Permit � � CITY OF TIGARD PLUMBING PERMIT
; ' : COMMUNITY DEVELOPMENT Permit #: PLM2011 -00257
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/11/2011
Parcel: 2S103CC08800
Jurisdiction: Tigard
Site address: 12130 SW KELLY LN
Project: Clark Subdivision: WHISTLER'S WALK Lot: 35
Project Description: Install 30' of sanitary sewer line and 30' of water service, (1) hose bib & (1) sink to existing shed.
Contractor: UPMF LLC Owner: CLARK, CHRISTOPHER W
17201 BEATON RD SE 12130 SW KELLY LN
MONROE, WA 98272 TIGARD, OR 97223
PHONE: 360 - 794 -5557 PHONE:
FAX: 360- 794 -5502
FEES
Quantity Description Date Amount
30 If Sewer Service 08/11/2011 $62.54
Specifics: 30 If Water Service 08/11/2011 $62.54
1 ea Hose Bib 08/11/2011 $25.02
Type of Use: SF 1 ea Sink 08/11/2011 $25.02
Class of Work: OTR 1 12% State Surcharge - 08/11/2011 $21.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $196.13
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, • wo • suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility ...tification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 -00 '0 :0. You may obtain a copy of the rules
or dir•ct questions to OUNC b : ing 50 2.1987 or 1.800.332.2344.
Iss ed By: I #0 (v Permittee Signature: �� �,�i
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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.
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Plumbing,Pemit-Aptilkation
Building Fixtures
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, . Supplemental Information
:' ''TYPO 'WORK . . . FEE* SCHEDULE
0 New construction 0 Demolition For special infornuilien use cites-Mt
is
Description ___ 1_, 'Qty. I F. I Total 1
-,,
0 Addition/alteration/replacement _ 0 Other: NeSy,L1=' (includes 100 ft. for each utility connection)
CATROORY ;OF CONSTRUCiToN SFR (I'fbatE 312:70 T -------- 1
...... .. r ,
, ,, . STE2' 437 78
0 1- and 2-family dwelling . • 1.....bCommerCialiinclustrial
SFR:(3),bath: 500 32
EI Accessory building 0 Multi4amily -I
Each additiOna1 bath/kitchen 25.02
O , Master builder 0Other: Fire sprinkle( sq. ft.) Page 2
4I5IP SE PWO*ATION , AND , LOCATION , Site utilities:
Catch ice:silt:oral area 18.76
Job site address:12130:k,Lane
Drywall; leach line, or trench drain 18.76
City/State/ZIP:T , igard, , Or. '97223 - .
,•FoOtingAittin (no,. lineal ) Page 2 •
Suite/bldg./apt, no:: , Project name: Shed . ,'Manufaetured'horne utilities 50:03
Cross strect/directions'66 job Me: It.) ,anbeies 18.76
Rain drain connector 18.76
Sanitary setydr (no. linear:ft:7:30 )- 'Page 2 61
Storm SeWer (no. linear 11,40r Page 2 t
S'ir' I
Water so (no. linear ft.: $C) ) Page 2
Subdivision i Lot no.: , FIX or iterni ______•_,___
, Backflow prevente 31.2?
tax mapiparcel no.: ..........
DESCRIPTION OF WORx ' Backwater valve 12.5
--
' Ciothes,washer 25.02
Install waste and feed lines to shet1fneSink
. Dishwasher 25:02
... Driiii(ing:Inuntain 25.02
__
Ejectnrs/sucup 25.02
21 PROPERTY -OWNER I 0 TENANT , Expansion tank 12.51
, -- -
• Fixture/sewer cap ,25.02
Name: Kelly Clark .
Floor"drain/floor 2502
Address: 12130ICelly, Lane
Garbage disposal 1 25.02
City/State/ZIP: Tigurd, Or (lose bib 1 25.02 525.
Phone: (503)360-3566 Fax: ( ) Icepalrer - 1 12.51
ti **:4C14-1;:r NT' PERON S
_ a COTAC
.. • Intercemor/itreasetrap 25.02 _1
Business Warne: lif:?M..:g." Z e e. , IVIedical g,liS(valuc 3 )
„ - - , Page 2
. - , Primer 12.51
Contact name: //na c A ,, .
fr7,-,..)e.:. k ,, . . , E 12.51
.,,,
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Address: i :t..V 6e4, /7 72-a .....‹E : SinkibaSinflavatory / 25.02 0 7,47. 4 *
Ci ty/State/Z1P: ''o4 r ,,,e. ,,,,..4. f:''. F 2 ., '7,2_,.._ _ Solar unite (potable water) ; 62 54 -
Phone: (M) iv': ....? - i .53 . '7 ,
1 Fax' : ( 7
, ....,. Tulyshowerislinwer.pan
______ ..._ ._ _ 12 51
/ ' Urinal 25.02
E ntail: c r , . , , A , : , i f d zgr 0 j' c' , 'i,,-
Water closet 25.02
CONTRA OR
. War& heater ' 37.52
Business - name: ty , ,,c 4 L..;C Water pining/OWN' 5629j
Address: i 774 i d g e e t ,.. frif .. ..s'E-, ' Other: C l 25.02
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City/StateIZIP: /4/1077 i o u - 2 qk 2 , - Subtotal
Phone: g'fl 7.,
.F-, . 3 , , s - s , ,- , : - F......-(7 -.
0 ' ' f 4/ ,,s7a2,:. , mihimum permit fee: 372.50 o 1
2rm I
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CCB Lie.: /-,. , ,,,, . 0 19 11,19,1: Lic no.: ireTy 2- Plat ( ,. 5% of peit lee) :
13_1_1
Aorized signal ::jeg:0WAIIIIIIIWXIMr _ I i 11'4 State surcharge (12% of per
uth mit feet -** Lc6
roTAI_ PERMIT FEE ,
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Print name: i fy) a r t (..,.., ,,, prc . Date: 87.7....i/ This permit application expires if" pennit Is ow obtained iii thin ISO ti.;r
after it'has been accepted'. complete. 1 3
•pce methodology set by "Fri-County BuildIng Industry, Serves Road / 6 •
I ,tioildinglPemut,PLMLI-PermicApp.doc 10101419 440.4616T(10.'02.1
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