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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit#: PLM2020-00196 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/15/2020 Parcel: 2S115AB01900 Jurisdiction: Tigard Site address: 16200 SW PACIFIC HWY Project: Tigard Town Square Subdivision: 1994-028 PARTITION PLAT Lot: 2 Project Description: Replace OCDA device on fire line. Contractor: LOCAL PLUMBING COMPANY Owner: SN PROPERTIES PARTNERSHIP 20833 SW OLDS PL 1121 SW SALMON ST SHERWOOD, OR 97140 PORTLAND, OR 97205 PHONE: 503-642-2067 PHONE: FAX: 503-642-5954 FEES Quantity Description Date Amount 1 ea Backflow Preventer 05/15/2020 $31.27 Specifics: 1 12%State Surcharge- 05/15/2020 $8.70 Plumbing Type of Use: COM 41 ea Minimum Fee Adjustment- 05/15/2020 $41.23 Plumbing Class of Work: OTR Type of Const: Occupancy Grp: Stories: Total $81.20 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: // / ///1 a Permittee Signature: e"7--77e)A Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building Fixtures RECEIVED FOR OFFICE 1SE ONLY City of Tigard Received q DaDale/BY, iy 2-0X07) PermitN.P4/A'2e).02. _Q 0/ II a SW 13125 S W Hall Blvd.,Tigard,OR 97223C:.R R 2 9 2020 pin Review • ' Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No.: 1.i c 1RD Internet: wwweti 503.639.4175-0o CITY OF TIGARD 1 Dale Ready By: y lu e: ® See Page 2 for g , f�,,nt Plyt'/ISIOn- Notifed/Method: / Supplemental lnformatjee € tt tfb.sp, MKv�^KM r Yr 1 a e rok 1 , p; TYPE'-►F-,,, - 2$,, .f k= FEE* Ut ._;; w gd , - . .e - �rr fl: .es. trt'l h b.r-. # � �v`I. %YkYAr ❑New construction ❑Demolition Far speciallnformation use checklist Description I Qty. I Ea. I Total Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) f °`r ,i t ',CATEGORY O "1,,CONSTRUCTION- "-.-`trya „°;d SFR(1)bath 312.70 } k Ell-and 2-family dwelling M'Commercial/industrial SFR(2)bath 437.78 CI Accessory buildingSFR(3)bath 500.32 ❑Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 bYE t i hwa 1L£ 4' 1 aQIi ... xT0,�,$t' INFORMATION ARN,�.3[,deiTlQ'EE �� �.@ Site utilities: Job site address: r Catch basin or area drain 18.76 1lo?d a Sw P0.Ctr�F IL1444 5� Drywell,leach line,or trench drain 18.76 City/State/ZIP: Pat." e,ai 1 pit, 17l 21 Footing drain(no.linear ft.: ) Page 2 Suite/bldg./apt.no.: Project name:T i,5W.4 -i-,,L.+M Ili a.�A Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.7E Sanitary sewer(no.linear ft.: ) Page 2 Storm sewer(no.linear ft.:, ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: l Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer ` 31.27 31,11 DESCRIPTION OF`WRY i „. ,� Backwater valve 12.51 }nC.,4�./) 1' 0‘.-.0 ,l. �i((__ � - '�f�."),"`� '` Clothes washer 25.02 1 fa-CA- 0 .-QIfl G»✓.Ca c-1n "F>t,e_itilt Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 0 PROPERTY OWNER # p% NAT i1, Expansion lank 12.51 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 APPLICANT" 0 R `. ` © CONTt cT PERSON ,, Interceptor/grease trap 25.02 Business name: L c 4i pi -- ;0. Co Medical gas(value:S_) Page 2 Primer 12.51 Contact name: (21C� A �JQ Roof drain(commercial) 12.51 Address:. i 31 5_ O let S 13)at Cc, Sink/basin/lavatory 25.02 City/State/ZIP: S kiii_A„‘s.3,3d,,J Q Ki. 7'2/i/O. Solar units(potable water) 62.54 Phone:(37l3 )Gy 3_ 3_Q'o-7 Fax:: ( ) Tub/shower/shower pan 12.51 E-mail: brancitS6 1c,..1 Jc4 t f to cof Urinal 25.02 gp ,t:' Water Closet 25.02 0 . •,,�y CONTRACTOR Water heater 37.52 Business name: b:)G0.1 £)r e ,L,.t./ co. Water piping/DWV 56.29 Address: Di)8 33 Sw O 4et_2 r Ia-c. J Other: 25.02 City/State/ZIP: 3 }J or . 9 7l t7 O Subtotal 3 !.a 7 Phone:Q'G3) (p y 1 _ 4,) Fax:(S)--3)6( - S9 Sy Minimum permit fee: $72.50 '7 a, -SD q Plan review (25%of permit fcc)r CCB Lic.: )'� J Plumbing Lic.no.:34-/..)7 Pe, State surcharge(12%of permit fee) 8.7 0 Authorized signature:s ,( caest ei,,a TOTAL PERMIT FEE 8 1,2.7> t Date:(/- }q This permit application expires if a permit is not obtained within 180 days Print name: IJ,(� SO/«w...e) / y 1 after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board. I?BuildingTmnits`BLMU-PmniIApp.doc I0/01/09 440-4616T(I O/OLCOM/Wea)