Permit "?"y�, PLUMBING PERMIT
:} 'm CITY OF TIGARD
j 11 Permit #: PLM2010 -00162
a COMMUNITY DEVELOPMENT
R 1 SW H Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/20/2010
TIGA Parcel: 2S104BB07900
Jurisdiction: Tigard
Site address: 14300 SW BARROWS RD
Subdivision: RUSSELL'S SCHOLLS FERRY SUB Lot: 2
Project: Albertsons
Project Description: Replace backflow device in produce department.
Owner: FEES
NEW ALBERTSON'S INC Quantity Description Date Amount
ATTN: 70428 CORPORATE TAX, PO BOX 20, 1 ea Backflow Preventer 05/20/2010 $31.27
250 PARKCENTER BLVD 1 12% State Surcharge - 05/20/2010 $8.70
PHONE: Plumbing
41 ea Minimum Fee Adjustment - 05/20/2010 $41.23
Plumbing
Contractor:
COMMERCIAL PLUMBING SERVICE
21185 NW EVERGREEN PKWY SUITE 105
HILLSBORO, OR 97124
PHONE: 503 -439 -9999
FAX: 503 -439 -1999
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: U N /52/),) `/ 49 erfe_____
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.
0511912010 11:24 Mechanical Services, Inc. (FAX) P.002/003
Plumbing Permit Application c I, A ;
Site Utilities i
City of Tigard MAY 1 9 20 1 0 Reee ; vea
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q
13125 SW Hall Blvd., Tigard, OR 97223 DRate/B g/�� / L �y -2 f
Phone: 503.639.4171 Fax: 503.598.1 Ti Plan Revie �C� JT / Permit No.: n / " � 1 �� 4 /�',/�
Inspection Line: 503.639.4175 [ I of fIGARD Date/By: Oft Prrmtt �/C . ao �� , /y
T I G nRD P 1 J
Internet www.tigard- or.gov BUI DI VISION No te f d/M et yh : 1u ' : @ See Pa a for
A� Nodfie
FYPE .OF WORK
' Supplemental Informal on
❑ New construction ❑ Demolition For special information use checklist
addition/alteration/replacement Description Qty. Ea. I Total
❑ Other: New I- 2- family dwellings (includes 100 t1 for each utility connection)
. CATEGORY:OF CONSTRUCTION SFR (I) bath 312.70
❑ 1- and 2- family dwelling [ mmercial/industrial SFR (2) bath 437 -78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
❑ Master builder Each additional bath/ldtchen 25.02
❑ Other: Fire sprinkler ( , sq. ft) Page 2
JOB" SITE INFORMATION AND LOCATION
Site utilities:
Job site address: ii 5w �P, t�o \i.aS 2D 76
Catch basin or area drain I8 76
te
CitY/SlateiZIF: acldres Drywell, leach line, or trench drain 18
T ea eN P2 0 , t.PZ..• 9'1 2 2 3
Suite/bldg./apt. Footing drain (no. linear ft.: ) Page 2
no.: Project name: P3E2TSpN Cj") Po Manufactured hone utilities
Cross street/directions to job site: 50.03
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Water service (no. linear ft.: _) Page 2
I Lot no.: _ Fixture or item:
Tax map /parcel no.: Backflow preventer % 31.27
,31.. 'z-1
DESCRIPTION OF WORK Backwater valve 12.51
fZEP+CE t�� �: � V testa Clothes washer 25.02
utrn (>?>2 - ..t-�PZ/ Dishwasher
25.02
9 Owl 1 C e t tv P aura tic c 'ipz -. Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER: ; ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal 25.02
Hose bib 25.02
Phone: ( ) I Fax: ( ) Ice maker f
- ❑ APPLICANT I ❑ CONTACT PERSON Interceptor/grease 12.51 I
P grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Contact name: Primer 12.51
Address: Roof drain (commercial) 12.51
Sink/basin/lavatory 25.02
City /State/ZIP: Solar units (potable water)
62.54
Phone: ( ) J Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal
25.02
CONTRACTOR Water closet 25.02
Business name: Water heater 37.52
�OMMi`QS'IAL ��rrt tvc S =aV.t� Waterpiping/DWV -
56.29
Address:
21t9, t�1 W E J�t2e nx - ?1LW■1 ;S"1 k IBS Other: 25.02
City/State/ZIP: # v o. _ s P..Q2_4:
1 �^ ,Q -. �t l Za Subtotal 31- 27
Minimum one: (�3) �. y • 9 c q Fax: ( ) nimum permit fee: $72.50 c C)
�3 'I • i ei '19
P --72 ,s
CCB Lic.: lZta�1 Plumbing Lic. no.: 3- I1.421 Pb Plan review (25%ofpermit fee)
Authorized signature:
State surcharge (12% of permit fee) --I p
• TOTAL PERMIT FEE $ , 20
This name: , \�•ft� is permit a pplication expires if a permit is not obtained within 180 days
t._1 r��.(Z'j> ) LC Date: s I t p
( after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board.
1 :\ Building \Permits\PLMU- penu¢App.doc 10 /01/09 440- 4616T(10/01/COM/WEB)