Permit (40) / rrm�fri) 411 4 &A✓/..v.., sc./k!(e. ice'—v03i/
CITY OF TIGARDtiECEIPLUMBING PERMIT
I ' COMMUNITY DEVELOPMENT Permit#: PLM2016-00484
t 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/21/2016
T ` �`r g SEP 2 2 2.016 Parcel: 2S103AB01000
Jurisdiction: Tigard
Site address: 11130 SW WALNUT ST CRY OF i!GA
RD
Project SW Walnut St. BUILDING 04210Y4.11N MCMICHAEL HEIGHTS Lot 1
Project Description: Abandon drain field and connect sanitary sewer into public sewer system
OFFICE COPY
Contractor: ROTSCHY INC Owner: ROGERS,ANDREW D&ANGELO D
9210 NE 62ND AVE 11130 SW WALNUT ST
VANCOUVER,WA 98665 TIGARD,OR 97223
PHONE: 360-334-3100 PHONE:
FAX:
FEES
Quantity Description Date Amount
65 If Sanitary Sewer 09/21/2016 $62.54
Specifics: 1 12%State Surcharge- 09/21/2016 $8.70
Plumbing
10 ea Minimum Fee Adjustment- 09/21/2016 $9.96
Type of Use: SF Plumbing
Class of Work: OTR
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.
Issued By: 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.