Permit -w-'t PLUMBING PERMIT
CITY OF TIGARD
I: s COMMUNITY DEVELOPMENT
Permit #: PLM2010 00245
, ,. Date Issued: 07/27/2010
"T I GfARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel 2S113A600101
Jurisdiction: TIGARD
Site address: 16101 SW 72ND AVE 200
Subdivision: PACTRUST BUSINESS CENTER Lot: 0
Project: Sunset Mortgage
Project Description: Relocate breakroom sink and dishwaster.
Owner: FEES
PACTRUST Quantity Description Date Amount
15350 SW SEQUOIA PKWY SUITE 300
PORTLAND, OR 97224 1 ea Dishwasher 07/27/2010 $25.02
1 ea Sink 07/27/2010 $25.02
PHONE: 503 - 624 -6300 1 12% State Surcharge - 07/27/2010 $8.70
Plumbing
Contractor: 22 ea Minimum Fee Adjustment - 07/27/2010 $22.46
ADDISON PLUMBING Plumbing
27425 S BEAVERCREEK RD
MULINO, OR 97042
PHONE: 503 - 740 -8116
FAX: 503- 632 -1168
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 w in 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules ad., by the Oregon
Utility Notific tinn ('enter. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obt in a copy of the rules
or dire uestions to • ■ • C by ca ' g 503.246.6699 or 1.800.332.2344.
Iss d By: e 1 / � /Qe....(4.440 Permittee Signature Illir
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.
Building Fixtures q . ; ,r,w,�r.. Y rga f g nietinl,I I'61 ssl`7�tils I 1 rj' {tyy`
1'?�'utdhi':.1. - 461 . Y; ?.taut! t+ .t - 4iirto.,W9Gb G+eR eL"iy -..l l"�
pr vfi " "' C of Tigard Received 1 P ermit No.: D __ A r t . Date /By: 7 7 /O a
a 13125 SW H Blvd.. Tigard. OR 97223 i
Wi', Plan Review
y ..., Phone: 503.639.0171 Fax: 503.598.1960 y: Other Permit No..
Date/By:
<7 ^t:a Inspection Line: 503.639.41 Date Read /D lu ris: BI Se Page 2 for
Pa
ciir ;/ Nf' d
l ^7 I nternet: www.ti an ov Ready /By: l
r'i4'- r..i =4 � S S Notified /Mahal: Supplemental Information
TYPE OF WORK FEE" SCHEDULE
❑ New construction ❑ Demolition For special information use checklist:
Description 1 Qty. 1 Ea. 1 Total
® Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connectooi
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
❑ 1- and 2- family dwelling ® Commercial /industrial SFR (2) bash 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 LNFORMATION AND LOCATION Site utilities:
Job site address: 1 till 01 S W 12 Ave 5 .6i 7 Catch basin or area drain 18.76
Drywell. leach lint, or trench drain 18.76
City/Stale / %1P: Footing drain (no. linear ft.: �) Page 2
Suite/bldg. /apt. no.: Z(Jk. I Project name: SK 1► orAy X Manufactured home utilities 50.03
Cross street/directions to job site: SW - b la, /2"W,e.s Manholes 18.76
Rain drain connector 18.76
■r¢.0 t.--e f d . •
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear R.: _ ) Page 2
Subdivision: ' I Lot no.: Fixture or item:
Tax map /parcel no.: Back flow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
+ 1 Clothes washer 25.02
(:).-Q 1N1 o (C k' nSkc A c- i t c� G �- nc i �i r n1 1 J f.ee- k r w Dishwasher .1 25.02
�', .k 4-_ ( J Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
1 Fixture /sewer cap 25.02
Gv
Name: Par,"- Floor drain /floor sink/hub 25.02
Address: i, S3 SO , 51/ S A o j, pk 5...t. 3 3� Garbagcdisposal 25.02
City /Slate /ZIP: >Pc) r „, 0 Q 4 11Z-4 t Hose bib 25.02
Phone: (5U1) ( u,./00 Fax: ( ) lee maker 12.51
❑ APPLICANT '" 10 CONTACT PERSON Interceptor /grease trap 25.02
Business name: edical gas (value: $ ) Page 2
OLAriA.S co c n S� t0/X
lei Primer 12.51
Contact name:
G r t S G\t I Roof drain (commercial) 12.51
Address: i O 3 (. one r - W �a -}e.0 f (A . Sink/basin /lavatory 1 25.02
City /Statc /ZIP: j,,,V„ 05 e5� Solar units (potable water) 62.54
Phone: (603) '?„,A.) - 5 ( 33 Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: �C; 0 dt4rK3I Cor✓t Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Addison Plumbing LLC Water piping/DWV 56.29
Address: 27425 S Beavercreek road Other: 25.02
City /State /ZIP: M ulino, OR 97042 Subtotal
Phone: (503) 632 -1657 Fax: (503) 632 -1168 Minimum permit fee: S72.50 7:2„517)
CCB Lic.: 151754 Plumbing Lic. no.: 3 -449PB Plan review (25 % of permit fee)
State surcharge (12% of permit fee) g...76,
Authorized signature: t I eog--7...., TOTAL PERMIT FEE. SI . AU
Print name: Jay Moore Date: This permit application expires if a permit is not obtained within 180 day:
after it has been accepted ns complete.
*Fee methodology set by Tri- County Building Industry Service Board.
IAntal ermits'.PLMU- PcrmitApp.doc 10/01/09 440- 46161(Io,O/COM/WEB)
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