Permit (167) .111 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00073
Date Issued: 02/27/2019
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S103AB02300
Jurisdiction: Tigard
Site address: 11320 SW WALNUT ST
Project: LANDWEHR Subdivision: ECHO HEIGHTS Lot: 9
Project Description: Connecting existing house to sewer: 140 ft. of sanitary sewer.
Contractor: BLACK ROCK UNDERGROUND LLC Owner: LANDWEHR, LUKE A
267 NE 34TH PLACE LANDSBERG, JENNIFER M
HILLSBORO, OR 97124 16669 SW RIGERT RD
BEAVERTON, OR 97007
PHONE: 503-747-9312 PHONE:
FAX: 503-214-5886
FEES
Quantity Description Date Amount
140 If Sanitary Sewer 02/25/2019 $100.06
Specifics: 1 12%State Surcharge- 02/25/2019 $12.01
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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.
''---276:rol5—
Issued By: a ttee 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 Application
Site Utilities FOR OFFICE USE ONLY
d EIVEReceived
- City of Tigard Permit No.: 3
• 13125 SW Hall Blvd.,Tigard,OR 97223 2 2��9 Date/By: r2 !k �L�►')a�)�4 � 7
Phone: 503.718.2439 Fax: 503.598.1960 FEB Plan Review
Date/By: Other Permit No.:G ip�ty- S-
I
Inspection Line: 503.639.4175 �'
T IGARD s i 1 AR O.Date ReadyBy: Juris: iH See Page 2 for
Internet: www.tigard-or.gov (,1 0 y t,, (- AIatiGed/Method: G Supplemental Information
TYPE OF woRK3UILOING IVIS1 N FEE* SCHEDULE
E;)New construction 0 Demolition For special information use checklist
Description 1 Qty. I Ea. I Total
/e IN Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
�' CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
�
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: �/ J
�(O S, -W` ' t l q`IA GA- Catch basin or area drain 18.76
City/State/ZIP:� 0 A Drywell,leach line,or trench drain 18.76
i_I4,.\(.4. 1 T. Footing drain(no.linear ft.:_) Page 2
1' Suite/bldgiapt.no.: Project name: �rt(wriA r Manufactured home utilities 50.03
C' Cross street/directions to job site: Manholes 18.76
c\1 Rain drain connector 18.76
Sanitary sewer(no.linear ft.:140) a Page 2 ick),040,
`0. Storm sewer(no.linear ft.:_) Page 2
Water service(no,linear ft.:_) Page 2
r- Subdivision: I Lot no.: Fixture or item:
_iTax map/parcel no.: Backflow preventer 31.27
t.. DESCRIPTION OF WORK Backwater valve 12.51
� t 1 Clothes washer 25.02
T:\''' L�(BGG\;1 o ` Ic1\1 1 ll Y'%(A) ,1A�A(., Se..,e(' Dishwasher 25.02
�Ov� A` ow G y4o 4 (14 16, Drinking fountain 25.02
t.el.; 560% cl‘C e - S- L as T1w 1014`4-�`�4" ` Ejectors/sump 25.02
I�J7PROPERTY OWNER 1 ❑ TENANTS;ftN.t�t' c. Expansion tank 12.51
Name: Z.,./.4 / ���,"cr/„Y- ,..f. �-c/t9V �,in fit - Fixture/sewer cap 25.02
s t' ey
Floor drain/floor sink/hub 25.02
E�
` Garbage disposal 25.02
.S Address:
City/State/ZIP: Hose bib 25.02
' ' Phone:( ) Fax:( ) Ice maker 12.51
, ❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
1 Contact name: Primer 12.51
�) Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
l City/State/ZIP: Solarunits(potable water) 62.54
- Phone:( ) ]Fax::( ) Tub/shower/shower pan 12.51
E-mail: 1, ke blackrocA‹wYIOI ('0ken.a.•com Urinal 25.02
Water closet 25.02
CONTRACTOR
Q Water heater 37.52
Business name:� Gk aG (�k V t OUYJ. 1 L�-G Water piping/DWV 56.29
Address: gcif-i NC --514A . PI Other. 25.02
City/State/LIP: `-M1 k oc' dR s 1 �11 Subtotal f al
Phone:
(cam) 141`9 31r1 Fax:( ) Minimum permit fee: $72.50 6
of
CCB Lie.: 1 C%4 11 a Plumbing Lic.no.: P Sit-155 Plan review (25%of pet mit fee)
L 1 State surcharge(12%of permit fee) /A,C7
Authorized signature: TOTAL PERMIT FEE -//A.07
Print name: 00(2..E\ INAi%) C\I t Date: This permit application expires if a permit k not obtained wl hin 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
LiBuildtnePennitsTLMU-PermitApp.doc 10/01/09 440-0 6t6r(t0i02/COMWEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11320 SW WALNUT ST, TIGARD, OR, 97223 March 12, 2019 at 1 :12:58 PM
Record Type: Record ID:
Residential - Plumbing PLM2019-00073
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Approved with inspection.
Pump receipt received. Septic tank filled.
Violation Summary:
Inspector Contractor