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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2011 -00007 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/12/2011 Parcel: 2S102CB00302 Jurisdiction: Tigard Site address: 13185 SW PACIFIC HWY B1 Project: Tamale House Subdivision: Lot: 0 Project Description: Backflow preventer for soda machine. Contractor: PIPELINE PLUMBING Owner: CJ GLOBAL LLC 333 S STATE ST, STE. V -108 PO BOX 5668 LAKE OSWEGO, OR 97034 ALOHA, OR 97006 PHONE: 503 - 624 -1906 PHONE: FAX: 503 -624 -1926 FEES Quantity Description Date Amount ea Backflow Preventer 01/12/2011 $31.27 Specifics: 1 12% State Surcharge - 01/12/2011 $8.70 Plumbing 41 ea Minimum Fee Adjustment - 01/12/2011 $41.23 Type of Use: COM Plumbing 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 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 -0090. You may obtain a copy of the rules or direct questions to OU C by calling 503.232.1987 or 1.80044. Issued By: / Permittee Signature: ? Ca 50 . • 9.4175 by 7:00 a.m. for the next available inspection date. 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. p.1 P lwmbine Permit ApplcatiO ECE E `)' • Building Fixtures l�OR (An( i:. 1 Sl_ ONi-� . • C i t y of T i g a r d JAN 1 1 2 011 Received i ! i / Permit No.: Pl n� rf _ 0000 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review p� Point No..: 1. Phone 503.639 4171 > 5033 OF TIG ARD > See t z tor T1( . . \ 1; D won bile: 503.639.4175 BUILDING DIVISION l >� I sdnpleP� ororm Internet www.tigard-or.gPV N : FEE* SCHEDULE TYPE OF WORK For inforinformally"! nin t e checklist Demolition For 1 Qty . I Ea. I Total 10 New i�Addition/alteration/replacement ❑ Other. New 1- 2 -family dwellings fmcludes 100 R. for each utility vim ) 51•K (I) bath h 312.7D CATEGORY OF CONSTRUCTION SFR K ( bath 437.78 ❑ 1- and 2-family dwelling [ Commercial/indusbrial SFR (3) bath 50032 ❑ Armory building ❑ Multi- family Each additional balb!kitchen • 25.02 ❑ Master builder ❑ Other. Fire sprinlder (,.,_,_ sq. ft) Page 2 JOB SrlE INFORMATION AND LOCATION Site nullities: , 1t (}, basin or arcs drain 1836 Job site adder 1 '3 ` j 6t,t)._� pc.G 6 c, ' - r 1,{ - Drywall, leach ]me, or trench drain 18.76 City /State/ZIP: .J-- �•l,. ()lam-. q 1 22 Footing dram (no. linear ft: _� 2 Suite/bldgiapt . mO': 6� Project name: A Tc . 0 k. u s ` _. MH° home Willies 50.03 �A ��: Manholes 18,76 Cross s etldirections to job site: Rain drain connector 15.76 Sanitary sewer (no. linear R: ___1 Paget Storm sewer (no_ linear ft.: _„) Page 2 i Water service (no. linear ft: _-__) Page 2 Subdivision: l Lot no.: Fixture or item: f 3117 131, / pimento Tax map/parcel no.: Barker valve 12.51 DESCRIPTION OF WORK Clothes washer 25.02 1 cloiCktAaA fzP Ci. (2A-)(..Q., . 0 err) eAa , Dishwasher 2.5.42 Drinking fountain 25.02 f vl(kE ft bap 25.02 >;,lpalsiontamk I231 ] PRUYEYi i Y OWNER- , ❑ TENANT Fia:barelsewer cap 25.02 Nance: Floor drainffloor sink /hub 25.02 Garbage 25.02 Address: Hose bib 25.02 City /State/LIP: ` 12. Fax: ( ) lee maker 51 Phone ( ) Interceptor/pease trap 25.02 ❑ APPLICANT ©CONTAC' PERSON ,n Medical gas (vale= $ ) 2 Business name: P k? ` ��' 1 , 1 it iM 'll \Y\1 - pier 1251 Contact name: \ J Roo 12 .51 Address: Sink/basin/lavatory 25.42 Solar units (potable water) City/State/ZIP: 1251 Phone: ( ) 1 Fax ( . ) Tub /shower/shower pan 12 1 • � urinal E -mail: 'p � f3��` i�(tQ.- {p‘ W`i� t Q V i Y1C'1 e C`�C , r� " 1 'Water closet 25.02 ` ` CONTRACTOR" Water beater 3732 Business name: ,'p ex l ,.J`S \Y� Water pipingtDWV 5629 (� U orbs 25.02 Address:�3 S{� . �GA, . /� C?1 ` ` Subtotal _ City/State/ZIP: , OC7) Q 0 V t-- an 63 1 `� vrn permit tae: $72.50 - 7), .� — Pisane: L(}Z l� `ley DLO �J Fax: �}�) U� t z Pl an review (25% of permit fee) CCB Lie.: Plumbing Lin~ no.: ??5\C) - Q ej . Stale surcharge (12% of permit fee) r , 7 Authorized signature: TOTAL PERMIT FEE . (c ako �"' �� 1 X 1'" � J This Parmir applkafioa sptra da permit s u�et obtained 180 days I Date: [ ! � 6I i \ a@ er la hem as ea mpktt Print name: J t 1 l P 1 Q r f 1 `�� 1{ .iFr wrN.noled 1w. ah lw T.iJ'n`w+. R... 1.4..4... Grovr [L.w+l