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Permit n CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2016-00053 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/03/2016 Parcel: 2S103CC00500 Jurisdiction: Tigard Site address: 12125 SW PLANTATION TER Project: Plantation Estates,Lot 4 Subdivision: 2012-001 PARTITION PLAT Lot: 2 Project Description: Installation of approximately 50'of sanitary service and 50'of water service to be done prior to issuance of building permit. Contractor: RENNER TRUCKING& EXCAVATING INC Owner: KKNW LLC 228 SW WALNUT ST BY CRANDALL, MARK L HILLSBORO, OR 97123 1800 NW 167TH PL STE 150 BEAVERTON, OR 97006 PHONE: 503-846-1512 PHONE: FAX: 503-846-1354 FEES Quantity Description Date Amount 50 If Sanitary Sewer 02/03/2016 $62.54 Specifics: 50 If Water Service 02/03/2016 $62.54 1 12%State Surcharge- 02/03/2016 $15.01 Type of Use: SF Plumbing Class of Work: NEW Type of Const: Occupancy Grp: Stories: Total $140.09 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 No n Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules orCued t questions UN calling 503.232.1987 or 1.800.332.2344. IsBy: 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. Plumbine Permit Application Site Utilities ' j Received ! City of Tigard 3 Permit No.:Date 13125 SW Hall Blvd.,Tigard,OR 97223._ Plan Ry: ■ Phone: 503.718.2439 Fax: 503.5981960' 3 ?0116 Pian Review Date/By: Other Permit No.:"'51-90 t6--0091 Inspection Line: 503.639.4175 Date Ready/By: auris: 0 See Page 2 for Intemet: www.tigard-or.gov t I It ty 4 Notified/Method: I Supplemental Information TYPE OF DIVISION EEE* SCHEDULE New construction ❑Demolition For special in ormadon use checklist -Description Ea. Total ❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 ElAccessory building ❑Multi-family 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: Job site address: I Z JS J t /(QA14.6 LOn �ri^Q C� Catch basin or area drain 18.76 Drywell,leach line,or trench drain 18.76 City/State/Z1P: It r w, ©K RAZZ 5 Footing drain(no.linear ft.:_) Page 2 Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 Sanitary sewer(no.linear ft.: C7rD Page 2 Storm sewer(no.linear ft.:_) Page 2 Water service(no.linear ft.: J ) Page 2 Subdivision: p,� IG,y� ES Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 Backwater valve 12.51 DESCRIPT ON OF WORK / Clothes washer 25.02 r J LAW a KO( O .^ Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY C!2W R_- ❑ TENANT Expansion tank 12.51 Name: 5e p GLC Fixturelsewer cap 25.02 Floor dram/floor sink/hub 25.02 Address: Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Iee maker 12.51 AE'PLICANT [].:CONTACT PERSON Interceptor/grease trap 25.02 Business name: Medical gas(value:$ ) Page 2 ,Gs�i,/�o O/'l�t S �-e Primer 12.51 Contact name: A �t- Roof drain(commercial) 12.51 Address: I Z7aa /vjr/ Gp/jt�l( Siuk/basin/lavatory 25.02 City/State/ZIP: C r n Q1Zu' Solar units(potable water) 62.54 Phone:(al( ) 6 _ 5019Fax::( ) Tub/shower/shower pan 12.51 E-mail: R� "5fWp al't1t T LL[`,Cam Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: w Q, Water piping/DWV 56.29 Address: 'ZZ_ Other: 25.02 City/State/ZIP: Subtotal Phone:(SG3) Z Fax:( ) Minimum permit fee: $72.50 CB Lic.: 3 3 Plumbing Lic.no.: 63 Plan review (25%of permit fee) State surcharge(12%of permit fee) Authorized signature: 1-� , ,� TOTAL PERMIT FEE cg nx; Print name: c" / Date:'ti �.. l f This permit application expires if a permit is not obtained within 180 days S Fi: U~ , 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(IO/02/COM/WEB)