Permit (28) CITY OF TIGARD PLUMBING PERMIT
INI11. COMMUNITY DEVELOPMENT Permit#: PLM2017-00362
T[tomA D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/07/2017
Parcel: 2S101 CB00400
Jurisdiction: Tigard
Site address: 12700 SW HALL BLVD E
Project: Wood Trade International Subdivision: None Lot: None
Project Description: 100 ft.of sanitary sewer to reconnect sewer lateral to new city lateral.
Contractor: RAYBORN'S PLUMBING INC Owner: MCLELLAN ESTATE CO
PO BOX 69 BY CHRISTOPHER M CAVE ESQ
19990 SW CIPOLE RD 707 OLD COUNTY ROAD
TUALATIN, OR 97062 BELMONT, CA 94002
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
1 ea Manholes 09/07/2017 $18.76
Specifics: 100 If Sanitary Sewer 09/07/2017 $62.54
1 12%State Surcharge- 09/07/2017 $9.76
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $91.06
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:
r.
Call 503.639.4175 by 7:00 a.m.for the next available i, ,--orfdate.
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 "0 •
Building Fixtures 1 oR 01 { I( ► 1I 0y I.1
,7 �"i. Permit No.: r ► 7 -1
Cityof Tigard J w 1 ' '/
13125 SW Hall Blvd.,Tigard,OR 97223 Plan Review Other permit No.: it
■ Phone: 503.718.2439 Fax: 503.598.1960 Date/By: A . .• - `
Inspection Line: 503.639.4175 S i p 0 (`• 2 Q 1 ' Date Ready/By: Juris: ® See Page 2 or
I I''\It 1 rNotified/Method: „�„ Supplemental Information
Internet: www.tigard-or.gov
ip
¢ For special injormarionuse checkl�st
New construction 0 Der
�R'�1 r � i f / at
}1 Description 1 Qty• 1 Ea. I Total
❑Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
SFR(1)bath 312.70
437.78
SFR(2)bath
121-and 2-family dwelling 0 Commercial/industrial 500.32
SFR(3)bath
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder [I Other 1/4 l'(i 4 i t 5 Fire sprinkler( sq.ft.) Page 2
.0:1:;: ,"'''1,':::i'
? `i` r €_ t:€ 1 Site utilities:€� ��' tI",ee,�C ��� p_._ .� 18.76
•
Catch basin or area drain
Job site address: (2 760 5(.4 14 tel L ' 6 Drywell,leach line,or trench drain 18.76
City/State/ZIP: 7'4 c., as 9 q 3 3 -7--- , Footing drain(no.linear ft.: ) Page 2
t ,/ Manufactured home utilities 50.03
Suitt./bldg./apt.no.: �' I Project name: _ ;,,. . ..". t
Cross street/directions to job site: Manholes ] 18.76 i8>�
OA /
j Rain drain connector 18.76 cy
L0--- 1.)fJ Cd/►' t1!?i-/ -Sanitary sewer(no.linear ft.: 100) ( Page 2 'T /j
1 Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.: Zs f 01C-0 00 • _ 12.51
�� Backwater valve
;" ,'k` 1 r F�. . h 'J • ,'' 25.02
,i�': .,r• "-i -,,,,,t" _ , _ ". Clothes washer
(r,r.Insc-' S'i,,.r(f- (o.-v . f 40 /1Cz-..; Dishwasher 25.02
Drinking fountain 25.02
G�' (r... ( Ejectors/sump 25.02
' � am ..-. ' r . r Expansion tank 12.51
':•;`.-.-4-' ' 4+ <- ° d . , �` � -' •2 •,:',-,:-4 7 „1a
25.02 1
Fixture/sewer cap
Name: !NP /t((A4 of 71; c v Floor drain/floor sink/hub 25.02
Address: c- 30x 906, Garbage disposal 25.02
City/State/ZIP: ? 61-64.6"47 CA ci'g0D 2 Hose bib. 25.02
Phone:(lir) s-17-9/7 Fax ( ) Ice maker 12.51
• # Interceptor/grease trap 25.02
4 _ , :1.i.._ e z, : Page2
Medical gas(value:$ )
Business name: QA,/,3,,,ix PL M r3/.J G
Primer 12.51
�" Roof drain(commercial) 12.51
Contact name: �f}�s f f met:nSJ.,!
Address: (1q?fo 5c,/ c Sink/basin/lavatory 25.02
Solar units(potable water) 62.54
City/State/ZIP: ��fnra f;, ergc7 7-067- Tub/shower/shower pan 12.51
Phone:(5a3 )0t- yi31 I Fax::(5-03 ) 69 i - 232 8 25.02
Urinal
E-mail• M 25.02
>q S f(' yj)(L✓S r 'OWater closet
CONTRACTOR Water heater 37.52
Business name: kA`(atyLnl pc,04,44(,_ Water piping/DWV 56.29
Address: f�'j eyqo st,i ( ii,°dLL g a Other: 25.02
Subtotal _
City/State/ZIP: yy(G,r,"n d 517-19 C 2
12 Minimum permit fee: $72.50 6(-. -
Phone:(5a3 ) Z Yl3 Oi Fax:(5-03) (-- 2 3 7 Plan review (25%of permit fee)
CCB Lic.: $-?•1)S'Z Plumbing Lic.no.: 3(../-/6`ed - State surcharge(12%of permit fee) G( 71...0.'•
Authorized signature: % i----7_____--
TOTAL PERMIT FEE £( p6
This permit application expires if a permit is not obtained within 180 days
Print name:041.43 E/ot L.Je/r-SJ;--) Date: 3/4(16_24 7, after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.