Permit ' =CITY OF T GA ' D PLUMBING PERMIT
IN
.; COMMUNITY DEVELOPMENT Permit #` PLM2010 0005
F'l GA RD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/03/2010
t k .. 4'. Parcel: 2S101AC00400
Jurisdiction: Tigard
Site address: SW GONZAGA ST '�
Subdivision:� Lot: 0
Project: NATIONAL SAFETY BUILDING
Project Description: Installation of medical gas for dental office. 1
Owner:
FEES
NATIONAL SAFETY COMPANY Quantity Description Date Amount
17010 SW WEIR RD
BEAVERTON, OR 97007 4310 ea Medical Gas 02/23/2010 $72.50
PHONE: 1 Plan Review 02/23/2010 $18.13
1 12% State Surcharge - 02/23/2010 $8.70
Plumbing
Contractor:
. PORTLAND MECHANICAL CONTRACTORS
2000 SE HANNA HARVESTER DR
MILWAUKIE, OR 97222
PHONE: 503 - 656 -7400
FAX: 503- 655 -0620
•
Type of Use: COM
Class of Work: NEW Type of Const:
Occupancy Grp:
Stories:
Total $99.33
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 Notifieaf r. Those rules are set forth in OAF 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or dir ce t questions to OUNC,by c. • g 503.246.6699 or 1.800.332.2344.
.
Issued By: 1 . 11" Permittee Sign. ure:
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.
CITY OF TIGARD PLUMBING PERMIT
a s p
>; COMMUNITY DEVELOPMENT Permit #: PLM2010 -00054
At GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/03/2010
Parcel: 2S101AC00400
Jurisdiction: Tigard
Site address: 7095 SW GONZAGA ST
Subdivision: Lot: 0
Project: NATIONAL SAFETY BUILDING
Project Description: Installation of medical gas for dental office.
Owner: FEES
NATIONAL SAFETY COMPANY Quantity Description Date Amount
17010 SW WEIR RD
BEAVERTON, OR 97007 4310 ea Medical Gas 02/23/2010 $72.50
1 Plan Review 02/23/2010 $18.13
PHONE: 1 12% State Surcharge - 02/23/2010 $8.70
Plumbing
Contractor:
PORTLAND MECHANICAL CONTRACTORS
2000 SE HANNA HARVESTER DR
MILWAUKIE, OR 97222
PHONE: 503 - 656 -7400
FAX: 503 - 655 -0620
Type of Use: COM
Class of Work: NEW Type of Const:
Occupancy Grp:
Stories:
Total $99.33
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 N. ' • • '. -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or • ect questions to OU C by c. • g 503.246.6699 or 1.800.332.2344.
Issued By: } / L /� , ! � � � - Permittee Sign. f /(
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 -
Building Fixtures FOR OFFICE USE ONLY
City of Tigard CC p Q ~OtO Received Permit No.:
n 13125 SW Hall Blvd., Tigard, OR 9722FEB i7 Date/By:
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: u/a5Ol1• -A,-!07
Inspection Line: 503.639.4175 , y ul- . ;•,~1
Internet: www.tigard-or.gov ° l(', w71~11^` n C Date Ready/By: orris: ® ee Page 2 for
I- Notified/Method: Supplemental Information
TYPE OF WOf2 FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty, Ea. 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
❑ Accessory building El Multi-family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler L- sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 7095 SW Gonzaga Street ` Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/ZIP: Tigard, OR 97223
' Footing drain (no. linear ft.: ~ Page 2
Suite/bldg./apt. no.: t name:• ' d\~ 0 Manufactured home utilities 50.03
Cross street/directions to job site: sOJ g5G p ` Manholes 18.76
OJQ :C' Rain drain connector 18.76
d Sanitary sewer (no. linear ft.: Page 2
ire
Storm sewer (no. linear It.: Page 2
Q' \
U'( \b. Water service (no. linear It.: Page 2
Subdivision: Lot no.: Fixture or item:
, e5°•' Backflow preventer 31.27
Tax map/parcel no.: 15vi-
D WORK Backwater valve 12.51
Clothes washer 25.02
Install new piping and outlets f 4enfal office medical gas.
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 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: Portland Mechanical Contractors Medical gas (value: $4610) Page 2 72.50
Primer 12.51
Contact name: Jeff Hunt
Roof drain (commercial) 12.51
Address: 2000 SE Hanna Harvester Drive Sink/basin/lavatory 25.02
City/State/ZIP: Milwaukie, OR 97222 Solar units (potable water) 62.54
Phone: (503) 656-7400 Fax:: (503) 655-0620 Tub/shower/shower pan 12.51
E-mail: jefflt@pme-g.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Same as above. Water piping/DW V 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 72.50
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50
CCB Lic.:~518~~~j1~p Plumbing Lic. no.: 3-425 PB \1 Plan review (25%ofpermit fee) 18.13
State surcharge (12% of permit fee) 8.7
Authorized signatur TOTAL PERMIT FEE 99.33
Print name: Jeff Hunt Date: ,Z. 17. 10 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodolo6y set by Tri-County Building Industry Service Board.
1:\Building\Permits\PLMU-PermitApp.doe 10/01109 440-4616T(10/02/C0M/WEB)
CITY OF TIGARD (,- 1 % -• 10 • 00 `�: y
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 �»e
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' "'I I..
INSPECTION WORKSHEET FOR DATE:/,/ 1 / /i C) TIME: PAGE:
SITE ADDRESS: r c 7 l ( 2 2-'7/ ' 27 - 1:'1. CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
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OWNER: - PHONE #:�5 _ /
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: r- , ;> Pour Time:
Code # Inspection Description (Confirm ) Contact # Message
Corrections /Comments / Instructions:
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/1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 34id Date: 'I —!" /)J Phone #: (503) 718- iy4
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CITY OF TIGARD* „ . pL 2 _ - 0 /0 ados
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BUILDING DIVISION" PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-41.71 Ai,
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i 9ction Requests (24 Hrs.): (503) 639-4175 ., IL
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INSPECTION WORKSHEET FOR DATE: g 1 /// 0 TIME: PAGE:
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SUBDIVISION: " LOT V „, S ... tr\ TYPE 110F USE:
PROJECT NAME: 0 '.i
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DESCRIPTION: ., .
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Code # ' Inspection Description ' Confirm # Contact # Message
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lnspe8tor: ' ••:. ,'-. : ;,. • Date: 12- Phone #: (503) 718-
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. �. WASHINGTON COUNTY INSPECTION CARD PROJECT
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DEPARTMENT OF LAND USE AND TRANSPORTATION PERMIT # P� ' -'Otte 6
()REG& FOR INSPECTION CALL : 503- 846 -3699 - 24 HOURS DATE - _S "10
FOR INFORMATION CALL: 503- 846 -3470
FAX: 503- 846 -8111
ADDRESS '7 0 9 - - . . ( . . 0 2-013-743 PERMITTEE
PHONE # 7
IVR # INSPECTION DESCRIPTION
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INSPECTED , DATE :3— 3—( 0
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DEPARTMENT OF LAND USE AND TRANSPORTATION PERMIT # — oo s-4
RECD FOR INSPECTION CALL : 503- 846 -3699 - 24 HOURS DATE "3 _5 -10
FOR INFORMATION CALL: 503- 846 -3470
FAX: 503- 846 -8111
ADDRESS '7 b Q " to /) `7-41/4 c, PERMITTEE
PHONE # / / O -
IVR # INSPECTION DESCRIPTION
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