Permit { CITY OF TIGARD PLUMBING PERMIT
:1'2' COMMUNITY DEVELOPMENT Permit #: PLM2010 -00244
1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/28/2010
Parcel: 2S 112 DD00400
Jurisdiction: Tigard
Site address: 15912 SW 72ND AVE B17
Subdivision: OREGON BUSINESS PARK I Lot: 17
Project: JOHN CRANE INC
Project Description: TI
Owner: FEES
PACTRUST Quantity Description Date Amount
15350 SW SEQUOIA PKWY SUITE 300
PORTLAND, OR 97224 1 ea Drinking Fountain 07/27/2010 $25.02
2 ea Floor Drain/Floor Sink/Hub 07/27/2010 $50.04
PHONE: 503 - 624 -6300 3 ea Sink 07/27/2010 $75.06
1 ea Ice Maker 07/27/2010 $12.51
Contractor: 1 12% State Surcharge - 07/27/2010 $19.52
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 $182.15
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 m obtain a copy of the rules
or di - questions • • UNC • • Iling 503.246.6699 or 1.800.332.2344.
sued By: L. / � Permittee Signature:
�f -!'lam
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.
A_t2_ot.
Building Fixtures 1.0R ,,01•l 1(, 1 1 , ,r: ()N1 )..
City of Tigard /0 P erm it No. �LW, ., . al
4;1 13125 SW Ilall Rlvd.. Tigard. OR 97223 Plan Review
Other Permit No.: �(U� Rao-QQ��
• Phone: 503.639.4171 Fax: 503.598.1960 Date /By:
Inspection Line: 503.639.4175 DateRcad /B ru ris:
I I C, . �11t 1�` Y Y: Fa See Page 2 for
Internet: www.tigard- or.gov Notitied/Method: Su
ppkm total Information
TYPE OF WORK FEE* SCHEDULE
El 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 connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 437.78
ID Accessory building SFR (3) bath 500.32
ry g ❑ 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: "� � e a .0____, Catch basin or arca drain 18.76
/ q / a (t j Dryweli, leach line, or trench drain 18.76
City /State/ZIP: ( `T
Footing drain (no. linear ft.: ) Page 2
Suite/bldgiapt. no.: Project name: ®k n ‘yrQM. o
/ id, G Manufactured home utilities 50.03 - IP
Cross street/directions to job site: 00 7,,�,r„ " • 13,06 -174. -174. r 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.: rlackftow prcwenter 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
. " - r . .
Dishwasher 25.02
g. (3---pr. Drinking fountain ( 25.02 6" a
0 { C) Ejectors /sump 25.02
IRI PROPERTY OWNER j ❑ TENANT Expansion tank 12.51
1 Fixture /sewer cap 25.02
Name: "7ite.„-n,
Floor v
`� Floor drain/floor sink/hub 1 25.02 5jj-
Address: 1 5: Q 5 e f D f4 ! k�� Garba disposal 25.02
City /State/ZIP: � 1 41 Z2- 1s Hose bib 25.02
Phone: (303) (mot q _6 gefl Fax: (6C?� & VI 7-7 S Ice maker 1 12.51 /9-' /
D4PPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name : .. S 1 ��. Medical gas (value: $ ) Page 2
, � A T x �'( Primer 12.51 _
Contact name: s / Z �!A� Roof drain (commercial) 12.51
Address: / .5"g/� r � � OE ,, y Sink/basin /lavatory 3- 25.02 75.00
[_G
City /State/ZIP: C. / /<.e 6 0 a K_ ei 1 Y e23 5 Solar units (potable water) 62.54
Phone: tfO3) ? yr _ 6, / `Fax: ( 3) 6 gy o / e l Tub /shower /shower pan 12.51
„ Urinal 25.02
i - ' s
E -mail: ! (� 4 y tl,$ It/ ➢ Le vil Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Addison Plumbing LLC Water P l P in DWV 56.29
Address: 27425 S Beavercreek road Other: 25.02
City/State/ZIP: Mulino, OR 97042 Subtotal /(pg. ( 3
Phone: (503) 632 -1657 Fax: (503) 632-1168 Minimum permit fee: $72.50
CCB Lic.: 151754 Plumbing Lic. no.: 3-449PB Plan review (25% of permit fee) ffj'
State surcharge (12% of permit fee) /9, 5"?- ,„
Authorized si nature:
g c - TOTAL PERMIT FEE / g,. /S
Print name: Jay Moore Date: This permit application expires if a permit is not obtained within 180 days
l after it has been accepted as complete.
*Foe methodology set by Tri- County Building Industry Service Board.
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