Permit (26) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00541
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/27/2016
g Parcel: 2S112CA04400
Jurisdiction: Tigard
Site address: 15185 SW 79TH AVE
Project: BARNUM Subdivision: DURHAM ACRES Lot: 36
Project Description: Connecting existing home to sewer: 100 ft.of sanitary sewer. Reimbursement district fee expired.
Contractor: PARKER CONCRETE INC Owner: BARNUM, KEITH L TRUST
11000 NW MARSHALL DR BARNUM, LUCILLE R TRUST
YAMHILL, OR 97148-8331 15185 SW 79TH AVE
TIGARD, OR 97224
PHONE: 503-680-9925 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 10/27/2016 $62.54
Specifics: 1 12%State Surcharge- 10/27/2016 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/27/2016 $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.
Issued By: ge."7..L.4.... (�. Permittee Signature: >
Call 503.639.4175 by 7:00 a.m.for the next available inspection da
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
City of Tigard Received
`J g 1 ' Date/By: 1 Q/.a/`ct 677-
Plan
/J / Permit No.: ��t"' f� I S�i
• 13125 SW Hall Blvd.,Tigard,OR 97223 �» Plan Review
= Phone: 503.718.2439 Fax: 503.598.1960 t Other Permit No.:
Date/By:
Inspection Line: 503.639.4175 O':( � Ready/By: -J�uris F H See Page 2 for
l I R D Internet www.tigard-or.gov 'c oh ethod w Supplemental Information
E 1F W FEE!'"'FtwflEtfl5,l
❑New construction 0 Demollt F.4. °� For special information use checklist� " Description I Qty. Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
(TE wOld'CONstRVCfo 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
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOE SITE INFORNIATION ANI)CATION Site utilities:
Job site address:15185 SW 79th Ave Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site:Bonita Road to 79th Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:pa ) / Page 2 1p2 .Ej L(
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
SON OF WOw Backwater valve 12.51
Clothes washer
25.02
Installation of sewer line to existing home currently on septic system Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
t$ pop, Expansion tank 12.51
Name:Keith Barnum Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:15185 SW 79th Ave.
Garbage disposal 25.02
City/State/ZIP:Tigard,OR Hose bib 25.02
Phone:(5023)6392724 Fax:( ) Ice maker 12.51
1;Q' tp'i!uI 0 coNTACT.PES: Interceptor/grease trap 25.02
Business name:J.T.Roth Construction Inc. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:David Jensen
Roof drain(commercial) 12.51
Address:12600 SW 72°d Ave. Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(503)8060602 Fax::(503)6240239 Tub/shower/shower pan 12.51
E-mail:davidj@jtrothinc.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Parker Concrete Water piping/DWV 56.29
Address:2850 SW Taylor Way Other: 25.02
City/State/ZIP:Forest Grove,OR 97116 Subtotal a-4;--i{
Phone:(503)9920400 Fax:(503)9920412 Minimum permit fee: $72.50 7; t)
CCB Lic.:46947 PlumbingLic.no.: f,� Plan review (25%of permit fee) a---
( + (iU` ,, ISL State surcharge(12%of permit fee) r,7()
Authorized signature: C� �'�-� Y�trvt.f �1° .' �,� it) .x 7�/ua .5.7,
TOTAL PERMIT FE rj.it
Print name: Date:10/27/201r �' "L This permit application expires if a permit is not obtained hin 180 days
after it has been accepted as complete.
/� /� P A/j�� *Fee methodology set by Tri-County Building Industry Service Board.
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