Permit •
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CITY OF. TIGARD PLUMBING PERMIT
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'''! COMMUNITY DEVELOPMENT Permit a: PLM2010-00009
TIGARD 13125 SW Hall Blvd:, Tigard OR 97223 503.639.4171 Date Issued: 01/07/2010
Parcel: 1 S134AA01900
Jurisdiction: Tigard •
Site address: 10115 SW NIMBUS AVE 250
Subdivision: Lot: 0
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Project: Java Mama
Project Description: Remove and replace floor sink drain.
Owner. FEES
ROBINSON, CONSTANCE A Quantity Description Date Amount
BY NIMBUS CENTER, 2501 SE COLUMBIA
WAY 1 ea Floor Drain/Floor Sink/Hub 01/07/2010 $25.02
PHONE: 1 12% State Surcharge - 01/07/2010 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 01/07/2010 $47.48
Contractor: Plumbing •
RELIANT PLUMBING & MECHANICAL
11575 SW PACIFIC HWY STE 219 • •
TIGARD, OR 97223
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PHONE: 503 - 246 -1201 • •
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FAX: 503 - 246 -1205 • . •
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Type of Use: COM
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Class of Work: ALT Type of Const:
Occupancy Grp:
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Stories:
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Total $81.20
Required Items and Reports (Conditions)
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This permit is issued subject. 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 staited within 180 days of
issuance, or if work is suspended for the 180 days. ATTENTION: Oregon law requires you to follow the Hiles 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.
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Issued By: Permittee Signature: /9 G
• Call 603.639.4176 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.
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Approved plans are required on the Job site at the time of each Inspection.
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• ' 0i/07/2010 09:29 477 PAGE 01/01
• Plumbing Permit A.pplienibECEI !+ ED
Building Fixtures JAN 0 2010 FOR OFFICE USE. ONI.V
C ity of Tigard Dates Reccivcik / ► (J r
a 13125 SW Hall Blvd., Tigard. 0' r'9 F TIGARD Plan Resin : e Phone: 503.639.4171 Fax: = Oilier Pcrmtl No.:
� � 11 G DIVISION D ote / 13y
T i G A R D Inspection Line: 503.639.417- Dm Randy /fly: Jnrla: 15 Sec Page 2 for
Internet; www,tignrd- or•gnv Notified/Method: Supplemental
tYPt F.. K.'
O 3308 FF;fE % ..5 ��1<ils'DUL•C;
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❑ New construction I ❑ Demolition, For special information use checklist.
Description I Qy Ea. I Total
® Addition/alteration /replacement I ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
; ::;' ' CATEGORY OF CONSTRUCTION ' SFR (1) bath 24920
❑ 1- and 2- family dwelling Cnmmcrcialrndustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) both 399.00
❑ Master builder 1:1 Other: Each additional bath/kitchen I 45.00
Fire sprinkler ( sq. ft.) Page 2
41013 S1TF. AND .L:OA'lt7ON I S utilities
Job Job site address: 10115 Southwest Nimbus Avenue Catch basin or arca drain I 16.60 I
City /State /ZIP: Tigard/Oregon/97223 Drywell. leach line, or trench drain I 16.60
Suite/bldg. /apt. no.; a5o Project name: Java Mama Footing drain (no. linear ft.: _,) I Page 2
Manufactured home utilities 110.00
Cross street/direetions to job site: Scheib; Ferry Rd
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear 11.:_) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision; I Lot no.: I Water service (no. linear ft.; ) 1 Page 2
Tax map /parcel nn.:
I Fixture or item
s 16.60 I
. ,....... ton valve
.DESCRIPTION OF WO17TC :'
n . pW 17rCVCnler
Page 2
.:........:.:....:.: ..... ........ ,... ;.,•.,,:..�� .. B skit
Remove and replace sink floor drain Backwater valve 16.60
Clothes washer 16.00
Dishwasher 16.60
. :::ti .14000(1' !OWNER;:: ;: itiAto Drinking fountain 1 11.10
Name: �, � .. , .... ., Ejectors/sump I 16.60
Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City /State/ZTP: Floor drain/floor sink /huh I 16.00 16.60
Phone: ( ) Fax: ( ) Oarbage disposal 16.60 I
K:: APPLiCA1\"C : .I CONTACT pi5iigef ';
�. . Hoc bib 16.60
a;
,..., .. ,...... .. �'" .. ,
' I Ice maker 16.60
Business name: Relaint Plumbing & Mechanical intercepmr /grease trap 11.150
- Contact name: Ernie Beasley Medical gas (value: S ) Page 2
Address: 11575 SW Pacific Hwy #219 Primer 16.60
I City /State/7.TP: Tigard /Oregon /97223 Roof drain (commercial) 16.60
Phone: (503) 246 -1201 Fax: : (503) 246 -1205 I Sink /basiMavatory 16.60
Tub /shower /shower pan I 16.60 j
E -mail: ernic(Jre1iantplumbing.com
Urinal 16.60
CON
TRit,'CTOR
• . . . . . .. .� ,. Water closet 16,60
Business name: Reliant Plumbing & Mechanical J Water heater 16.60
Address: 11575 SW Pacific Hwy #219 Other:
City /State/7.1P: Tigard/ Oregon/ 97223 Subtotal 16,60
Phone: (503) 246 -1201 Fax: 503 246 -1205 Minimum permit f $72.50 72.50
( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: 169844 . Plumbing Lic. n0.: PR1117 Plan review (25% of permit fee)
Authnri�cd signature: L - II. `
State surcharge (12% of permit fee) gr
/� l TOTAL PERMIT FEE
Print name: Ernie Beasley 0 Date: (11/07/10 Thls 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 $crvicc T oard.
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