Permit
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2010-00027
. * 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/22/2010
Parcel: 2S 102AA03903
Jurisdiction: Tigard
Site address: 8859 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: ('1011 1 , J~l 11 fa~~- ~ Permittee Signature:
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 Applicati ®n
. _ . .
Building Fixtures R F OFFICr USE ONLY
City of Tigard Received Permit N
`� g JAN 2 201 Date/By: VID o m O.05w7
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 .. Pho ne: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
CITY Da teBy:
Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: u •s: ®Sec Page 2 for
TI G A R D. Internet: www.tigard- or.gov BUILDING DIVISIO Notified/Method . ^ Supplemental Information
• TYPE OF WORK FEE* SCHEDULE . .
❑ New construction ❑ Demolition For special information 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)
CATEGORY OF CONSTRUCTION • SFR (1) bath 312.70
❑ I- and 2- family dwelling IS 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: } v -� c J-1 o rn rn e rep (C1 I Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: l 1 e � € .e- Cl 1 0 _, 2 1
! 2 2
Footing drain (no. linear ft.: _ ) Page
Suite /bldg. /apt. no.: 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.: _ ) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Water service (no. linear ft.: _ ) Page 2
• Subdivision: f Lot no.: Fixture or item:
Tax map /parcel no.: Backflow presenter 31.27
. DESCRIPTION OF WORK Backwater valve 12.51
1 Clothes washer 25.02
',fS k � /i1 � Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER I . . • • .❑ TENANT Expansion tank 12.51
Name: �V WI-- `- Fixture /sewer cap 25.02
DR Vk. Floor drain /floor sink/hub 25.02
Address: ? l-:/ 22 7 0 (2 -rn Garbage disposal 25.02
City /State /ZIP: i 'z. Gtr O "7 2;11 Hose bib 25.02
Phone: (co ) Ipti -43 Zs Fax: (may ) 35 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/basir avatory ( 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 I 37.52
Business name: f I urn h i (i E x .r e f Ts ry�� Water piping/DWV 56.29
Address: p Q 1 4 3 e x 5- � Other: 25.02
City /State /ZIP: QC cwt CATS/ OK ( 1' "7 0 y5 _ Subtotal
Phone: ( $ 2 ' 3 ) 7 ,_ je / Fax: (.. 3) 6-32, 7 t , Minimum permit fee: $72.50
CCB Lic.: j y 9 0 Plum ing Lic. no.: Y_ e Plan review (25% of permit fee)
3 State surcharge (12% of permit fee)
Authorized signature: /�� /�,; ` 9 / _ TOTAL PERMIT FEE yl� �pJ�i/
1 � `� m ^ This permit application expires if a permit is not obtained within 180 days
Print name: O Li �b l '� r �(\o 1 ^ V (V Date: ` after it has been accepted as complete.
l
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \PcrmitsU'LMU- PeimiiApp. doc 10/01/09 440- 4616T(10 /02 /COM/WEB)