Permit (134) 71q CITY OF TIGARD PLUMBING PERMIT
:? COMMUNITY DEVELOPMENT Permit#: PLM2017-00315
TIGARD13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/02/2017
Parcel: 2S103BA00600
Jurisdiction: Tigard
Site address: 11765 SW WALNUT ST
Project: Drake Subdivision: None Lot: None
Project Description: Install 100'of sanitary sewer line and ejection pump to connect to public sewer system. Septic system must be
certified that it has been pumped and filled or removed prior to final inspection.
Contractor: PRO PLUMB Owner: DRAKE, GEORGE L&LINDA K LIVING
4125 SE 102ND AVE 11765 SW WALNUT ST
PORTLAND, OR 97266 TIGARD, OR 97223
PHONE: 503-867-5042 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 08/02/2017 $62.54
Specifics: 1 ea Ejectors/Sump 08/02/2017 $25.02
1 12%State Surcharge- 08/02/2017 $10.51
Type of Use: SF Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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.
or-
Issued By: � �� Permittee Signature: �� P2./� ? _
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.
lifCEIVED
Plumbing Permit A plica
Site Utilities AUG 2 2017 I t)i' t 11 L II I ,I. O.1 ,
City of Tigttrtl �'4 /7 (I- Penult No e /7-20.57....S:• 13125 SW Hall Blvd.,Tigard,O OF TIGARD Plan Review
' w Phone: 503.718.2439 Fax: S0 Data/t1y; Other Permit NStaai#17•-eiji g5/
Inspection Line: 503.639.417131111,DO G DIVISION Date Read/B Lurie: la Ste rage 2 for
Internet www.tigard-or.gov Notitied/Method: So entai Information
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0 New Construction 0 Demolition For special hl/brnoulon use checkllsx
Description r Qty. I R. r l'ota1
El Addition/alteration/replacement 0 Other: New 1-2-famil dwell' includes 100 ft.for each utili connections
�.( rr.`s:1' d t'„itiVIOia 'rr°il a dki1.;",, f" , , a SPR(I)bath NM 312.70
El 1-and 2-family dwelling 0 Commercial/industrial SPR(2)bath 437.78
SFR(3)bath 500.32
Q Act:ussory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: • Piro sprinkler(_sq.ft.) Page 2
r , 4 r 1I 7a 1 t' i o ` V i'"I1 u 6i"" a '44144-10,10 Sitc n1i1111ca:
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Job site address:11765'SW Walnut Catch basin or area drain 18.76
Drywall,leach line.or trench drain 18,76
City/State/ZIP:Tigard,OR Footing drain(no.linear ft.: I'age 2
Suite/bldg.apt.no.: T Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:l0)) Page 2 ,s":e.52
- Storm sower(no,linear ft.:_) Page 2 1,,2.5
Water service(no.linear R,:•�) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: ".. Ick flow prcvcnter 31.27
S ,711,,,,„;,,,, q �IX1711 O r 7�P e'„:O1y ' "1' ''='
Backwater valve 1251
,t!.� ,r •" 4 `'+,,', rt,,, % s, �n'., � , !it p ` ' -'';34' trr.4a ;�:,,,y
Clothes washer 25.02
Drill 100 ft of sewer and Install sewage ejection pump Dishwasher 25,02
Drinking fountain 25.02
Ejectors/sutnp 1 25.02 25,02
12,51
} 1.+kt � 9k4rm I;''/ o� ` '-; •, ,..'44a.'!"leg $r iy ii ,,,,$), rt•t,r tlxpansiontank
Name: _1r %4'lL6l C�'ge/ , LI JO ' Fixture/sewercap 25.02
Floor drain/floor sink/hub 25.02
Address: S 6-r-ic " " Garbage disposal 25.02
City/State/ZIP: i-lose bib 25.02
Phone:(L, ) Fax:( ) leo maker 12.51
MIA't;st�ij u�,lvlQt 14f, Eix,i 1n I 4' i �,:1. litfoitfoe. B ;:, 1/d !: 'Y ��,r^'t ,4,•l rt� 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:( ) Fex::( ) ' Tub/shower/shower pan
12,51
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E-mail: Urinal 25.02
Wetor closet 25.02
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r, II, :1 4'4',� ,l'I 'V,Ice '1 n.4 li b:b , . rt'a.,,,.,4V.•,t,,,•wi. -{. .ti.,^iv...N. ..• :i.•r;,•� ' Water heater 37.52
Business Hume:Pro Fleet NW Pk& /0 4-141-i 6 Water piping/DWV 56,29
Address:4125 S1;102nd AveOther: 25.02
City/State/ZIP:Portland,OR Subtotal 5(m
Phone:(503)946-1733 Fox:(503)719-6304 Minimum permit fee: $12.50 '
CCB Lk:185634 Plumbing Lie.no.:PB 1521 Plan review (25%of permit foo} to S
/ State surcharge(12%of permit tie) ,l1.-70-
Authorized signature:. Ale, • J , TOTAL PERMIT PEE ,8•l!lt1'
-
Print name:Jennifer Ket Der Date:7/31/2017 This permit application expires lia permit Is not obtained within 180 days
after It has been accepted as complete (le,e/7
"itce methodology sot by Tri-Conoty Building Industry Service Board.
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