Permit ePr CITY OF TIGARD PLUMBING PERMIT
li : COMMUNITY DEVELOPMENT Permit #: PLM2010 -00114
4 Date Issued: 04/16/2010
T t ak 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S102AB05300
Jurisdiction: Tigard
Site address: 9169 SW BURNHAM ST
Subdivision: Lot: 0
Project: Burnham Street Improvements
Project Description: Relocate irrigation backflow device.
Owner: FEES
JB OAK HILL LIMITED PARTNERSHIP Quantity Description Date Amount
9169 SW BURNHAM
TIGARD, OR 97223 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: Permittee Signature:
Ad
CaII 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 RECEIVED
Building Fixtures APR 1 5 2010 FOR OFFICE USE ONLY
Cl of Ti and Received ,` Permit No������ xi
g DateB 7 I b /O
• 13125 SW Hall Blvd., Tigard, OR 97223CI� OF TIGARD Plan Review /
II Phone: 503.639.4171 Fax: 503.598..'.'gILDING DIVISION Date/By: Other Permit No.:
'I' I G A R D Inspection Line: 503.639.4175 Date Ready/By: )u F 63 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: . / l� Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use check list
Description Qty. I Ea. I 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:
Catch basin or area drain 18.76
lob site address: 9 P 9 S c f I f #
9 Q Drywell, leach line, or trench drain 18.76
City /State /ZIP: �eted, O R_. / 7223 Footing (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 3 u r,i AerYi 5f , ,2,pr� p, 7 V Ae l e ,, 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:
Tax map /parcel no.: Backflow preventer / 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
L 1 f Clothes washer 25.02
Rt1oC , .i.r v t
1°l e ito 1 c t'"I
f oc4) dcv1.4C be , ti Dishwasher 25.02
At t ) 5 1 A f totj e l Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
�^ Fixture /sewer cap 25.02
Name: VIA ie)rli Ceri4
r Floor drain floor sink/hub 25.02
Address: 2 1, 5 c,1/4..) u r t t 1 1 2..141 Garbage disposal 25.02
City/State /ZIP: TT ., op, 97 ` 2 73 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:
Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: Ko K ? A < /F ( i 7 ' ( 77C/(" POrj Water piping/DWV 56.29
Address: j7 k 85( Other: 25.02
City/State /ZIP: t 'T.„ tA hi./ 0 a. 97 0 l0 2 Subtotal
Phone: (501) 7 3 Q Minimum permit fee: $72.50 7P's�
' 4'_ Fax: UdP ' 777
Plan review (25% of permit fee) -(--
V CB Lic.: 5 ? r 3 Plumbing Lic. no.: 34 - A 1 - 7 PA State surcharge (12 %of permit fee) $. V Authorized signature: '7�/ f 1/ TOTAL PERMIT FEE g 9.0
Print name:
/74, go o tj J Date: +. IS / I D This 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 Service Board.
I? Building \Permits\PLMU- PermitApp.doc 10/01 /09 440- 4616T(10 /02/COM/WEB)