Permit (89) CITY OF TIGARD PLUMBING PERMIT
111 11; COMMUNITY DEVELOPMENT Permit#: PLM2017-00447
T IGA RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/30/2017
Parcel: 2S 103AA02800
Jurisdiction: Tigard
Site address: 10495 SW CLYDESDALE PL
Project: MCCLUNG Subdivision: CLYDESDALE Lot: 9
Project Description: 7 ft.of sanitary sewer repair for root intrusion.
Contractor: DAVID LINN TRUCKING AND EXCAVATION Owner: MCCLUNG, HALEY N
PO BOX 316 10495 SW CLYDESDALE PL
BRIGHTWOOD, OR 97011 TIGARD, OR 97223
PHONE: 503-701-7053 PHONE:
FAX: 503-662-1049
FEES
Quantity Description Date Amount
7 If Sanitary Sewer 10/30/2017 $62.54
Specifics: 1 12%State Surcharge- 10/30/2017 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/30/2017 $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: ittee Signature: 4 ttV1
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
Site Utilities
FOR OFFICE USE ONLY
iNN44.,_,..coI:V-Al � Received
City of Tigard >'' Date/By: t(3,1 7 Permit No.:- ql 13125 SW Hall Blvd.,Tigard,OR 97223 j G /1 � �(��(� ��7
t� Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 t� i '3 v DateBy: Other Permit No.:
TI G A R n Inspection Line: 503.639.4175 kik-, ' � � ate Ready/By: Juris: H See Page 2 for
Internet www.tigard-or.gov
,
a l (.) ted/Method � Supplemental Information
11
.,, 3 ,� _ ,FEE* APW
❑New construction ' For s ecial in ormation use checklist.
®Addition/alteration/replacement ❑Other: Description Qty. I Ea. I Total
New 1-2-family dwellings(includes 100 ft.for each utility connection)
;faTC ' F LfiCT31 SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builder 0 Other: Each additional bath/kitchen 25.02
Fire sprinkler( sq.ft.) Page 2
tali )1 `�` Q ** LO 1O Site utilities:
Job site address:10495 SW CLYDESDALE PL Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 1 Project name: Manufactured home utilities 50.03
Cross street/directions to job site: :,:)i.,1/4)X fr ilk ^° Manholes 18.76
t�l: �1 V--
Rain drain connector 18.76
- Sanitary sewer(no.linear ft.: '7 ) I' Page 2 (61" ,S i
Storm sewer(no.linear ft.: ) Page 2 �T�
Water service(no.linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map/parcel no.: 25103 AR 7..Zoo Backflow preventer 31.27
µ, ... ,i D1E CR PTI O.UWG
Backwater valve 12.51
Clothes washer 25.02
Spot repair via trench to repair root intrusion in 4"cast iron line. Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
' ` jwAC;')8,y, Expansion tank 12.51
Name: Hat ell MC CI uh Fixture/sewer cap 25.02
1 Floor drain/floor sink/hub 25.02
Address: (0
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:(503 ) 47C,-(,1„56 Fax:( ) Ice maker 12.51
�t '1tilEic.� '; ❑_'..co$tAiT`PER$O Interceptor/grease trap 25.02
Business name:Sygnet Solutions,LLC. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Maleah Hammons-Gumienny
Roof drain(commercial) 12.51
Address:PO Box 1707 Sink/basin/lavatory 25.02
City/State/ZIP:Clackamas,OR 97015 Solar units(potable water) 62.54
Phone:(503)882-2104 Fax: :(503)213-7682 Tub/shower/shower pan 12.51
E-mail:SygnetSolutions@gmail.com Urinal 25.02
� Water closet 25.02
li ... Q! 1;ACTOR. "V
Water heater 37.52
Business name:David Linn Trucking and Excavation Waterpip in WV 56.29
Address:PO Box 316 Other 25.02
City/State/ZIP:Brightwood,OR 97011 Subtotal 6d j'°
Phone:(503)701-7053 Fax:(503)662-1049 Minimum permit fee: $72.50 7 ,Si)
CCB Lic.:205239 Plumbing Lic.no.: ,P.C7)t•1 Plan review (25%of permit fee)
ail l� State surcharge(12%of permit fee) ��;
Authorized signature: X71/%t�, TOTAL PERMIT FEE ''6"1 A
� Yrtrf,�?KL�/
This permit application expires if a permit is not obtained within 180 days
Print name:Maleah Hammons-Gumienny % Date:10/17/2017
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)