Permit �� CITY OF TIGARD PLUMBING PERMIT
ihi "- COMMUNITY DEVELOPMENT Permit#: PLM2013-00288
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TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/20/2013
Parcel: 2S104AC00600
Jurisdiction: Tigard
Site address: 12925 SW 132ND AVE
Project: Onpoint Community Credit Union Subdivision: MORNING HILL NO.1 Lot: G
Project Description: Replace 50'of sanitary sewer line.
Contractor: SANITECH LLC Owner: ONPOINT COMMUNITY CREDIT UNION
201 SHIRLEY ST PO BOX 3750
MOLALLA, OR 97038 PORTLAND, OR 97208
PHONE: 503-803-1207 PHONE:
FAX: 503-303-8238
FEES
Quantity Description Date Amount
50 If Sewer Service 08/20/2013 $62.54
Specifics: 1 12%State Surcharge- 08/20/2013 $8.70
Plumbing
10 ea Minimum Fee Adjustment- 08/20/2013 $9.96
Type of Use: SF Plumbing
Class of Work: OTR
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: ,(15111 (2./././(i_j_e_ Permittee Signature: ON, `/,o fpL �
L f--rzON
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.
Aug 18 13 06:30p Sanitech . 503-303-8238 p.1
Plumbing Permit Applica
Site Utilities I`I
�! I OIt O1 1( l: 1'51: O\1.1
City of Tigard Received �y
13125 SW Hall Blvd.,Tigard,OR 9723�UG 19 2013 DaruBy: Q 2 ) /3 -PermitNo)l /.J7 2 /3 /�a.sp.
: 2'' Phone: 503.718.2439 Fax: 503.598.1960 Plan Review eC !J offs
i GA RI) Inspection Line: 503.639.4175 Date/By: Oder Pura it No.:
Internet: Line:gaud-or.,41 CITY OF TIGARD ��R y'�" //�' See Page 2 for
TYPE OF DING DIVISION NoufiedlMedtod I a Sapptemendl Information
FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist
Addition/ttlteration/replacement ❑0th Description Qty. Ea. Toter[
New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath❑C
W.- 2-family dwelling L 312.70
ommercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
❑Master builder ❑Other: Each additional bath/kitchen 25 02
JOB SITE INFORMATION AND LOCATION Site sprinkler( sq.R) Page 2
/ •'� Site utilities:
Job site address: / )(�C `C.( ) l-3 ( 19vL Catch basin or area drain
18.76
City/State/ZIP: �) `� V Drywell,leach line,or trench drain 18.76
Suite/bldg./apt.no.• Project name: ,A``� , V Footing drain(no.linear fl.; ) Page 2
�r+e�t?/NT�i7i 1reNi Manufactured nom -
Cross street/directions to job site: / / e utilities 50.03
�SO rT uNiO Manholes
18.76
Rain drain connector I8.76
Sanitary sewer(no.linear fL: / Page 2
Storm sewer(no.linear ft.:_J Page 2
Subdivision: Water service(oo.linear It: ) I Page 2
Lot no.: Fixture or item:
Tax map/parcel no.: Backftow prevemter
31.27 f
DESCRIPTION OF WK Backwatavalve 12.51
OR
Clothes washer
JI
25.02 1 Pta e,- L5e.o -e r x p, /Ii 1t Cj le Dishwasher 25.02 c. , Za Drinking fountain Yr) 25.02
_Ejectors/sump 25.02
❑ PROPERTY OWNER J ❑ TENANT Expansion tank
12.51
Name: • - Fixture/sewer cap 25.02
Address: - _ . - d Floor drain/floor sink/hub 25.02
City/StateJZIP: -- Garbage disposal 25.02
Hose bib
Phone:( ) Fax:( ) 25.02
Ice maker 12.51
APPLICANT • ❑ CONTACT PERSON Interceptor/grease trap
t `^ 25.02
` ,,F�^ 1 Medical gas(value:S ) Page 2
Business name:
Contact name: y-�I^ p Primer
TG' 1,t�' i�L 4 J� 12.51
Address: ' �()1 3kLv f Rnk/bas in(commercial) 12.51
A , I�, � Sink/basin/lavatory its lavatory 25.02
CitvrStatelZlP: !V 9 CrlO3��y--� .-•... 4 Solar units(,potable water) 6254
Phone: (`i_1 - Pf0 1 / pFaax::F ) -S',433 Tubishowerrshower pan 12.51
E-mail: A ;�( e.l tv`l Jc'^, ,o.r 1 -.2- Urinal 25.02
` ,�-t CONTRACTOR �x/l 1 V1 -Water closet 25.02
Business name: t
,( Water beats
� .. L LC- 3 7.52
Address: Water piping/DWV 56.29
City/State/ZIP:
Other.
25.02
Subtotal
tone:( ) • Fax:
( ) Minimum permit fee: S72.50 ��.j.S'0
•CCB Lic.: t ciustcl y f61/y Plumbing Lic.no.: Fr 3t k I Plan review (25%of permit fee)
Authorized signature: {\ I ^ a. State surcharge(12%of permit fee) 1,70
I V /J/ ) TOTAL PERMIT FEE
Print name: �� �p �/
NA,......-JL�S5A 1.k Date: ICI , z t This permit application expires if o permit is not obtained within 180 days
t� I
after ii has been accepted as complete.
'Fee methodology set by Tri-County Building industry Service Board.
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