Permit
q CITY OF TIGARD PLUMBING PERMIT
>z COMMUNITY DEVELOPMENT Permit#: PLM2010-00057
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/23/2010
Parcel: 2S 101 AC01300
Jurisdiction: Tigard
Site address: 7105 SW HAMPTON ST
Subdivision: Lot: 0
Project: Kaiser Dental
Project Description: Cap (2) sinks, and demo (3) medical gas outlets.
Owner: FEES
KAISER FOUNDATION HEALTH Quantity Description Date Amount
PLAN OF THE NORTHWEST #838, ATTN:
GENERAL ACCCOUNTING 11TH F. 500 NE 2 ea Fixture/Sewer Cap 02/23/2010 $.04
1 12% State Surcharge - 02/23/2010 $8 $8.70
PHONE:
Plumbing
22 ea Minimum Fee Adjustment - 02/23/2010 $22.46
Contractor: Plumbing
HEINZ MECHANICAL INC
2615 NW ST HELENS RD
PORTLAND, OR 97210
PHONE: 503-220-0855
FAX:
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:
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 e e
City of Tigard F E B 2 3 2 010 Received ~0
Date/By: Permit No.:
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Far: 503.598.}~~3Q. , OF TIGARD Date/By: Other Permit No.:
e Inspection Line: 503.639.4175 l 1 Date ReadyBy: 's: 0 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/'Method: Supplemental Information
. - - - - - - - - - _ - - - _ -
TYPE'OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. I Ea. 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 ® Commercial/industrial SFR (2) bath 437.78
El 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: 7105 SW Hampton St Catch basin or area drain 18.76
City/State/ZIP: Portland Oregon 97223 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: Page 2
Suite/bldg./apt. no.: Project name: Telecom Improvements 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
Demo 2 each Exisitng Sinks and Demo 3 each Medical Gas Oulets Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Kaiser Permanente Fixture/ ewer c 25.02
Floor drain/floor sink/hub 25.02
Address: 500 NE Multnomah St 12th Floor
Garbage disposal 25.02
City/State/ZIP: Portland Oregon 97232 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name: Heinz Mechanical'Inc. Medical gas (value: $ 610.) Page 2
Primer 12.51
Contact name: Brian Wheeler
Roof drain (commercial) 12.51
Address: 2615 NW St Helens Road Sink/basin/lavatory l/ 25.02
City/State/ZIP: Portland Oregon 97210 Solar units (potable water) 62.54
Phone: (503) 220-0855 Fax:: (503) 220-0260 Tub/shower/shower pan 12.51
E-mail: Urinal . 25.02
- - Water closet 25.02
CONTRACTOR.
Water heater 37.52
Business name: Heinz Mechanical Inc. Water piping/DWV 56.29
Address: 2615 NW St Helens Road Other: 25.02
City/State/ZIP: Portland Oregon 97210 Subtotal
Phone: (503) 220-0855 Fax: (503) 220-0260 Minimum permit fee: $72.50
CCB Lic.: 43866 Plumbing Lic. no.: 34-165PB Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: Brian Wheeler Date: 2/22/10 This permit application expires if a permit is not obtained within 18 'days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01109 440-4616T(10/02/COM/WEB) RD