Permit � CITY OF TIGARD PLUMBING PERMIT
III - COMMUNITY DEVELOPMENT Permit #: PLM2011 -00166
T1.GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/01/2011
Parcel: 1S 126BC01506
Jurisdiction: Tigard
Site address: 9020 SW WASHINGTON SQUARE RD 350
Project: Primary Residential Mortgage Subdivision: ONE EMBASSY CENTRE Lot:
Project Description: Install water line for coffee maker. Demo and reinstall breakroom sink. No change in EDU's
Contractor: GRIDLINE PLUMBING Owner: WISCO REAL ESTATE EQUITY FUND I
4343 SE 37TH 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97202 PORTLAND, OR 97205
PHONE: 503 - 771 -8790 PHONE.
FAX:
FEES
Quantity Description Date Amount
1 ea Sink 06/01/2011 $25.02
Specifics: 25 Misc Other Fee 06/01/2011 $25.02
1 12% State Surcharge - 06/01/2011 $8.70
Type of Use: COM Plumbing
Class of Work: ALT 22 ea Minimum Fee Adjustment - 06/01/2011 $22.46
Plumbing
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 . - . adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. •u may obtai a copy of the rules
or direct questions to OUNC by calling 503.232 •
Issued By: Permittee Signature:
Call 0 9.4175 by 7:00 a.m. for the next available insp; ti•J d
This permit card shall be kept in a conspicuous place on the job site until comp etion of the project.
Approved plans are required on the job site at the time of each inspection.
06/01/2011 13:12 73109 GRIDLINE PLBG PAGE 01/01
r - rl Plumbing Permit A I be = if o pi
Building Fixtures FOR OFFICL USE ONLY
City of Tigard JUN 1 2 011 Received P No.: �,r MI! �A dl � oo/ 6°
11
14 1 31 25 r SW HallBlvd., Tigard, O 9 23 Date Sy:
, ik
r� ^ flan Review Other Permit No.:
I Phone: 503.718.2439 Fax: 5031598 ,196.0 TIGARD Date/By: Oth Set Page 2 for
Tltil�lt Inspection Line: 5Q3.639.41r DIVISION Date Ready /Sy: Apia. RI
Internet: www,tigard- or.gov • Notified/Method: Su oernental Information
TYPE OF WORK. ...... , . W, SC E
F or S e - ki lti ormat U us
❑ New construction [] Demolition
Description use checklist
� E a. Total
1 Addition /alteration/replaeement Q Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION . 5FR (1) bath 312.70 '1V
SFR (2) bath 437.78
❑ 1- and 2- family dwelling ► 1 Commercial /industrial •
SFR (3) bath 500.32
❑ Accessory building ❑ Multi family Each additional bath/kitchen 25.02 %
❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2
JO8 SI I E INFORMATION AND LO . ATION Site utilities: j .1�
r Catch basin or area drain 18.76 1
Job site address: 4'14 1 k /MYd . 4 1 a
Drywall, leach line, or trench drain 18.76
City /State /ZIP: I et j/y. 0 t ri .34 Footing drain no linear It.: _) N-"
Suite /bldg. /a t. no.: • D Project name: ,,„: ' -; �
P Project ,....;.,.• 1�om � �„�� Manufactured home utilities 50.03 \ N
Cress street/directions to job site: � �/ l�� V � .0 Ipf 4-1, M anholes 18.76 v
l`1O12..T - a/re g 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: Lot 110.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
- • Backwater valve 12.5I
DESCRIPTION OF WORK Clothes washer 25,02
ifir'Mi�� r. / .. _• , . / . / AA- Dishwasher El 25.02
� / .1 / • e Drinking fountain 25.02
. i' -
; , • ✓. , 4 5-C t LD . / :.I r Electors /sump 25,
❑ PROPERTY OWNER 1 •.❑ TENANT. ) .. Expansion tank 12.51
Name: Fixture /sewer cat) 25.02
Floor drain /floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib . . 25.02
Phone: ( ) Far: ( ) Ice maker X 12.51 .2 . fl
❑ APPLICANT ' ❑ CONTACT PRsoN . Ihterccptor /grease trap 25.02
Business name: Medical gas (value: $ _) Page 2
Primer 12.51
Contact name: .
Roof drain (commercial) 12,51
Address: Sink/basin/lavatory Wil 25.02 r} , et .
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax :: ( ) Tub /shower /shower -pan 12.51
"" Urinal 25.02
E -mail: . .
• - Water closet 25.02
CONTRACTOR
- -....... ' Water heater
Business name: -or ".' A. Water piping/DWV 56.29 MEM
Address: l.�lt3 37 Other: 25.02
City /State /ZIP: �j,7-7,,,.,,,, l es-- 7e7 Subtotal
Phone: ) 777_,./379 Fax: (g'7) ' /,.-�Q83 Minimum permit fee: S72.S0
CCB I,ic.. 7` to Plumbing Lie. no.• -+ • ° Plan review (25% of permit fee)
• . State surcharge (12% of permit fee)
Authorized signature: � rte,
r TOTAL PERMIT p i .,2 0
Print name: 1•' /Jai, Date: _1 // 'Phis permit application expirab ((A permit is not obtAined within 18U days
after it has been accepted ay complete.
*Fee methodology set by Tri'County Building Industry Service Ftmanl.
f : \Suildin $\Permits \PLMU•PermitApp.eoe 10/01/09 440.401011io /o11COM/WEBI