Permit PLUMBING PERMIT
%IL-V:P''' CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00246
TtGARI? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 08/03/2010
Parcel: 2S102BD00600
Jurisdiction: TIG
Site address: 12725 SW PACIFIC HWY
Subdivision: Lot:
Project: Hafez Restaurant
Project Description: Replace existing fixtues: (1) commercial sink, (1) hand sink, and (1) dishwasher for bar.
Owner: FEES
FARID ADRANGI Quantity Description Date Amount
4289 ORCHARD WAY
LAKE OSWEGO, OR 97035 1 ea Dishwasher 07/28/2010 $25.02
2 ea Sink 07/28/2010 $50.04
PHONE: 1 12% State Surcharge - 07/28/2010 $9.01
Plumbing
Contractor:
CLEARWATER PLUMBING LLC
11755 SE HOLGATE
PORTLAND, OR 97266
PHONE: 503 - 935 -0918
FAX: 503 - 761 -2143
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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 Notifica • er. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or direc estions to OU • b calling 503.246.6699 or 1.800.332.2344.
Issu d By: I1/ Permittee Signature:
AIL r
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
Buildin Fixtures , , I O
Tigard R OI 1 I(i I til - i)\I 1 't ' s
Building
�j �O Date/By / ran i Permit No.:
_IA L1 � `
131 S Hall Blvd., Tig ard , OR 97223 Plan Review
-1 .'
, 11 Phone: 503.639.4171 Fax 503.598; , \\� DateBy: Other Permit No.: y n' „,, _ , 7 ,.
Ins Line: 503.639.4175 r
11(,:A I 1 ) ' Date Ready/By: kids Pi See Page2 for
Internet: www.tigard - or.gov Notified/Method: trf0 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 connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling Dmmercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
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: � 5 / o P v . G I Catch basin or area drain 18.76
City /State /ZIP: -1-il c, 1 X223 U Drywell, leach line, or trench drain 18.
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: 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
CAC/ l i C
0 _C) C iQI % Iw�,( G) �� I Clothes washer 25.02
`J ��) t f Dishwasher 1 25.02
A Cetet •5:" ( 0 2;1 1 r , t..J Ash Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I WI TENANT Expansion tank 12.51 -
Fixture /sewer cap 25.02
Name: 5 h 0 i 0 h I tin
Address: 5 -../.._ 2 0 5 t sets/ lie .6 V e Floor drain floor sink/hub 25.02
R Garbage disposal 25.02
City /State /ZIP: � (t t? W 0 5 8 (s n R T 1 5 Hose bib 25.02
Phone: ('a,) 6 a G i GI g Fax: ( ) Ice maker 12.51
❑ APPLICANT X] CONTACT PERSON Interceptor /grease trap 25.02
Business name: 01 F �`Z ( es .-F i t-ei `- n "y- Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: M H r I Roof drain (commercial) 12.51
Address: 51-2.0 S w/ 'self a_ I t e A tit e" _
Sink/basin/lavatory 1 25.02 ` , tali i'
City /State /ZIP: (( O S of a t kJ J p., q .-o3$ Solar units (potable water) 62.54
Phone: (5'61) 3'3 r3 y S - 0 Fax: : ( ) Tub /shower /shower pan 12.51 -
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: � i Q / Z,a 14. 24)1 1 %.•__4_C.,,_ Water piping/DWV 56.29
ill Address: //7..5.5` S1' /� /�qTC i ' ` � Other: 25.02
City /State /ZIP: / � ay,- K d d • ` 9" 7Z to 6 Subtotal
Minimum permit fee: $72.50 '2 t v�
Phone: t93 9 - .09/8 , F ax 3) 7 � y3 -
Plan review (25% of permit fee)
CCB Lic.: /g 77. Plumbing Lic. no.: pa ....Cr,/
-
State surcharge (12% of permit fee) 1 N 0 1
Authorized signature: `. /j TOTAL PERMIT FEE 7
Print name R a Dater /�y a :� This permit application expires if a permit is not obtained within 180 days
Z.. / M �!�5 / I after it has been accepted as complete
*Fee methodology set by Tri County Building Industry Service Board.
1 : \ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB)