Permit
v CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2009-00120
. 0 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/13/2009
Parcel: 2S101 BB01400
Jurisdiction: TIGARD
Site address: 12150 SW GARDEN PL, BLDG# 3
Subdivision: PARK 217 Lot: 0
Project: Harris Worksystem
Project Description: Replace (1)dishwasher, (1)icemaker,(1) floor drain, (1) garbage disposal, (1) breakroom sink, (2)
lavs, and (1) w/c, cap (1)breakroom sink, (1)lav, and (1)water closet.
Owner: FEES
WALTON CWOR PARK BC 8 LLC Quantity Description Date Amount
BY TTA/EPROPERTYTAX DEPT 325, PO BOX 1 ea Dishwasher 05/13/2009 $16.60
4900
2 ea Fixture/Sewer Cap 05/13/2009 $33.20
PHONE: 1 ea Floor Drain/Floor Sink/Hub 05/13/2009 $16.60
1 ea Garbage Disposal 05/13/2009 $16.60
Contractor: 1 ea Ice Maker 05/13/2009 $16.60
CASCADE PLUMBING CO, 2630 N HAYDEN 1 ea Sink 05/13/2009 $16.60
ISLAND DR #3 2 ea Lavatories 05/13/2009 $33.20
PORTLAND, OR 97217 1 ea Water Closet 05/13/2009 $16.60
PHONE: 503-289-7095 1 12% State Surcharge - 05/13/2009 $19.92
FAX: 503-283-9514 Plumbing
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $185.92
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:
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.
'I 13 2009 1 2: 59PM HP LASERJET FAX p • 1
Plumbine Permit Application ! (tl( x.11 (,� �. , , {,,. y
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ciri or Tigard Reserved
: 13125 SW Hall Blvd., 'flgerd, OR 97223 oet /H !".• ° Penmt Np. :P U/ .6Q I .1V
® Phone: 503.639.4171 Fax: 503.398.1960 I ( t t• Plan Renew
1 1 1t r �; Inspection Line: 903.639.4175 , g (,
. u • Drle /BY: Other Perinh No.:
lntemet: www.tfgard- or,gov Dim Raady/By: m See e 2 for
� r", �, ��. a, ai: rry, ! .: *:; ,':• • . Notified/Method: , Su. • nx[ynT�Ml laforalInformation +'.i f A ,et 1 J T�sUtAd}ui; A ,i : "1 'tr 1 ■(` ,' .': ; t.� ' ? 1 , ; hi'..'>>''R°`t,gt ' t G� . tali � ° 1 1 '• •
CI Ncw construction 0 Rti It on • �' t 1
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ddltloNeltaretionl Description
`y re pleoement ❑ Other: OtY. Ea j Total
11 dwell' tility connection)
r '�i�' ° , '1 �'Y , �is� ^� ;(twq�*,tr. +�� Tuft .��,nn �r �>x New l - 2. dwelling/ (includes 100 R. ibr each
Riffit ilia a8_r�i�.G• ' ��.� nr ,` I:. . 1 l ' 4 , X 11 1 (t ! a 1. . i6:1•)1:�,t ,:,( : /'';; i i' Y' , ; -
l':,,,,: ;a:.1.s'..a .u. �In�!vrLlu ,h, ,1 „.!�, ; ;:i . ,•:;l:f�• �'rL.i SFR (1) bath
249.20
❑ 1 - and 2.faatily dwelling .'; . merciel /industrial SFR (2) bath 350.00
(] Accessory building ❑ Multi•family SFR (3) bath 399.00
❑ Master builder 0�pOther: Each add(ttonan I bath/kItchen 45.00
�t }T.1ejq:� I F),� • + „'�< �r',r�,161!� t q(�?'U ^lv' , Y IC"'�1�7 �s:1'�' , ,a •I, './4:.:'..41.:;:);'?-‘',4, . Fire sprinkler ( a it. _ see
t i ' :' x 1. i ;�:r`F ° .{; M s;..�.'�J' 'k EA ° 1 . ' q• ) P - Z
lifts utilities
Job site address: 4 5 p Su.) • a...' Catch basin or area drain
16.60
City /State/ZIP: I. s ct. 02- Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: �.0 ' s Footing drain (no. linear R.: _) Page 2
1 . Manufactured home utilities
Cross street/dinotions to job 91te: 110.00
Manholes 1660
Rain drain connector 16.60
Sanitary sewer (no. linear R.: _) Page 2
Storm sewer (no. linear ft: _ ) Pap 2
Subdivision: 7 Lot no.: Water service (no. linear fl.: _) Page 2 "
Tax map/pttrael no.: �v Fixture or Item
'''' 7 :. kil rf "��ki�r Gii1Y1 �3`' c,s:n ?a?r.»�$sn. Absorption
t p Ft ;� ��:,,,. a 16.60
rift l:�klg dF:.` ^. . t dal r'aai4`.l'.:: ; clil�d:i.� °_� • •_ {: , �'� ;: , 1(: ( ` . Backfluw prev -_ Page 2
enter
fi r.
Lit . a �r1 01..).. 0 . _it $ ,1 •I ( C Backwater valve 16.60
i� r N.
Clothes washer _ 16.60
Dishwasher t 16.60 1 • b 0
F a i} r .ac:Plr, ��i��a(�t�?a r 'Ijaj 7,3 fir? yr :r 11 r:' 7 !'. ' tg s r ; • Drinking rbunteln -
1f,ciu..uad �t�i9:dr..,e'uaw' $ is 1 : : +. g' X111 hp , a ; t 16.60
""�� '/ EJ
Name: p 16.bD
Expansion tank -
Address: �A 16.60
_ Fixture/sewer cep Q ( l ( 6.60 33 •
City/State/ZIP: Floor drain/floor Sink/hub al 16,60 1,,,
Phone: ( ) Fax: ( Ga rbage disposal
E �y,�{ ) 16.60 +m • tv a
. istSf�; :.' fie` �1�•'7 Via' 4 �i� ''.A _ ; ren j� w�y��e Hose bib 16.60
Business name: 0 • 7 Qf7 nab Ice maker , i - 16.60 q)"
Interceptor/grease tree 16,60
Contact name: / -I C' II _ Medical gas (value: S ) Pap 2
• . is ei r� Primer 16.60
City/State/ZIP: , thia � / t' # °713 Roof drain (commercial) 16.60
Phone: ( 4 Sl -7095 3 > d 8- , e.•�� ` J S ink /b asin/laratory � o / 16.60 (-71 . g 6'
X03) Fax
8•ma(I: Tub /shower /shower pan 16.60 •
� 'rrj�ggY�a1��,�frnr1ty,7�� , -x�.• r •(` , t{ . t , . Urinal _ 16
Fii{L (d.`C+l:tIKI X'ri Vitt 9 tlll��k,�,(` e t*lgl> "(! lT y v.' 1.�� ; :�? 'F'li' 'R; ";• ;y -' p
f •i (�:.: kh''. i4ii L'S-d 'F'f:tre. at ittlltngzLJ i!h !• ti�' @: . `Nl t^i,!iri•�r M�!., :•ti'": ��Z 'n." "i �ry!!" t Water c10 et 4 16.60 (
- _' LL. Water heater U r 16.62 zZ �
Address ,` �, 4I 4 I ' / . A Other:
City /State2JP i trt _ I •I r� • `"-� _,__ Sub total -{ ( ( • Qa
Phone: . 5) Minimum permit fcc: 572.50
Fax: (3) • Residential backflow minimum permit fee: 536.21
CCB Li c.: Plumbing Lie. no.: , 1 -i ,44 I - '45 Plan review (25%ofpermit fee)
Authorized signature: State surcharge (12% orpermit ha) `q .q
� L � ��_ TOTAL PERMIT FEE ;
Print name: ` n ne.S � •
_ l � � in
'Ll� Date: 1 Thi9 pe rmit appl ication expires if a permit is not obtained within
160 days ater it has been accepted as complete.
•Fee methodology set by Tri -County Building Industry Service Board. •
1 121 u 0 dIng 1 Perm iIl1PLM.P4T610App.doo 06r2W06 44 0.4616'(110/O:r(:OM/WPA) •