15/2016 $62.54
Specifics: 1 12%State Surcharge- 03/15/2016 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 03/15/2016 $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 d' questions •OUN sy calling 503.232.1987 or 1.800.332.2344.
sued By: / /, Permitt Signature:
— Call 503.639.4175 by 7:00 a.m.for the next available insp: tion 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.
Mar 11 16 01:53p Royal Flush Plumbing 5036573940 p.1
I
PlumbingiPermit Application � :L.--
Building Fixtures
ve
City of Tigard
III
• 13125 SW Hal]Blvd.,Tigard,OR 972ate
23
Plan Review
Phe: 593.639.4171 Fax Receid f / Permit Na.: ( �j(�b�IS?
503.598.1960 Date/By Other Permit No.:
Inspection Line: 503.639.4175 Dale Ready/By: iuris ®See Page2 for
TIG h 1 Internet www. d $o -or. ov Notified/Method: , Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction 0 Demolition For special informain are checklist
Description I Qty. I Ea. I Total
-jitAddition/alterationfreplacement ❑Other: New 1-2-family'dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70 1
*and 2-family dwelling ❑ComnierciaUndustrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
O Master builder 0 Other', Fire sprinkler( sq.ft.) Page 2
.1013 SITE INFORMATION AND LOCATION Site utilities:
Job site address: �(-7 1 0 :- \x `,k-1 ,..-...:47...__, Catch basin or arca drain 18.76
Drywel I,leach line,or trench drain la 76
City/State/ZIP: 1 f Footing drain(no.linear ft.: 1 Page 2
Suite/bldg./apt.no.: Project name: 1-4-Wrif A-(.uAY Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
1"----- \7. \v' ( E E- .. Rain drain connector 18.76 6
\ ,� �, __\�, -..\----.1.:7
� ,` Sanitary sewer(no.linear ft. �) Page 2 (t.-:L ��
�" Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear It.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12,51
- Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
' Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: 144(1-14-49 w/Y`I
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
Cit}/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51 ,
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( I ) Tub/shower/shower pan 12.51
E-mail: ` Urinal 25.02
CONTRACTOR 1 • Water closet 25.02
t Water heater 37.52 J
Business name: til..c. G - .0,..::,-,.....,.�,,N-�t\`�\`c'�,. a ,-,,....c.\ LC.1 Water pipingDWV 56.29 J
Address `�� - .\�,- �� "f J Other: 25.02
City/State/ZIP:;__ Ic_ l Subtotal .
Phone:( ) ___- -,C.:i Fax:( ) ( C' .e Minimum permit fee: $72.50 y�'--'."
! 1 �� ' ' �' Plan review (25%of permit fee)
CCB Lie.: \ Plumbing Lie.no.: 1a3-P� .7 -7 L
1 State surcharge(12%of permit fee) 1 G
Authorized signature; .-' � .Z' -
//1, !�� TOTAL PERMIT FEE jl F}{ 3
r� This permit apptitation expires if a permit is not oblaiued within 18U days
Print name: i 4-/ t. ;( `i k--‘_6V• _‘5 Date.:7.7'// ic.,.
( atter it has ttCen steepled ascompkte.
'Fee methodology set by Tri-County Building Industry Service Board
::LBuildicelPereniulPLMC-PenaitApp.doc 10/0109 440-4616T(10/4PJCOM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
6710 SW PINE ST, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00137
David Young
Approx 35' sanitary sewer replacement.
Violation Summary:
Inspector Contractor