Permit (56) o
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00371
TIG R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/12/2016
Parcel: 2S109DB01800
Jurisdiction: Tigard
Site address: 13052 SW KOSTEL LN
Project: Summit Ridge No.5,Lot 145 Subdivision: SUMMIT RIDGE NO.5 Lot: Multiple
Project Description: 60 ft.of storm sewer to connect to lateral.
Contractor: G CAM LTD Owner: VENTURE PROPERTIES INC
PO BOX 1144 4230 GALEWOOD ST STE 100
CANBY, OR 97013 LAKE OSWEGO, OR 97035
PHONE: 503-263-2005 PHONE:
FAX:
FEES
Quantity Description Date Amount
60 If Storm Sewer 07/12/2016 $62.54
Specifics: 1 12%State Surcharge- 07/12/2016 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 07/12/2016 $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 direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
L __t
Issued By: Permittee Signature: ,p/...---,,04,un
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
Building Fixtures
City of Tigard _ Received
" t : � Y 0 lei _� Permit No.: �`l l a�1 - 7 r
3125 SW Hall Blvd.,Tigard,OR � ,, V•It�i'� /'
r.-� Plan Review
Phone: 503.718.2439 Fax: 503. �'"" Daffy Other Permit No.: /6-.121
1:
Inspection Line: 503.639.4175 q
Internet: www.tigard-or.gov U �! Dateoa aRethy: ra^s: 21 See Page 2 for
Notified/Method: Supplemeatal Information
r os BFE'
>� i Y µi g rpt�V�
❑New construction ,IPn ° ` For specsal information use cbeckfirt
Description I Qty. ( Ea. I Total
❑Addition/alteration/replacement ■ Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
1CA�O,co 'Ruu'1`�,ON SFR(1)bath 312.70
❑1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
Jamsrrit ct ' i oc. Site utilities:
Job site address: \'� � b n Catch basin or area drain 18.76
City/State/ZIP: ��t IIVJJ 11 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Summit Rid e
1?i i C-e-i 1Y"t(,--- 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.linear ft.:(4() Page 2
`t Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.:\YC Fixture or Item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve
t111.3N GC 1W61* 12.51
Clothes washer 25.02^1 \it/lka6`k4, \ 40-St Dishwasher
25.02
Drinking fountain 25.02
itcrii-11.));W1 LA-VIVA, Ejectors/sump 25.02
fl, Expansion teak 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 Al «icl4.rrr Q..corQm.cr: !( Interceptor/grease trap 25.02
Business name: DR Horton Inc Medical gas(value:$ ) Page 2
Contact name: Emerald Weeks Primer 12.51
Address: 4380 SW Macadam Ave Ste. 100 Roof drain(commercial) 12,51
Sink/basin/lavatoty 25.02
City/State/ZIP: Portland, OR 97239 Solar units(potable water) 62.54
Phone:(503 ) 222-4151 ext 1107 Fax::( ) Tub/shower/shower pan 12.51
E-mail: esweeks@drhorton.com Urinal 25.02
iNear4rv� Water closet 25.02
Water heater 37.52
Business name' e,„ut r I L.
WaterAddress: Q) CSC `iii iping/Dwv 56.29
� �� �/���.e 'l {�, Other: 25.02
City/State/ZIP:Q j di J ✓� Viz Subtotal
Phone:C 73•,f ,kpb- Fax:( 1 Minimum permit fee: $72.50 ,5-4
CCB Lic.:%� /`-- ‘ ��Vll I Plumbing Lic.no.: Plan review (25%of permit fee)
('�11 - State surcharge(12%of permit fee) Q
Authorized signature i I 1 4 74�
L- � TOTAL PERMIT FEE ' )
Print name: rIl 1° ! / ,J-' II Date' ke MIN This permit application expires it■permit is not obtained within 180 days
after h has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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