Permit q CITY OF TIGARD PLUMBING PERMIT
1,1 8 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00103
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/05/2011
Parcel: 1 S 135BC00700
Jurisdiction: Tigard
Site address: 10795 SW CASCADE AVE
Project: Arden Subdivision: Lot: 0
Project Description: Backflow preventer.
Contractor: PATRIOT FIRE PROTECTION INC Owner: CH REALTY III /PORTLAND INDUSTRIA
4708 NE MINNEHAHA ST BY THOMSON PROFESSIONAL &
VANCOUVER, WA 98661 REGULATOR
CONTROLLING OWNER OF
EPROPERTYTA
PO BOX 4900
PHONE: 360 - 699 -4403 SCOTTSDALE, AZ 85261
FAX: 360 - 699 -4485 PHONE:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/05/2011 $31.27
Specifics: 1 12% State Surcharge - 04/05/2011 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment - 04/05/2011 $41.23
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 OUNC by calling 503.232.1987 or 1 ;II 3
44 11WIP
Issued By: ' Permittee Signature: /:
Call 503.639.4175 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.
APR. 1. 2011 2:20PM PATRIOT FIRE VANC NO. 4477 P. 2
Plumbinaennit Application
Building Fixtures , , FOR 01.EICE I SE ONO
City of Tigard ";' ameived I ,..., N No
-
c.' ,. 11.'" Dol.. -
, ,,-- ,.. q 131.5 2 SW Hall Blvd., Tigard, OR 97223 $'4, \ • .., Plan Review
• Phone: 503.713.2439 Fix: 503.598.1966 :.%. (\ Date/Br.
7
, "1. Other ?errant No:
Inspeetioxi Line: 503.639.4175 Due Ready/Ety: ist. S
See Page 2 for
Intemet www.tigard-orgov tified/Method ! - ui upplemental Intbrmatlea
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0 Demolition . ' For specialinfonnation um checklist
0 New construction
Descri Potal
Xatition/alteration/rephoomeat 0 Other New 1-. 2-family dwelltags (includes 100 ft for each utility cormection) ..
' ':• -• . '.'''' .••,1 : 5424' %. 2:4 1 KIttr!,:,.' ''',Y, :,*,,, h dt, , , '';' _. :.:- ''' ;.". l'i'.C.Irr"e":1,...•; SFR ( 1 )bath 312.70
SFR (2) bath 437.78
13 1- and Ifamaydwenies 'II Commerendrmdmade
sat (3) bath 500.32
Cl Accessory beading 0 Mtdd-famtly
Each attirstional bath/kitchen 25.02
0 hiliwOr bander 0 Other: nee Eginkler (...._ sq. ft) _ Page 2
9170MOISMON20110:77:0 7:::,i':, i *91 st. wilitit- - -
Job site addmsm 1071 iiti ALDE ei-- 0 C.2teh bgsin or area drain 18.76
Drywall, leach line, or trench drain 18.76
City/State/DP: . 174-7•04gCl i e,(e__ Footing drain (no. linear ft.: _) Page 2
Suite/bldg./apt. no.: - 4
Prideet satmez • _ A 0....,.. ffi A Mattufactumd home utilities 50.03
CMS ntreatiaintedons to job titet ' I LI-1 ■1/4-.)ez Ihnboles 18.76
_
Raid drain connector J 18.76
Sanitary sewer (no. ham fi.: ) Page 2
- Storm sewer (no. lines:ft.: __) Page 2
- Water service (no, linear ft: ) Page 2
_____________Lsion Lot no-: Fixture Backfkrw m-venter °rite=
p
Tax mnp/pareel no,: - 1 31.27
"1•50VitielO r ',‘`
=•:•.■ : ,),.? , .'t ' wrder• Bs& valve 12.51
Wiq'I - Amlo . .i'Ll., 4h.. ,,■.:, 1. ,,', , ,. . . N;„,,..';‘ ••• ••• , - • .,,,, • "Lt or, , S ''',.,:', ' '-• ' ' me imher 25.02
Abb bi-b -Prgazis-st.,,e. -
Dishwasher 25.02
% - rEc- - cog._ 4SE.k`"%8C.-.1. e DriMcing forossin 25.02
MO liZWE ITT. i ht A P la Ejectors/sump 25.02
g ''e . :■' ‘ ?;: ::. 0. , ; t3 :.. , 1 ',', ExPinsimt=k 12.51
Fixture/sewer cap 25.02
Name:
Sour &lin/floor sink/hub 25.02
Address: Garbage dispospl 25.02
City/State/ZIP : Hose bil> 25.02
Mane: ( ) F= ( ) Ice maker 12.51
i etAiii ',.:::..j, K '; i'="4,"tv . Isr cat: P t°t/ g rease 111P 25.02
Medical gas (value: ) 111111022E1
Business name: 18 A - Cair..31 - t P.- • p.47, I r..._r.. L $
Printer 12.51
Colgan MIN: .,..15.PF Z.,,s,(4...0.1 - ,
Reofdram (commercial) 12.51
Address: '4 1 P 1 1 `4 1 ■ 1 E-4-1A g A ST . Sioldbasinilronsory -
25.02
(Sty/State/ZIP: ote.,64 I solar units (potable water) 62.54
Phs CoTt 4403 Pa= :?1,60 ) 6- - i4e5 Tub/shower/shower pan 12.51 • thins' 1
"Itil: IWC-e----fdilh.----rieldr eieE , ._ 25.02 . . _
... ....„ Water closet 25.02
• ?iv 4ir " ,' .... ,
.qt•k MP ,4 11 7 .7.1t , -r\. t.;1%.1‘:47: .1„
. , t .1. , 44.. .. o.e. s. (4 , .4 ' ' ,. ., • . -,. - `,.. . ',, . ' • 4 .e. ' •"".17 ' • ` ' ' ' '. . " " .4."' "‘‘ • • ' Water heater 37,52
Business name: 1 11 0 &C112.i.0. 7 7 - 112-e-- IMINI C. Water piping/DWV 56.29
---
Address: 0607 25.02
. .
... -.. ,
City/SlateM __
P! - - Slibtotal SH
__
Phone: ( ) Fa ) Minim= permit fee: £72.50 - 7Z • Sb
= (
pieji review (25% of permit fee) .------
CCB Lac. - 70g 'Z, ... Plixrobing Lie. no,.:
state surcharge (12% of permit fee)
Authorized signature: ..,,,00
. TOTAL PERMIT
Print name: . a Ce.i....- i t-J S Date: .4 gam This permit uppliartion expires 11 a pcnnit is not obtained within ISO days
merit has been anintai at complete.
- "Fee cthodQ1e' aelt by TriC aunty Build* Industry Service Bimini,