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Permit £ . :N C' CITY OF TIGARD PLUMBING PERMIT a a a COMMUNITY DEVELOPMENT Permit #: PLM2010 -00119 nh Date Issued: 04/16/2010 Tf GAR ti. , 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 .■ ,; `,•;,i'',''': ,,u Parcel: 2S102AD02200 Jurisdiction: Tigard Site address: 8900 SW BURNHAM ST Subdivision: BURNHAM TRACTS Lot: 6 Project: Burnham Street Improvements Project Description: Relocate irrigation backflow device. Owner: FEES BURNHAM BUSINESS & STORAGE LLC Quantity Description Date Amount 9500 SW BARBUR BLVD STE 300 PORTLAND, OR 97219 1 ea Backflow Preventer 04/16/2010 $31.27 PHONE: 1 12% State Surcharge - 04/16/2010 $8.70 Plumbing 41 ea Minimum Fee Adjustment - 04/16/2010 $41.23 Contractor: Plumbing KODIAK PACIFIC CONSTRUCTION PO BOX 886 TUALATIN, OR 97062 -0886 PHONE: 503 - 783 -4300 FAX: 503- 682 -3777 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: .„, � a / 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 J FOR OFFICE USE ONLY City of Tigard Date/By: / / /fc3 /t J � U/ Rece tp /�f Y permit No.: O - DD//9 • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review C Phone: 503.639.4171 Fax: 503.598.AR 1 5 2010 Date/By: Other Permit No.: Inspection Line: 503.639.4175 TIGARD Date Ready/By'. lv . Pi See Page 2 for Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: /'e Supplemental Information TYPE OF `!f DING DIVISION FEE* SCHEDULE ❑ New construction 0 Demolition For special information use checklist Description I Qty. I 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 ❑ 1- 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: � y Catch basin or area drain 18.76 Job site address: st t.-41 n "l Aiii Drywell, leach line, or trench drain 18.76 City /State /ZIP:, q 722 3 Footing drain (no. linear ft.: ) Page 2 Suite/bldg. /apt. no.: J Project name: j3 u rr A, y,.1 5 .../enitem.!ese,r4 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: I Lot no.: Fixture or item: Backflow preventer i 31.27 Tax map /parcel no.: Backwater valve 12.51 DESCRIPTION OF WORK Re ! J Clothes washer 25.02 \ o c+t ..1- Y r I j '' ell i'1 b4W. D W (IC V I.4 r b e h "^ ci Dishwasher 25.02 6t' 1.) s! C C liV e I Drinking fountain 25.02 Ejectors /sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Fixture /sewer cap 25.02 Name: f1, r<.I F/ , , , + Floor drain/floor sink/hub 25 Address: 8960 t t.N °v') ^ s1 Garbage disposal 25.02 City/State /ZIP: TT) �,, CI P., 9 7 2 2 - 3 Hose bib 25.02 Phone: ( ) J Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Medical gas (value: $ ) Page 2 Business name: Primer 12.51 Contact name: Roof drain (commercial) 12.51 Address: Sink/basin/lavatory 25.02 City/State /ZIP: Solar units (potable water) 62.54 Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51 Urinal 25.02 E -mail: 25.02 Water closet CONTRACTOR Water heater 37.52 Business name: KOD /4 K P4t fffc. C0M571 r») Waterpiping!DWV 56.29 Address: PO k 045(0 Other: 25.02 City/State /ZIP: - ,,A1'I l 1, G Z. 9 7 0 (O 2_ Subtotal Minimum permit fee: $72.50 /A' Cy Phone: (,p3) 7 8 3 - 4 30 Q F a x : ( ) c Q U ap' 7 7-7 Plan review (25% of permit fee) - CCB Lic.: 5 5-5 Plumbing Lic. no.: 34 - A 1 - State surcharge (12% of permit fee) $'. 1O Authorized signature: TOTAL PERMIT FEE g( , . Print name: e7(VI Date: }, A ,4 go ej J 4r) / ,S /10 This permit application expires it 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. I: \ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10/02/COM/WEB)