Permit (3) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2019-00405
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/07/2019
T l c;.r\R - g Parcel: 2S103AA04600
Jurisdiction: Tigard
Site address: 10965 SW ERROL ST
Project: COLEMAN Subdivision: ECHO HEIGHTS Lot: 5
Project Description: Rerouting 100 ft of sanitary sewer line.
Contractor: EXTECH NW Owner: COLEMAN, CODY&RACHEL
PO BOX 68682 10965 SW ERROL ST
MILWAUKIE, OR 97268 TIGARD, OR 97223
PHONE: 971-201-7656 PHONE:
FAX:
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 10/07/2019 $62.54
Specifics: 1 12%State Surcharge- 10/07/2019 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 10/07/2019 $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 OA' 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC b calling 503.23 1987 o 1.800.3 .2344.
Issued By: Permittee Signature: c'er COV7S0S,7
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.
RECEIVED
OCT 4 2019
Plumbing Permit ApplicationCITY N� DGARD
l nes � BUILDING: DIVISION
-Site-13tittti.s-._
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IIICity of`Tigard J 1 # n /���
erred
13125 SW!tall H1vd,flq:ud,uk 97221 nsu nr_ L .4 a,.., ilk �i_ _L..-1�
Phone 503 718 2439 Fac ;.03 598 1V(di Wm Rewece
Other MAIO No
Dale Di __ —.---
-1 1 t,P,t 1 Inspection!inc 503 639.1175 Date Rmxy Dy tort. F1 tine rage I inn
Internet nwtt ng rt-orgw Noutied/Method '3upldeaenMl infurmaI,n
TYPE OF WORK FEE" SCHEDULE
0 New cont.tructiort ❑I}etnohitmn For information nsr rherdtisL
I. •• �Description I �ti Ea alat
AddmionlalttnGat•repl <ement 0 Other:
New 1-2-faaail dweaia, _ includes 100 II fur each uu11t•connection
I •-- CATEGORY OF CONSTRUCTION SFR(1)bath .- 31270
I-and 2-tarnily duelling ❑Commerciallindu&trial SFR(2)bads 477,7& •
. SFR(3)bath 500 32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02 _
❑Mas0.vbuilder Q Other.
Fire sprinkler( sq.ft) Page 2
rt
JOB srrE INFORMATEON AND LOCATION utilities:
A
f Job site address: 10 t� t Catch basin or area drain 18,76
# t� f Dryweft teach line,or trench drain 18 76
! City/State/ZIP: Footing drain(no.linear ft.:�) Page 2_
Suite/bldg apt.no.: Project/tame: Manufactured home militias 50.03
Cross street/directions to job site: Manholes 1876
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:l % Page 2
Storm sewer(ma.linear It:_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or iteat:
Tax map/parcel nu.: Backtlaw preventer 31.27
DESCRIPTION OF WORK
Backwater valve 12.51
. Clothes washer 25.02
'""t
s" C1 " 0 a* Dishwasher 25.02
( t
♦ a_r t r e,s5 Nokias fountain 25.02
•+ Ejectors/sump 25.02
D PROPERTY OW14-4: ®TEFL NF ExParniontank E2.51
Name: eU 1 Zl r alit t y A l e el Fixture/ewer25.02
Floor drain/floor
sink/hub 25,02
Address: Garbage disposal 25.02
i City/State/ZIP: ERise bib 25.02 1
Phone:( ) Fax:( ) ice maker 12.51
0 AP?L*CANT 0 cotmi+r PERSON Enterceptodgeeesc trap 25.02 t
Business name' Medical gas(value:$ ) Page 2
Prima 12.51
Contact name: Roof Blain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/Slate/ZIP: Solar unks(potable water) _ 62.54
Phone:( ) 1 Fax::( ) Tub/shower/shower lava 12.51
E-mail: t_ ) 1 h W a G.el ti'v\ Urinal 25.02
- . ,rOlt Water close r 25.02
Water heater 37.52
Business name: 6 T 1., Water piping/DWI/ 56.24_
Address: tit ! r.- Gther: 25 02
City/State!LIP: f ' it ILL), p . °R.. .,_..Ct"1Z ,tja �N Subtotal
) 1 . Fax:( )_ Mini rum pcmnit fee $72,50
Phone:
�� ,„:•-- Plan review (25%oimint fee)
CCB Lie.: 22, Plumbing Lie.nu.: — - �,
State surcharge(12%ofperinit fee)
Authorized signature: .....,,, li
__ Tam.PERMIT FE:ti
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