Permit
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2010-00017
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/15/2010
Parcel: 1 S 136 DD05300
Jurisdiction: TIGARD
Site address: 11850 SW 67TH AVE, STE# 100
Subdivision: TIGARD TRIANGLE COMMONS Lot: 13
Project: Spec Space
Project Description: Install new dishwasher.
Owner: FEES
PNWP LLC#2 & Quantity Description Date Amount
PNWP LLC, 6600 SW 105TH AVE #175
BEAVERTON, OR 97008 1 ea Dishwasher 01/14/2010 $25.02
PHONE: 1 12% State Surcharge - 01/14/2010 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 01/14/2010 $47.48
Contractor: Plumbing
NORTHWEST WATER WORKS
40110 SE MEADOWSONG RD
SANDY, OR 97055
PHONE: 503-668-0375
FAX: 503-668-0375
Type of Use: COM
Class of Work: ALT 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 952-001-0100. 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:
O
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.
0.,1/.13/2010 15:15 5036680375 NORTHWEST WATERWORKS #0381 P.001 /002
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City of Turd SAN 13 2010
13125 SW Hall Blvd, Tim oR�t FTIGARD
�� CO 41071 Permit No.: �GN'obro - � /�
Phooe: 503.639.4171 Fax:503 _119d9' Pl�ltevicw
otter PemitNe.
l coon l isa: so3.63.griv BUILDING DIVISION
Internet Y , '0���+0,
www.r at.�ov Page z roe
Semiannual latarrnadon
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New ❑ nea,olition Fu , ,,,. , `. —
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Addition/altet°atiot lscemem [} Other
t t,� En. Total
New 1-2-family 100 ft. for each utility ooamecTiaQ)
[] 1 -and 2 ._�. _ SFR (1) bulb 2492(1
- �y g •_• Commercial industrial SFR (2) bath
0 Amy building ❑ n -family SR (3) bath 399.00
❑ Master bulkier Othar Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft) Page 2
—
Job $d address. ® - 6 - V1/ 6 vJ _. Stte utilities
Ciry/Stmda2lP � • et Catch basin or arm drain
16.60
�A_ Drywall, leach line. or trench drain 16.60 r
Sl fapr. no.: Project name: j egra % r it ! : ■ Footing drain (no. linear fi : _� 2
Crass /droner a is to job site: •J � d- - . 4 Man holes end borne utilities 110.00
Manholes ■ 16.60
��, f ,
Rain drain connector 16.60
�r ` i: . / A', Sanitary sewer (no. linear R: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Lot no.: Water service (no. linear R: ) Page 2
Tax map/pareci no.: I alb - DD 0 5 300 Fixture or item
Absorption vain 16.60
Backfow prav�ente' Page 2
_ Backwater valve 16.60
Clothes washer 16.60
. _ = Dishwasher • i 'i/! 1� � • �
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16.60
Drinking fountain r 16.60
Hamm _....... - _ . .5: , s Ejectoas/samp
Address: Expansion tank 16.60
Fixture/sewer cep 16.60
Clry/StatC ZIP: Floor dta ndloor sink /hub 16.60
( ) Fax: ( ) Garbage disposal 16.60
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16.60
Business name: , ; J d C/ - ice maker 16.60
-- �a /p 16.60
Contact name: / e, ,: [y _' - n Medical gas (value: S ) Page 2
Address: -. 5X55 ! , ` 1 / `� P 16.60 .
City/Stater A /. ; _-, . 4. v Roof drain (caanmavial) 16.60
Phases :.` ^G � Fax : ( ) S� 16.60
E-mail: Tub/shower /shower pan 16.60
. A - . • - j /� ■ r __. Urinal 16.60
/ i p r , - _ 1
. , -• ' i 1 �C closet 16.60
Business name: '' • .._ _.. W� heater 1640
Address: -
L ' c L. MI d i / Other
City/State/ZIT: .� . �. , r ' r Subtotal
I1
Phone: ( Residential baCd�ow minim perm
fee: 536.25 50 7;
CCB Lie.: . / G 7 Plumbing Lie. no.: 3 • ai t _ Plan review (25% of permit fee) .
Authorized -: .. / / / , _ State surcharge (1246 of permit fee) • .10
Print name:
. � ' TOTAL PERMIT FEE , Ao
l - s .r '/' f�/,3�/° This permit application expires if a permit is not obtained within
C�4.� h b 3 / 180 days e tfb y it has u been B n ustry Service (: 'Fee methodology set by Tri�oumy B irildin r Industry Service Board.
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