Permit CITY OF TIGARD PLUMBING PERMIT
.1114 �' COMMUNITY DEVELOPMENT Permit#: PLM2018-00486
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2018
T r c; s I.n 9 Parcel: 2S109BB02903
Jurisdiction: Tigard
Site address: 14305 SW HIGH TOR DR
Project: HASHIMA Subdivision: HIGH TOR WEST Lot: 29
Project Description: New 100 ft Sewer connection. Septic tank to be pumped and filled or removed and pump/fill receipt required at
final inspection.
Contractor: ENVIRONMENTAL WORKS LLC Owner: HASHIMA FAMILY TRUST
2634 SE STEELE ST BY HASHIMA, JASON N&LISA K TRS
PORTLAND, OR 97202 14305 SW HIGH TOR DR
TIGARD, OR 97224
PHONE: 503-719-6715 PHONE:
FAX: 503-972-1866
FEES
Quantity Description Date Amount
100 If Sanitary Sewer 10/16/2018 $62.54
Specifics: 1 12%State Surcharge- 10/16/2018 $8.70
Plumbing
10 ea Minimum Fee Adjustment- 10/16/2018 $9.96
Type of Use: SF
Plumbing
Class of Work: NEW
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:
/44
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
Building Fixtures � FOR OFFICE USE ONLY
City of Tigard OCTG ,� Received �% �)�/�j
13125 SW Hall Blvd.,Tigard,OR 97223 Uty f` l Date/By:G� ft' `(�� ���V(�t/�)6/9'fy,
_ Plan Review h 00P2s ?
Phone: 503.718.2439 Fax: 503.598.1tA6tk Date/By: P '
Inspection Line:
503.639.4175
Saris ® See Page 2 forTIGARD eE ,. Date Ready/By:
Internet: www.tigard-or.gov ‘,,...,,,:,_: 4
t - 'J
Notified/Method: Supplemental Information
❑New construction 0 Demolition For special information use checklist.
Description Qty. Ea. Total
�;!PAddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
`� ,' ,,., v. , a:. •113 Ifp� �,,7 SFR(1)bath 312.70
0,I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Firesprinkler sq. ) Page
2
;;-;'-g 6 * � TI �, WO/ 4 Site utilities:
Job site address: I L_1 c o5 SIN N 4 -c6a. Qr. Catch basin or area drain 18.76
City/State/ZIP: �( (� R {,t� Drywell,leach line,or trench drain 18.76
1 1 Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: S W 1 9 LI-rt^ A p Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: 10 0) t Page 2 k
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
� r1 ,-�� �� s� Backwater valve 12.51
` !%��/�y�`� �, .. ,�� ,�a� _...�.�., ...x..a. ;aii Clothes washer 25.02
/1 Sri-c,\' cQ CT t`'f _f.` (•,',... hco..i e Q Dishwasher 25.02
(\ W (A- -nk\ €C(0.4"../1,,;>5<<;n cjr ft' C Drinking fountain 25.02
Ejectors/sump 25.02
.. # " "i � : / Expansion tank 12.51 r .; a
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
„ aiesf,i 40 N r Interceptor/grease trap 25.02d r.
Medical gas(value:$ ) Page 2
pusiness name.
, ' • •r i •r • Primer 12.51
Contact name: 2634 SE Steele Street (commercial)
//--�,, Roof drain commercial 12.51
Address: Portland,OR 97202 f/kJii t Sink/basin/lavatory 25.02
City/State/ZIP: 503.719.6715 (j am(1 Solar units(potable water) 62.54
Phone:( ) dwight@eworkartw.com U c� Tub/shower/shower pan 12.51
E-mail: /' Urinal 25.02
,yi ' r � ur '
�% ti �� Water closet 25.02
'' � 1s ��G v 7, Water heater" rte Y
.< .,. ,,. ,�� .y., •• W t h t 37.52
Business name:
SC /`' /J /IS o v (�C Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: ' O S 1 8 c Plumbing Lic.no.: f r) t 1 S(D
State surcharge(12%of permit fee)
Authorized signe: TOTAL PERMIT FEE
,n \liJ t This permit application expires if a permit is not obtained within 180 days
Print name: jNlk '..-1.A...� c Date:( U I S_ (
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)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14305 SW HIGH TOR DR, TIGARD, OR, 97224 October 19, 2018 at
11 :24:02 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00486
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Pump receipt received. Septic tank filled with sand mix.
Violation Summary:
Inspector Contractor