Permit ;` : na, <! CITY OF TIGARD PLUMBING PERMIT
11 ';''''''- COMMUNITY DEVELOPMENT Permit #: PLM2010 00066
}T 6 GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/09/2010
Parcel: 2S112DD00701
Jurisdiction:
Site address: 15858 SW UPPER BOONES FERRY RD
Subdivision: OREGON BUSINESS PARK II Lot:
Project: AMEC
Project Description: Relocate (1) utility sink.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 1 ea Sink 03/09/2010 $25.02
PHONE: 503 624 -6300 1 12% State Surcharge - 03/09/2010 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 03/09/2010 $47.48
Contractor: Plumbing
ADDISON PLUMBING
27425 S BEAVERCREEK RD
MULINO, OR 97042
PHONE: 503 - 740 -8116
FAX: 503 - 632 -1168
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 direc : yes io - • OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue. =y: I /,' eAMAtit 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 roR oii icr. USE ONE)
City ll / of Ti and Received 7 /o g� Permit No.: ( • ' / O J
�/�
a 13125 SW Hall Blvd., Tigard, OR 97223 D a n /B y C�"""'Sv
C Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No.:
Date /By:
T l G A R D Inspection Line: 503.639.4175 Date Ready /By: Duns: 1 ® See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 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
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: 15858 Upper Boones Ferry Road Catch basin or area drain 18.76
Drywell, leach line, or trench dram 18.76
City /State/ZIP: Lake Oswego, OR 97035
Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: I Project name: amec earth Manufactured home utilities - 50.03
Cross street /directions to job site: Sequoia 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: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
TI jplr Q Q (j \ f\ kc . Dishwasher 25.02
// Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: PacTrust Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 15350 SW Sequoia Pkway, #300
Garbage disposal 25.02
City /State/ZIP: Tigard, OR 97224 Hose bib 25.02
Phone: (503)624 -6300 Fax: (503 )624 -7755 Ice maker 12.51
■ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Durus Construction, LLC Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Steve Adams
Roof drain (commercial) 12.51
Address: 15836 Upper Boones Ferry Road Sink/basin/lavatory I 25.02
City /State /ZIP: Lake Oswego, OR 97035 Solar units (potable water) 62.54
Phone: (503) 320 - 8601 Fax: : (503) 684 - 8144 Tub/shower /shower pan 12.51
E -mail: steve@durusllc.com Urinal 25.02 -
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Addison Plumbing Water piping/DWV 56.29
Address: Z 7 4LS s. $eo, i"e- -+-ems- t,- Other: 25.02
City / State/ZIP: 0 c,,, OA Q'70 - Z
Subtotal
Phone: (yes 3 ) (.3Z -- /6 S7 Fax: (S 3 ) 4.?Z - / /(&
Minimum permit fee: $72.50 ?2 •�
CCB Lic.: j Si 7Sµ Plumbing Lic. no.: s '� - e, Plan review (25% of permit fee) �-
State surcharge (12% of permit fee) g , 0
Authorized signature: Vkr-t7 n TOTAL PERMIT FEE $ /.
Print name: cam+ V1/4,56 , c -- e Date: 3/9/10 This permit ap 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.
1: \ Building \Permits \PLMU- PermitApp.doc 10 440- 4616T(10 /02/COM/WEB)