Permit
CITY OF TIGARD PLUMBING PERMIT
tt COMMUNITY DEVELOPMENT Permit: PLM2009-00318
0 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/03/2009
Parcel: 2S 112AD01000
Jurisdiction: Tigard
Site address: 7007 SW CARDINAL LN 105
Subdivision: Lot: 0
Project: Spec Space
Project Description: Relocate/replace (2) floor drains, (1) primer, (5) lavs, (1) urinal, (3) water closets, and (1) water
heater.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 2 ea Floor Drain/Floor Sink/Hub 11/03/2009 $50.04
1 ea Primer 11/03/2009 $12.51
PHONE 503-624-6300 5 ea Lavatories 11/03/2009 $125.10
1 ea Urinal 11/03/2009 $25.02
Contractor: 3 ea Water Closet 1110312009 $75.06
LEED CORP 1 ea Water Heater 11/03/2009 $37.52
12606 NE 95TH ST 1 12% State Surcharge - 11/03/2009 $39.03
VANCOUVER, WA 98682 Plumbing
PHONE: 360-213-0969
FAX: 360-213-0967
Type of Use: COM
Class of Work: ALT Type of Conet:
Occupancy Grp:
Stories:
Total $364.28
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 the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 11 jai Permittee Signature:
Y o
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 RECEIVE i.
Building Fixtures 3 FOR OFFICE•_ US( ONLY
N CAL U 3 2 009 Received ��
City of Tigard Dat /By: Permit No.:
l'il
a 131 25 SW Hall Blvd., Tigard, OR 97223
Plan Review
! 11 Phone: 503.639.4171 Fax: 503.5 98.1960 CITY OF TIGA' �' Date /By: Other Permit No. Oc? ,,x`1
T 1 G A R D Inspection Line: 503.639.4175 BUILDING DIVISI _I a te Ready /By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: .1- Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑Demolition For special information use check list.
Description I Qty. I Ea. 1 Total
..1211cddition/alteratio 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: 70v 7 j Cn- 7 2,Q4A,4/ G� 1 Catch basin or area drain 18.76
�� Jt � � Footing ram line, or trench drain 18.76
_
City/State /ZIP:
Footing drain (no. linear ar ft.: _ ) Page e 2
Suite/bldg. /apt. no.: /OS Project name: .c - /Q s" 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
DESCRIPTION OF WORK Backwater valve 12.51
,,( / Clothes washer 25.02
/
1' - femAi m c5 & Dishwasher 25.02
-
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: 7k✓7 Fixture/sewer cap 25.02
Floor drain/floor sink/hub a 25.02
Address:
Garbage disposal 25.02
City/State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer / 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin /lavatory S 25.02
City/State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal / 25.02
CONTRACTOR Water closet .3 25.02
Water heater / 37.52
Business name: L6Z�ePelf r Water piping/DWV 56.29
Address: / r /S Jf �L.c7b' C. • /6Q Other: 25.02
City/State /ZIP: U 41-4-9 2,1'5"Y Z Subtotal
Phone: (.74D ) d f,? _ c , 9 5 Fax: (Zy ) d ) / 3. D S 6 7 Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: /1/0 t Plumbing Lic. no.: fj? si 2 State surcharge (12% of permit fee)
Authorized signature: ... /� TOTAL PERMIT FEE 3
Print name: C et Date: // _0 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.
1:\ Buildin0ermits\PLMU- PennitApp.doc 10/01/09 440- 4616T(10/02 /COM/WEB)