Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00403
i Date Issued: 11/25/2015
T1G` RIS 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
; Parcel: 2S102AD01300
Jurisdiction: Tigard
Site address: 9095 SW BURNHAM ST
Project: Wyatt Fire Protection Subdivision: TIGARD HIGHWAY TRACTS Lot: 21
Project Description: Replacement of approximately 20'of interior sanitary sewer line.
Contractor: APOLLO DRAIN&ROOTER SERVICE Owner: WYATT PROPERTIES LLC
2208 NW BIRDSDALE#8 9095 SW BURNHAM ST
GRESHAM, OR 97030 TIGARD, OR 97223
P
PHONE: 503-684-2928
HONE: 503-239-8801
FAX: 503-669-9568
FEES
Quantity Description Date Amount
20 If Sanitary Sewer 11/25/2015 $62.54
Specifics: 1 12%State Surcharge- 11/25/2015 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 11/25/2015 $9.96
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss d By: , / Permittee Signature < �I„I'I �
_.f, l iLl�1 1
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Nov. 24. 2015 11 : 33AM No. 1491 P. 2
Plumbing Permit ApplieeliMraEIVED
Site Utilities Fog 0141.1(." C USE ONLY
NOV 2 4 2015
Cl of Tigard Received PermitNo.:
t ti I 13125 SW Hall BlVd.,Tigard,9111•97421-1F TI GARD n to Review l/ ASIS CrF�o�OI�-di�yp.3
t Phone: 503.718.2439 Pax: 583. 981 196
Date/By:
�aOther Permit No.:
T IGARD Inspection Line 503.639.415U1 WING ' ''01VIDate Ready/By: naris: 1E1 See Page 2 for
Internet; www.tigard-or.gov Notified/Method: g/O'S IS i Supplemental Information
--- . • i('va n$,og.Audit+. ._. . . - .I Ze' ars Ji).nriM
❑New constriction ❑Demolition si s 1 ie9/ For special Information use checklist
- Description Qty. 1 Ea. Total
A Addition/alteretion/replaoement. ❑Other: slop , New 1-2-family dwellings(includes 100 ft.for each utility connection)
• ! }i\!cp:ci'u F:'r.(DT•Itf:$37,!T 1'i;,:,r! c)i`I • SPR(1)bath 312.70
❑ 1-and 2-family dwelling II Commercial/industrial SPR(2)bath 437.78..
SFR(3)bath 500.32
❑Accessory building El Multi-farnily
Each additional bath/kitchen 25.02
Master builder ❑Other: - Fire sprinkler( sq.ft) Page 2
d,r0.:1:,thtli;ioi`l(i^lt4uiy;)r'(0)i•`.I .':Ni`.H i.ii'R7r:;Al t tilI`I Site utilities:
Catch basin or area drain 18.16
-JOb Site address: Q95 )� `� s i Drywall,leach line,or trench drain 18.76 '
7City/State/ZIP: Gyr) '
l Footing drain(no.linear ft: ( Page 2
Suite/bldg./apt.no.: Project name: -70 Manufactured home utilities 50.03
Cross street/directions to job site j W 15h P.,\ Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no,linear ft, O) Page 2
- Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
_�r -_
Tax map/parcel no.: Backflow preventer 31.27_
Backwater valve 12.51
c� Clothes washer 25.02
s0�U_LQ C), d�.LC*\' U Dishwasher 25.02
If)c/ur\'n S l Y`QDrinking fountain 25.02
Ejectors/sump 25.02
:Cl C11 IS 1al' .,;.( TI !1-..). _0Bz..lj' Expansion tank 12.51
Name: �,'r„� \YQ
Fixture/sewer 25.02
t Floor drain/floor sink/hub 25.02
Address: C.1 Uc( 5 gt� /V t CMCY1 .(w Garbage disposal 25.02
City/State/ZIP: • '✓ G 7')Th)- Hose bib 25,02
Phone:(z)-O3) , Pax:( ) Ice maker 12.51
IIIIIIIIIMZEMIIIIIIIII - 'r(;i7.1.( `r`r.Gi I';;y;'l:tiyt)i'i Interceptor/grease trap 25.02
n ,,^r',, Medical gas(value:$ ) Page 2
Business name; C JU0 Orcu)N,f� �Qr r w�� rl-
�4II I'O`+� Primer. 12.51
Contact name: ICH� _ Roof drain(commercial) 12.51
Address:?AI' /VW toirdadate Ave, s1t,(,"L, 8 Sink/basin/lavatory 25,02
City/State/ZIP: Oa&haft), O1 - q3o3O Solar units(potable water) 62.54
Phone:(503) gam. (I,' Pax::(503)L0(a' q,(0; Tub/shower/shower pan 12,51
B-mai' Jocc)'21 :1! 0 . Urinal 25.02
Water closet 25.02
- oG� r (,(, Water heater 37,52
�
Business name: R( Water 1I.'' 56.29
Address:jWD3 Nr.0 ` Ur/actg. , stubs 8' Other: 25.02
City/State/ZIP: Gresham op_ 170$0 Subtotal
Phone:(S(6)82,„ u pa„,_„_c5wo,1 G1510g
Minimum permit fee: $72.50 74,25-0
Plan review (25/ofperit fee)
Lic.: (i9gIBPlumbing Lic.no.:2L9-533 178
State surcharge(12%of permit fee) g-70
Authorized signature: TOTAL PERMIT FEE Si.isiO
Print name: 14,-si .e_e__ 6 1Date: )i ( �i l
This permit application expires if a permit le not obtained within 180 days
11 II after it hits been accepted aS complete.
^Fee methodology set by Tri-Conary Building Industry Service Board.
IriuiidingWermitsTIbtU,PermilApp,doc 10/01/09 410-4616T(IO/02/COM/Wna)
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
9095 SW BURNHAM ST, TIGARD, OR, 97223
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
December 3, 2015 at 8:28:03
AM
PLM2015-00403
Don Sylvester
Violation Summary:
Inspector Contractor