Permit .1111 1, CITY OF TIGARD PLUMBING PERMIT
111 COMMUNITY DEVELOPMENT Permit#: PLM2016-00266
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2016
T I A T_� g Parcel: 2S 108CA00100
Jurisdiction: Tigard
Site address: 15300 SW FINIS LN
Project: LUBRANO Subdivision: FINIS MEADOWS Lot: 1
Project Description: 60'of sanitary drain line,60'of water service,(1)double check valve,(1)outdoor sink&(1)outdoor shower.
Contractor: T&T PLUMBING &DRAINS Owner: CALCUTTA ESTATE LLC
PO BOX 33045 BY LUBRANO, OCTAVIO S& KALPANA
PORTLAND, OR 97292 15300 SW FINIS LN
TIGARD, OR 97224
PHONE: 541-337-3080 PHONE:
FAX:
FEES
Quantity Description Date Amount
60 If Sanitary Sewer 05/23/2016 $62.54
Specifics: 60 If Water Service 05/23/2016 $62.54
1 ea Backflow Preventer 05/23/2016 $31.27
Type of Use: SF 1 ea Sink 05/23/2016 $25.02
Class of Work: ALT 1 ea Tub/Shower/Shower Pan 05/23/2016 $12.51
Type of Const: 1 12%State Surcharge- 05/23/2016 $23.27
Occupancy Grp: Plumbing
Stories:
Total $217.15
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 952-001-0 90. 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: 1 i /� jie Permittee Signature: A. LIM-
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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.
Plumbing Permit Application
Site Utilities RECEIVED _
Cityof Tigard ReceivedBY
131SW Hall Blvd.,Tigard,OR 97 Y 5 a3 t'� Perms`N°.: �����, /,,�pv?lo
I Phone: 503.718.2439 Fax: 503.59 2 3 2 016Plan Date/By: ' Other Permit No.: /75raovG-ejo/ 3
i I'D
Inspection Line: 503.639.4175 Date Ready/By: kris: 0 See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE 0QING DIVISION
FEE* SCHEDULE
0 New construction ❑Demolition For special information use checklist
Description Qty. Ea. I Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) _
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
lkl-and 2-family dwelling ❑Commercialfmdustrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 50032
Each additional bath/kitchen 25.02
0 Master builder 0 other: Fire sprinkler P� s9-ft-) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: j 1 1
5 L� Catch basin area drain 18.76
�
6
City/State/ZIP: ��xa as (.�-72.a i4 Footing
1,leach line,or trench drain 18. 2
i O` Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: ;Q_r‘0 Manufactured home utilities 50.03
Cross street/directions to job site: 5 I,3 pkv;,,\ `v-\ Manholes 18.76
Rain drain connector �l 18.76
- Sanitary sewer(no.linear IL:1 j 2) L10 Page 2 ,!),SA
Storm sewer(no.linear ft.: ) Page 2 l t
Water service(no.linear ft.:uk kb Page 2 II)•514
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer I 31.27 ,-/
DESCRIPTION OF WORK Backwater valve 12.51 3l
11\5\73-\\-‘m YrY ,' N c\ o-vA. 0 Q2. a U0' o Clothes washer 25.02
. ,,,, � n �, 1 � �"b Dishwasher 25.02
w17�7C'pJ� \lam_h \ _ ekuL V vl3t ire- Drinking fountain 25.02
( VACI 0l dC1N Sl(IV- c. alt\i&-*-- Ejectors/sump 25.02
❑ PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Oe,DAA-h C W by
,, Floor drain/floor sink/hub 25.02
Address: IS- 1: D 51)3 „P n\5 lJl\
_ Garbage disposal 25.02
``�
City/State/ZIP: T , 61-u Hose bib 25.02
Phone:( ) J Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: I f ( ii hAIV1 k f In f.�.41[f pYLL1'LA. O
Primer 12.51
Contact name: i� f" J Roof drain(commercial) 12.51
Address: it (.. [/� Sink/basin/lavatory 1 25.02 o25.C9-
City/State/ZIP: 0/,�er/il i„d i Or Va•Vo Solar units(potable water) 62.54
Phone:(;. )5g/137- 36Sb Fax::( ) Tub/shyer/shower pan ( 12.51 12.51
E-mail: f Urinal 25.02
Ta-
E-mail: 1-5I X &l inaiL Ccyn Water closet 25.02
CONTRACTOR
y,, Water heater , 37.52
Business name: / 4 / P/tom/bi &ii ailz,.. Water piping/DWV 56.29
Address: --Pc) rex .530//5- Other 25.02
City/State/ZIP: r OY4!e4i £ . q70. -_ Subtotal
Phone:(5-1/1 )13'7 3v Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 1 Plumbing Lic.no.: b/� State surcharge(12%of permit fee) > br
Authorized signature: L ,L:dee, / TOTAL PERMIT FEE 7 15
Print name: l2-�7�tiyi Oka,...„ Date:57,2B/Io This permit applicationue it has been permitis epted as ople obtained within 180 days
a��f !!! te.
*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)