Permit
CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit#: PLM2010-00026
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/22/2010
Parcel: 2S 102AA03903
Jurisdiction: Tigard
Site address: 8863 SW COMMERCIAL ST
Subdivision: Lot: 0
Project: Spec Space
Project Description: Replace (1) lav, and (1) water closet, install (1) w/h.
Owner: FEES
NW URBAN DEVELOPMENT INC Quantity Description Date Amount
PO BOX 230307
TIGARD, OR 97281 1 ea Lavatories 01/22/2010 $25.02
1 ea Water Closet 01/22/2010 $25.02
PHONE: 1 ea Water Heater 01/22/2010 $37.52
1 12% State Surcharge - 01/22/2010 $10.51
Contractor: Plumbing
PLUMBING EXPERTS INC
11925 SW PARKWAY
PORTLAND, OR 97225-5413
PHONE: 503-708-2020
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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 952-001-0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature:
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Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 TO 4 of lcE USE ONLY
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City of Tigard B ECEVE D
Received Date/By: T Permit No.p ! \A A� 47
V 13125 SW Hall Blvd., Tigard, OR 97.... Plan Review
C : Phone: 503.639.4171 Fax: 503.598.196 Other Permit No.•
9AN 2 2 2010 Date/By:
f I G A R D: Inspection Line: 503.639.4175 Date Ready /By: lu Fa See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD Notified /Method: T Supplemental Information
TYPE OF WO FEE* SCHEDULE
U !LDING N - For special information use checklist.
El New construction Demolition
Description i Qty. I Ea. I Total
'Addition /alteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ I- and 2- family dwelling gl Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
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 � ` f1 \ Catch basin or area drain 18.76
` ` �c `M�� �� Drywell, leach line, or trench drain 1 8.76
City /State /ZI P: ] l `; ,-- f op 1 2,21 _
Footin drain (no. linear ft.: _) Page 2
Suite /bldg. /apt. no.: I 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.: -1 Page 2
Stonn sewer (no. linear ft.: , ) Page 2
Water service (no. linear fl.: _1 Page 2
Subdivision: l Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
Backwater valve 12.51
' DESCRIPTION OF WORK .
Clothes washer 25.02
�� '/ _u Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
-a PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: �V vLS t-b4.vA, Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 22 Garbage disposal 25.02
City /State /ZIP: i � � r Q „ p 5"t 2,2,3 Hose bib 25.02
Phone: (c-6 ) i - L3 2. --( Fax: (5 ) 63 O Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basi lavatory 1 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
. Water closet 1 25.02
CONTRACTOR . . .
Water heater 1 37.52
Business name: VI urn bin (� - x . � (T S rvLL• Water piping/DWV 56.29
Address: p Q 5 , X 7 5' Other: 25.02
City /State /ZIP: 0 ce. c\Qrt c 1 0 K R a Y..5 - Subtotal
Minimum permit fee: $72.50
Phone: (5"0.3) -2 17 ._ r rapo Fax: (.5e3 3 ,2^ ,..`j 7 Plan review (25% of permit fee)
CCB Lie.: l 4/ a 0 Plum ing Lic. no.:3 y_3 c 1 State surcharge (12% of permit fee)
Authorized signature: t„ � •
��. ��- TOTAL PERMIT FEE q8.0-7 . �� ��
This permit application expires if a permit is not obtained within 180 days
Print name: 1 � O I I t�lr C` '/ ��O O'I�� Date: / �Q I G after it has been accepted as complete.
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*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \ Permits \I'LMU -Pet mit App. doe 10/01/04 440- 4616T(10 /02/COM/WEB)