Permit t CITY OF TIGARD PLUMBING PERMIT
`p1 COMMUNITY DEVELOPMENT Permit#: PLM2020-00101
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/05/2020
TIGARD g Parcel: 2S103AD03900
Jurisdiction: Tigard
Site address: 13060 SW 107TH CT
Project: HUGHES Subdivision: PATHFINDER Lot: 29
Project Description: Replacing 80 ft.of sanitary sewer.
Contractor: NORTHWEST CONCEPTS & EXCAVATION Owner: HUGHES, MARJORIE FRANCES & JOHN
17242 S CARUS RD 13060 SW 107TH CT
BEAVERCREEK, OR 97004 TIGARD, OR 97223
PHONE: 503-632-3400 PHONE:
FAX:
FEES
Quantity Description Date Amount
80 If Sanitary Sewer 03/05/2020 $62.54
Specifics: 1 12%State Surcharge- 03/05/2020 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 03/05/2020 $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:• 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 Application
Site Utilities
City of Tigard ece;ved
r • 13125 SW Hall Blvd.,Tigard,OR 97223R ate By: d e Permit No.:�i il�9_ 1
• Phone: 503.718.2439 Fax: 503.598,19ECEIVEC IanRevieww � - y : /� �Ihl
Inspection Line: 503.639.4175 tt Date By: Other Permit No.:
3 !GARt) Internet: wv✓w.tigard-or.gov MAR 4 207P Date Ready/By: ) -
See Page 2 for
i
Notified/Method: '- Supplemental Information
TYPE OF WORK :- r�g.
p�(,;��tI of e .ar`e tab FEE* SCHEDULE
0 New construction ❑DetltylldOn For special injarntation use checklist.
Addition/alteration replacement Description I Qty. I Ea. I Total
❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUC"IYCN SFR(I)bath 312.70
0 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Ascessoty building SFR(3)bath
0 Multi-family 500.32
El blaster builderEach additional bath/kitchen 25.02
0 Other: Fire sprinkler P ( sq.R) Page 2
JOB SITE INFORMATION AND LOCATION Si[!utilities;
Job site address: .1 Catch basin or area drain
-W 18.76
City/State/Z1P: -1--,,,G\ac , ) Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldgapt.no.: `-' I Project name: fil, ��
Manufactured home utilities 50.03
Cross street/directions to job site: i path
W 1 d� < G t Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:rC(j) / Page 2 �+-04
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
1 DESCRIPTION OF WORK Backwater valve = 12.51
{ Clothes washer 25.02
` ` j71Lj(•l .`�.-�`- l?"IC ).0,1 T 0'(s. i�'Q.tAY C Dishwasher 25,02
`•'' thinking fountain 25.02
I Ejectors/sump 1 25.02
ri PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: koeti `_e._ Fixture/sewer cap 25.02
o
t,31-N .AP \fit, Y
Address: Floor drain/floor sink/hub 25.02
City/StetelZlP: Garbage disposal 25.02 1
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
10 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:` Medical gas(value:S ) Page 2
Pos
Contact name: y , 0( t� �V,CX_ Primer 12.51Address: tRi` / CO Roof drain(commercial) 12.51
1�Jt4 Sink/basin/lavatory 25.02
City/State/ZIP: e Y ok cC tg (k'-}cA - Solar units"t V (potable water) 62.54
Phone: ,-p,) a t'7 k,!y1 I Fax::( ) Tub/shower/shower pan 12.51
E-mail''� (l [ t ix !i cos ( /°Viq g Urinal 25.02
if, a � 1 R. it Water closet 37.52
Business name: .{",� Water heater 37.52
4 O ((fit�5(�i Vf: c\ .D 1)cAr)c Water piping/DWV 56.29
Addresij: t"` A L 9), (.L NI s,i Other: 25.02
City/State/ZIP: fJl1,.'`ex-Cf- I -I
`"1 (tl�� } Subtotal 6,a s-y
Phone: } 1 7Fax:( ) Minimum pennit fee: $72.50 -?A-5)
C� i L��J Plumbing Lis no.: Plan review (25%ofpemut fee)
CCB Lid.:
Authonied signature: ' State surcharge(12%of permit fee) 8!- d
1 TOTAL PERMIT FEE h �
Print name: e 1 )f Di fyi e (,,, Date: 1 " '. This permit application expires if a permit is not obtained wit 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building industry Service Board.
I:1Buitdingll'pmitatpLMU-PennitApp.doe lOoIA9 440.4616T(1a/02/COM EB)