Permit CITY OF TIGARD PLUMBING PERMIT
14 II
COMMUNITY DEVELOPMENT Permit#: PLM2014-00295
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/02/2014
T[[_ ;1R f7 9 Parcel: 1 S136CA02209
Jurisdiction: Tigard
Site address: 10945 SW 79TH AVE
Project: ALLEN Subdivision: MARG TERRACE Lot: 9
Project Description: Replacing 50 ft.of sanitary sewer line.
Contractor: TCJ CONSTRUCTION Owner: ALLEN,JUDITH
19750 SW PAGE CT 10945 SW 79TH AVE
BEAVERTON,OR 97007 PORTLAND,OR 97223
PHONE: 503-320-7831 PHONE:
FAX: 503-259-2432
FEES
Quantity Description Date Amount
50 If Sewer Service 09/02/2014 $62.54
Specifics: 1 12%State Surcharge- 09/02/2014 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment- 09/02/2014 $9.96
Class of Work: ALT
Plumbing
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:
ere?/74 !((�C�ave7 Or-
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 t 1,, 1 1 l l t l i .l WO 1
Received
City of Tigard /+J Permit No.:
• 13125 SW l fall Blvd.,Tigard,O 9
CiNfr-‘)
D ateB : sI �/ •�I
Phone: 503.718.2439 Fax: 503.598.11P 2 2 14 Plan Review Other Permit No.:
�` Date/By:
Inspection Line: 503.639.4175 ,�,s0. Date Read B luris: ® See Page 2 for
I It' \l:1, i � Ready/By: ne
Internet: www.tigard-or.gov „nay n 1 Notified/Method: •�g Supplemental Information
TYPE OF WORM, 1 S". FEE* SCHEDULE
A �1 For s, dal in ormatlon use checklist
❑New construction r ion
'Addition/alteration/replacement Descri,tion a�il� Ea. Total
❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
-and 2-family dwelling
�1 ❑Commercial/industrial
❑Multi-family SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
• Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
4 5 9 9 n,1/„ Catch basin or area drain 18.76
Job site address: t t-jc
City/State/ZIP: Drywell,leach line,or trench drain 18.76
--r t(�A S) f/&. Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: 11eAl Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ftr 1`I ) Page 2 ,,,'-`-/
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
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
,
(tegu-467 36 M r Tk iv .61---iet L/ML Dishwasher
25.02
01-t P(&. e -f Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
.,�,41 l�, Fixture/sewer cap 25.02
v
Name: l l�kl.J
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) lce maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name e S.Ct b -& rh I AN./ �/i ,/ /lA/(. . Medical gas(value:S ) Page 2
Primer 12.51
Contact name:--la v -m-- -1.....,E-L, L�
Roof drain(commercial) 12.51
Address:lg r? s_✓ PA L/t Sink/basin/lavatory 25.02
'?-
City/State/ZIP: g t 7 .�
uy 64z, 1 !L'G13 Solar units(potable water) 62.54
Phone: >-` )15 f , Fax::( ) Tub/shower/shower pan 12.51
E-mail: }, • Urinal 25.02
"C� L J • C.G%�-�T2'./c-t k 00-4 Q vA 46c) - cO UV\ Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: `T'G a Cu""SPlLtri.T ,, a., . t + Water piping/DWV 56.29
I
Address:(VS-6 gam, p t e..7" Other: 25.02
City/State/ZIP: L,6/Z-760.41 u2_ 176617 Subtotal C,.2,
Minimum permit fee: $72.50
Phone:( )3 ZG-r7 4 3 I Fax:( ) -LI 4-0
Plumbing Lic.no.: �v p./k5
Plan review (25%of permit fee)
CCB Lic.:
G� GA z/ g rJ State surcharge(12%ofpermit fee) g' ")Q
Authorized signature: Cn .�--�. TOTAL PERMIT FEE y/ .�
Print name:-1-�}--1 1 -VLyv�l�., Date:ryj_/-(,-1
This permit application expires if a permit is not obtained within 180 days
i after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10945 SW 79TH AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2014-00295
George Heimos
Violation Summary:
Inspector Contractor