Permit Support Document CITY OF TIGARD PLUMBING PERMIT
s Permit#: PLM2018-00309
0 COMMUNITY DEVELOPMENT101
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 t �j� Date Issued: 06/25/2018
i t A 1-Cy g Parcel: 2S103AB00401
Jurisdiction: Tigard
Site address: 11345 SW WALNUT ST
Project: Charlton Subdivision: None Lot: None
Project Description: INSTALL NEW SANITARY SEWER LINE FROM SEPTIC TANK TO EXISTING LATERAL ON PROPERY VIA
DIRECTIONAL DRILL. 6/28/18:REPRINT to change address from 11325 to 11345.
Contractor: SANITECH LLC Owner: BERMAN, JOHN M
201 SHIRLEY ST MYERS,THOMAS L&DIANE E
MOLALLA, OR 97038 7175 SW BEVELAND ST STE 210
TIGARD, OR 97223
PHONE: 503-803-1207 PHONE:
FAX: 503-303-8238
FEES
Quantity Description Date Amount
50 If Sanitary Sewer 06/25/2018 $62.54
Specifics: 1 12%State Surcharge- 06/25/2018 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 06/25/2018 $9.96
Plumbing
Class of Work: ALT 45 Misc Other Fee 06/28/2018 $45.00
Type of Const:
Occupancy Grp:
Stories:
Total $126.20
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: / r 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.
,
Plumbing Permit ApplicationRi,CFAIVEP
..0 . ,
Site Utilities FOR OFFICE t..SF, ONI,v
City of Tigard
;UN 2g 201'3 Received n�
Date/By: i---- Cs ermit 1499-4(.2078-1-(7.1._.-
499-'// J / Y
13125 SW Hall Blvd.,Tigard,OR 97223 + �� ( OOO !!�� �r//- ��6 1
I 0 TIC- ,vPlan Review
Phone: 503.718.2439 Fax: 503.598.1 5 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 1
TIGARt) Internet: www.tigard-or.gov 5
C Read iB
-�ilt:DIN("; _ 1rt'--' Ready/By Juris See Information
9 F otified/Method: Supplemental Information
TYPE:OF WORK.. _
FEE* �f'HEDUI.F ° ,
0 New construction 0 Demolition For special information use checklist
Description 1 Qty. .1 Ea. .1 Total
Addition/alteration/replacement 0 Other:
New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF'CONSTRUCTION ., SFR(I)bath 312.70
PS 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
❑Master builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: i i "-L� Lt)ai I► - ie Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: d 5
.1-1!) I U�Y)
-1 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: ````�) Manholes 18.76
IRVIf / a r. ss V1 1 re-VI:N y e i Rain drain connector 18.76
r
A.l Nvt a ht P_/-v h 2 12)9 iJ Sanitary sewer(no.linear ft.T1..)) J Page 2
lJ 1 t F V l ?V ( 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
DESCRIPTION OF WORK Backwater valve 12.51
} �� ,p ) � Clothes washer 25.02
'y"�lt- 5� -, i ,,J t` I) Dishwasher 25.02
d-ex-Al � 0(l p \4 (,+t,Y.1U. Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER ; . ,❑TENANT Expansion tank 12.51
Name: t \a,t 41011,1 () pi-f -„r. Fixture/sewer cap 25.02
fel �"t ` 1 1 (11 I Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT" 0 CONTACT<PERspN, ,; Interceptor/grease trap 25.02
Business name: r] Y1 t" ji ( t o Medical gas(value:$ ) Page 2
Gu K ^ ' t-"�^ -, Primer 12.51
Contact name: b Pivt d ' ,2 i"- A
� y�, L/-..{( Roof drain(commercial) 12.51
Address: fL ►" )( -1 Sink/basin/lavatory 25.02
City/State/ZIP: . i 4 "° qiC) Solar units(potable water) 62.54
Phone:( )e' -{„� Fax:: )t 0.7;49. Tub/shower/shower pan 12.51
E-mail: 5a' 4e f 1 o1 nt t t/�. ./u..in tJ . Urinal 25.02
t.tLL• 1 1C 1 Water closet 25,02
CONTRACTOR
�y �"�"=� p� Water heater 37.52
Business name: sSi��-I _I.0,C I Water 1 ina WV 56.29
�{ pip
Address: IP tet' Other: 25.02
City/State/ZIP: kD LD t3 Subtotal
Phone: ) `-1,4--1"i Fax: A-- '1, Minimum permit fee: $72.50
CCB Lie.: L e9 i9 Plumbing Lic.no.: p6it Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: �+ � TOTAL PERMIT FEE
Print name: ' r C ip\ t---?4,..4 .1 j A Date: �/ I t This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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