Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00354
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/06/2016
T I g Parcel: 2S104AC13000
Jurisdiction: Tigard
Site address: 12780 SW 135TH AVE
Project: Nadjaran Subdivision: HANDY ACRES Lot: 32
Project Description: Replace 20'of sanitary sewer line.
Contractor: ENVIRONMENTAL WORKS Owner: NADJIARAN, NAHIDEH
2634 SE STEELE ST 12780 SW 135TH AVE
PORTLAND, OR 97202 TIGARD, OR 97223
PHONE: 503-719-6715 PHONE:
FAX: 503-972-1866
FEES
Quantity Description Date Amount
20 If Sanitary Sewer 07/06/2016 $62.54
Specifics: 1 12%State Surcharge- 07/06/2016 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 07/06/2016 $9.96
Class of Work: ALT Plumbing
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 qu to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issue By: i $ �' Permittee Signature:
-44 , : ! is / (61--V
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.
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Plum.#in..- Permit A I licatio
. Permit
Site Utilities1HNI 9 9 ?ni,6 '.,.- • - .. - ' '-.. - .--•'FOR tii11(:1:: UNE ONI..Y .1-;••- - - ; ,:,-,---,--
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IN-• ; .: City of Tigard Receiwd
. Datol3v:
1 4, 71/4, (D.h., Pemit No.:p„,„41,„4,..0,0 35y I
.,,,- ,.. 4,1 13125 SW Hall Blvd.,Tigarkiii?,42ilif,1 ,, ,,••'.,i Al..i„i''
I
Plan Rev iow
S..' Phone'. 503,718.2439 Es;ri-?..y .A-4000 ,r;'•r ,-1 `Y,t11•1•'- 1 Orlior Portnit Niv
Duty/By
inspection Line: 503.639,41,3 a'1,„;;,,,•,;;'i.k.,1.,:: -'..,,`''; '-,',••.:,,'1).',:'*J;'
! age RaadyRy: Iwo,: , et hao Nati for 1
,..-:,:.':..::-• ..., Internet: www.tigard-orgov i Notifiedimethod: 1 8uppteeleniai informatioo
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i ED New construction I 0 DemolitionDcjpuort! For 112514Ifjyannation UP!cherklis ,
L ,,,,
Qt7.---1- Fa, r-Total,
! Ej Addition/alteration/replacement ; 0 Other: 11ew 1-2:fantlittlwellings(includes 100 ftfor each&inlay comigetiomi
4'1 „.
1 SFR 12)bath 1 1 337,78 !
1 0 I-and 24amily dwelling 0 Commercial/industrial
l----,------,,------------ ,1 -------. -------------,-..--.------„ st,R(3)Kith
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is ,
! -,.-...,Accessory b ±
hiding 0 Multi-family
TT TddTilTTIj471T ;Z':C5-1------7
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i 0 Master builder 0 Other 1 k-7-7-1--r-,---------111-71---"I"t'--- ------I
I 1-ire spookier( .,30-14( '
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i Job site address: 12780 SW 135th Ave
1------- - ----- ------ ;--
I Drywell,leach line,or trench drain
City/State/ZIP:
Pooling dram no linear 11
1 Suiteibldg"apt no' Project na'rne' i I;OP) --f)-12.374}1
MailtlitiCtured home utilities
Cross street/directions to job site: 1 I Manholes 1 1 i 8 76
,
Ram drain connector 18 16 '
, --
,
1---
, Sanitary sewer ino. !near rt.:,„Ql 1 1 1 Pne 2 i(Pal• '
i----------------------------------------------1 StOM1 KVVer mo.linear 0.:
1-.. --- ------, —_---- Water service(no linear ii ) 1 Page 2 1 !
Subdivision: Lot no.: r Fixture or pent: !
---- -
I Backflow prevenwr 1 31.27 !
Fax map/parcel no.:
1-••':•'0.!,441G,44'%ItOftW•Afaiiti.44. 74:'1'•::;iitir'-'•-"''''''K1.1"7•70.M,n77717,7,,,777;7,2,1 ! Backwater valve1
• 11 it
i *I 1.-
-- –r-- , -- — —
-1--- ----i
1 (..1.r les svasher i ' 25.02
25,02
Replace a section of sewer on property 1 Drinking fountain I 25 02
I , Eiectorsistimp
. . .1'5.02
• ;•-r-,-:771777,r477••••77-'77';••"',.; •,•••1•'11;••!,',•; '-;:•,'P7127,4.Ver-,.4'; '7,;',,,,:tr0;'117,!';'•:'77,1.r.24"77.7:14;:' r Expansion tank I I 2,51 i
i:t01-.11•10411,..:1,,It:J,1..,UTY1„,.,„,:'.;',.:,.!..,'.: 414,4%,',401416,60.,.,1_.„it'1',V1,'', 41•40:;',0tr,••,14:4!;g.','';'• 1.--•-- -
I Fixture/sewer cap 1 251)2
I Name:Nahid Nadjaran
t---- —------- ------- - ---- - ---1 ! l'loot drain/floor sink/hub 1 25.02 1 ,
Address:
1---, ---m— ---i tiarbege disposal , F.,,_
(ity/St_atcyzilt1_ „.., i I to6,q1i0 25,02 1 i
I Phone:( ) • Fats:( I I Ir makes i i 12.5 I ; !
l';'.,'---.A,,,,,r•snQt-,!,4;');17,10.00,''•-0,Wit1t-e..A.044,,,,,rt.treia-;Yre)!-,-4alwirk-opterlaglicis..j*4.4a,„441 ' Intercepturtgrsase trap 25,02 1
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Business name: ENVIR . AL WQIIKSJIIYAN leitEYER
ON% ----i 1 Medical gas(value'..1,, )
1--.--- --- --- - - - - I Primer _ 12.51 :
Contact mime; 2634 SE 6 ST.
– — i Rttofdrain(commercial) 1 12 31 1 i
I Address: PC)RTLAND,QR 97202 [ Sink/basin/lavatory
City/StateiZIP: 5034074385 --,--- i son,uniu(potable svater) I 62,54 1 1
Phone:( ) ryaLVOWOrkativi OW 1 Ftsx::f- ) ; , 'rub/shower/shower pan
I I Urinal „ 25.02.
E-mail:
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Business name: , - --7-- - --t— t -4-------1
1 Water piping/DWV , I 56,29
Address: 1 I Oher: 25.02
i City/State/ZIP: i I Subtotal 1 ,
I Fax:( i , [ Minimum pcnnit ice. $72.50 '7,A.5 i
Plan review (23%of permit fee) ---- !
CCB Lie.: 1857811 s ; Plumbing Lic.no.; -- -- —
L-- ---- — -----------------j — -- --i.;tate—s;r:barg;(12;;:C;;;;;it fis.T.1"--(6:=K.).-i
Authorized signature:
A I ITOTAL,PERMIT KE: 1 K6ti...) !
,,4,,,, ' I Ihi6 ih2ro.iit ophs4t1014 expiroli liJ pcirftlit hid(ibt4iusal‘41thir)HO di*N
Print name:Ryon Mcv•:' 10 ' I-,---,-Date:—0/29/1i; 1
after it hue have 4CUpttlii as veinal-eta,
-- ..„.„---
'Fee methodology vet by Triv(.1meav Beild111g1adevity Service Deeod
I Abe Ild i egWeilMoVet.M(),Poro*APP 5',', 1(44)2155 44i404