Permit
a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2010-00028
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/22/2010
Parcel: 2S 102AA03903
Jurisdiction: Tigard
Site address: 8861 SW COMMERCIAL ST
Subdivision: Lot: 0
Project: Spec Space
Project Description: Replace (1) sink, (1) lav, (1) w/c, and install (1) w/h.
Owner: FEES
NW URBAN DEVELOPMENT INC Quantity Description Date Amount
PO BOX 230307
TIGARD, OR 97281 1 ea Sink 01/22/2010 $25.02
1 ea Lavatories 01/22/2010 $25.02
PHONE: 1 ea Water Closet 01/22/2010 $25.02
1 ea Water Heater 01/22/2010 $37.52
Contractor: 1 12% State Surcharge - 01/22/2010 $13.51
PLUMBING EXPERTS INC Plumbing
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 $126.09
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. A -ll )
Issued By: Permittee Signature: Z~U- h\
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. .lam '
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.
PFdmbiln Permit A licatK
Building Fixtures V FOR OFFICE USE ONLY
City of Tigard JAN 2.2 -2010 Received
Date/By: Permit No.: rWO
d 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Plan
Date/By: Phone: 503.639.4 ] 71 Fax: 503.5 Other Permit No.:
Inspection Line: 503.639.4175 BUILDING DIVISION
Internet: www.ti ard-or. ov I Date Ready/By: lari : H See Page 2 for
g g Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. Ea. Total
*Addition/alteration/replacement, ❑ Other: New I- 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1- and 2-family dwelling Commercial/industrial SFR (2) bath 437.78
❑ Accessory building Multi-family SFR (3) bath 500.32
❑
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: Catch basin or area drain 18.76
City/State/ZIP: r 112 Drywell, 16ach line, or trench drain 18.76
Footing 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
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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
'Ra AZ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
V0' c.w
O~ Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: ~,r p Z LZ Hose bib 25.02
Phone: gKlj~j Fax: Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas (value: $ ) Page 2
Business name:
Contact name: Primer 12.51
Roof drain (commercial) 12.51
Address: Sin asi 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
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Ts V Water piping/DWV 56.29
Linn b (%A F X f2 e_ Address: j S 3 Other: 25.02
City/State/ZIP: 0 Q c, /1 p S- Subtotal
Phone: ($03) 70 8 _ Fax: (s'o3) Minimum permit fee: $72.50
CCB Lic.: 1119 Pl Plan review (25% of permit fee)
Q um ing Lic. no.: _
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE
Pi - 1-71 Print name: 0 Date: This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
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