Permit (31) CITY OF TIGARD PLUMBING PERMIT
Pri S.. `. COMMUNITY DEVELOPMENT Permit#: PLM2017-00364
13125 SW Hall Blvd.,Ti and OR 97223 503.718.2439 Date Issued: 09/07/2017
9 Parcel: 2S 101 CA00200
Jurisdiction: Tigard
Site address: 7900 SW HUNZIKER RD
Project: Wall Street Industrial Subdivision: None Lot: None
Project Description: (1)manhole and 100 ft.of sanitary sewer to reconnect to sewer lateral.
Contractor: RAYBORN'S PLUMBING INC Owner: WALL STREET INDUSTRIAL LLC
PO BOX 69 7900 SW HUNZIKER RD
19990 SW CIPOLE RD TIGARD, OR 97223
TUALATIN, OR 97062
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
1 ea Manholes 09/07/2017 $18.76
Specifics: 100 If Sanitary Sewer 09/07/2017 $62.54
1 12%State Surcharge- 09/07/2017 $9.76
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $91.06
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 503.232.198 . ,,332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available ins•-c'. d. -.
This permit card shall be kept in a conspicuous place on the job site - it c.• letion of the project.
Approved plans are required on the job site at the time of each inspection.
r:
Plumbing Permit Application (
Building Fixtures ^'
a d).
Received art_ ��°�
City of Tigard »a�/By: GJ�(, 7 Permit No.: Pti ( 7,a�r3 0 y
gli 13125 SW Hall Blvd.,Tigard,OR 97223 lylan Review
IIIIIII Phone: 503.718.2439 Fax: 503.598.1960 iOate/By: Other Permit No.:
Inspection Line: 503.639.41750 ady/By: Juris: H See Page 2 for
I( A H 1) Internet: www.ti and-or. ov g ;
g g ���� �Z� ���� /Method: -7-fp Supplemental Information
110 New construction ID Demolition For special information use checklist
Description I Qty. I Ea. I Total
D Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
'� 'X 61 ..a f 1- Pg ` 11' ( )
w-'44' "i ' '. � 1,- _a ;7,-; -:%•,..-„,..,�#, _ SFR 1 bath 312.70
437.78
El1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath
SFR(3)bath 500.32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 14 Other: V++t'(i.{-i G Fire sprinkler( sq.ft.) Page 2
''1"%'' Fes` ar. a°' - ' ` s rx' t „gl•`, +
0 V .�`z t'-8 er'''e ' s `'. -, �'' °''` � Site utilities:
Job site address: G ,r a Catch basin or area drain 18.76
T I'(rte 2 q 7Z� Drywell,leach line,or trench drain 18.76
City/State/ZIP:
1 o 3 `4 ti yf Y's 706%1'L17I►; rooting 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 It?4
Rain drain connector 18.76
2 (Lei„I-4 I i S4 Sanitary sewer(no.linear ft.: AO) ( Page 2 ()I sl
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: I Lot no.: Fixture or item:
Backflow preventer 31.27
Tax map/parcel no.: .25'/ 002_ 0 -
� 1 . ,,,,,,,6,,- Backwater valve 12.51
„ . _ : ., .-. °s4,, a -, . , ,_- - .,,
Clothes washer 25.02
Z.e w.-un e:.a-0.'.- a.(' Sr,...1-4-t- (s-1sJ'c- ( -Ic-, C.' ., Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
' '''..,_.'.'.,‘`-,7 t 't ;ill:,14;4, , . I i.' �r.,. ,,**a Expansion tank 12.51
:-4 ....z Zs ,,r. �_, , 1,_Z.,,,. .;x.},_ . u .
Name: Fixture/sewer
cap 25.02
h1Al,.. S`i-2t,txi in%DJ$12 t A( LL-C Floor drain/floor sink/hub 25.02
Address: 'Z a v O �;.,,, 0q' " Si Garbage disposal 25.02
City/State/ZIP: v_,T[..ft.Jp/ 0 g Ct 12 z 3 Hose bib. 25.02
Phone:(c3 ) ei,,) 93 y J Fax ( ) Ice maker 12.51
AP�.ITI ❑ C C4T N
Interceptor/grease trap 25.02
Business name: 0Medical gas(value:$ ) Page 2
�� 2.J J rv.3 IA/ Primer 12.51
Contact name: 0445 .r f",,1''SA,S,d,,"i'
Roof drain(commercial) 12.51
Address: 1 Q q 4 6 Sc.J G pd(..c Sink/basin/lavatory 25.02
City/State/ZIP: Ts),_,,f c.,,,,,..., tf g °l'7c1 6'Z Solar units(potable water) 62.54
Phone:( 3 ) (p Ci Z._ ( /3 7 Fax::(5-01 ) (9 q/- 2 R Tub/shower/shower pan 12.51
E-mail: 44,24„4 s CO_ Urinal 25.02
l�-A..'3`., - Sr r Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: RAY Ls,,14,3,5 Q(J.„^dtn/'G- Waterpiping/DWV 56.29
Address: l Ssyq 0 S,„,J- C i.,fvI.G9.j Other: 25.02
City/State/ZIP: ,J c.(44 t i, era Q -O aG 2 Subtotal 8i3
'r
Phone:(S63 c g Z -y/3 Fax:(6p 3 ) (�sj'( - Z 2 2.
Minimum permit fee: $72.50
3)
cb785") , 66 P,3 Plan review (25%of permit fee)
CCB Lic.:
State surcharge(12%of permit fee) Q'-
Authorized signature: TOTAL PERMIT FEE °�( °b
Print name: 'f Date: This permit application expires if a permit is not obtained within 180 days
PA PI ti(15Ja�/ 3(f11IU�1 ' after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
440-4616T110/02/COM/WEBI