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Permit • 1 Ili OF TIGARD PLUMBING PERMIT I` 2 COMMUNITY DEVELOPMENT Permit #: PLM2009-00174 TIGARD 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/02/2009 Parcel: 2S113AC00103 Jurisdiction: Tigard Site address: 7204 SW DURHAM RD 300 Subdivision: Lot: 0 Project: Consumer Cellular Project Description: Add (2) toilets, cap (1) breakroom sink and relocate (3) toilets. Owner: FEES PACIFIC REALTY ASSOCIATES Quantity Description Date Amount ATTN: N PIVEN, 15350 SW SEQUOIA PKWY #300 1 ea Sink 07/02/2009 $16.60 5 ea Water Closet 07/02/2009 $83.00 PHONE: 1 12% State Surcharge - 07/02/2009 $11.95 Plumbing Contractor: CASCADE PLUMBING CO, 2630 N HAYDEN ISLAND DR #3 PORTLAND, OR 97217 PHONE: 503 - 289 -7095 FAX: 503 - 283 -9514 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $111.55 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 issu , or if work is sus ended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon i ity Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC b -I 0. • 6.6699 or 1.800.332.2344. Issued By: / r _— � 1 / Permittee Si ng ature: /I�`�,.,/ eci---------____ 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. ....1u,-4' ? .1 2009 4:29PM HP LASERJET FRX p.1 RECEIVED Plumbing Permit Application JUN 3 0 2009 1'uu 01-.11(.1.: IIS 1: ONI.x ; ih City of Tigard Hved /_ �j� Permit No.: ���9 -�DQ, 7 _ 13125 SW Hell Blvd., Tigard, OR 9720ITY OF TIGARD ° eceiR , e1 � ( P - 4 i B Phone: 303.639.4191 Fax: sa3•ssu DIVISION Dete /By Other PermitNo. �2y f ..0 / I I< : .,. ; Tut n inspection Line: 503,639.4175 Dote flea : r r Internet: www,tigard -or gov Notified/Method: rum El See nen1 2for n . .Y .,,,'. i �,.,,r� F;,�';,;"' .. ,.;..,il�. 't'' `r'i,.'c'..V, :t" Pn , ,�,_.,:� .X � P a,. ...� t.•. •.. L,, ) .. � .. , ,q..:',I �,, „ '.,� :..rr ,.�, d•.ir' :�;� :' ,r+ � men * a rmr o r . „•,. '" S J .. i' 1 t ,. t , , e r k,, �, r� „'`I t i ; I 'a i' t I 1 h '1' � ? , 4',5� t r� i ( �y .t ,! °'�' �"i@ >e�1� ?', �`�9 , ru.St � ++�', �, )' �'I � ; l;i� �d�.n^ d, .,! ���i�`[� t• �� 0 ., fl'i''lVi1)rr „� �J((.P,I , , , � � ,,. A M l . �! ► b �., ,i,� 1, •n .q 'Y ,,_.. l.( +. ry I, : Cl New construction © Demolition For spedo! leafarmation rise checklist Desert .tton is • Ea, Total -- p ddition/alteratton/rep1ecement ❑ Other: New t. 2- family dwellings (includes 100 ft, for each utility connection) r'�tit(r3 , , l at L rc� ,4 z ! . k ,' 91 j , t),'.; ? : i'), 4 .'. �, , „,,, ,, ', SFR (1) both II 249.20 © 1- and 2- family dwelling ►".a.ommeroial /industrial SFR (2) bath 350.00 - ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 ❑ Master builder ❑Other: Each additional bath/kitchen 45,00 u” :,, „a; r l,r u q , , , . Fire sprinkler ( sq. R) Page 2 E ra rr�Sairanly� wI�IViti� �c i t., • •5, :4 E r. .. Site utilities Job site address: ' ,90/4 S . CO 7)t)rilrAill Catch basin or area drain 16 City /State/ZIP: A /- , I _ 6 Drywell, leach line, or trench drain 16.60 Suile/bldg. /apt. no.: 3 � Project name: , $.071,12A tad v/c�+ Footing drain (no. linear R. ) p 2 Manufbotured home utilities I10.0€ Cross street/directions to job site: Manholes 16,60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: _) J Page 2 Storm sewer (no, linear ft.: _) Page 2 Water service (no. linear ft.: _,,.) Page 2 Subdivision; I Lot no•: Tax map /parcel no.: o2 J 1 fi/ rd 3 Fixture or ite -- a 9 ,,.- y; , _ Absorption valve 16.60 r �' 3 � � exAtM ; x�7 ` � I P � .: a L ,� 1 + � f �` r, y, { S'If z h , 1 14. �, -- I. '.I,� ,r. !WiC •1elaVrM�7s:d:i O illlS.0 e` } t '� i w �' !!�� Baekflow preventer Page 2 _ V r (7 . ' 4 $ . 0 ./1' - Backwater valve 16,60 ' k p I { Clothes washer 16,60 12P- IA •I / 1 }r 2 ��, / / Diahwashcr 16.60 y� t £u V Vy ^ ��, � m @ ' i g y�wx }� v ! ” ,r Drinking fountain 16.6 '�.. I L . & .:: S�4, 4•,,, , a. 6i 4 , . s `'�I'i - a , 3 • ) ,-. v i „ w i t ' , Sl i! , I r „ .L : .. , Ejectors/sump 16,60 - - 17. Name: Expansion tank - 1560 Address: Fixture/sewer cap / 16.60 / b . o 0 CitylState/ZIP: Floor drain /floor sink/hub 16.60 Phone: ( ) Fax; ( ) Garbage disposal 16.60 y,' •t ' � w F' ° f' . , ,t' ! , i ?.', 1 ��� RRy}. ) ' :ti: Hasa bib 16,60 i'lli II,. Wid4it; '' t. .. 3l fi t • i.`01, , '' 'i : .C a P: I r ra 1'�. t1 t l } r l �� '� r e - - — ice maker 1$,$0 Busineas name: /4 , ......_ . 4 I t UAL „ ► ' a Interceptor /grease trap 16.60 Contact name: / y' Yi Medical gas (value: $ _) - Page 2 Address: c ,V6, () r r / . 1:) 41 Primer 16.60 City /State/ZIP: .J- / • J C� ow drain (commercial) • 16,60 Phone: ( rfp,3 ) _gc -7oct5 Fax:: 3 1 (27 8 . 4? 1 is / Sink/basin/lavatory _ _ 16,60 Tub /shower /shower pan 16.60 E-mail; Urinal 16.60 '. t,. 1 : x ! fi ` x , X y',:, ,1r _ 16.60 ' '� l `"l a'�'� h a ` ° �`� . S � ?, � �ti�, a 1 �- , v %r . ) ,,. �•,� 1 ,1 {,�.a,� ", , Water closet .� , Business name / , , Water heater 16,60 Address: , C) rI . 4 1 J . ► -R Other: City/State/ZIP : C<li. 0 / ' 1 Subtotal gq. y "'T 2 � Minimum permit Om $72.50 Phone: (e•-.).5) -' ' : • Fax: (, ' � - i Residential backtlow minimum permit fee: $36.25 GCB Lie.: Plumbing Lie. no. .q /,(3 Plan review (259Lorpsrmit tea) _ State surcharge (1 f e e ) I i .' 5 Authorized signature: ( 1 � � ' � � 'TOTAL PERMIT FEE / 1J.5S Print name: Ut,( -� ,,,,5 I Date: This permit application expires Ira permit is not obtained within tJ I 180 days after it has been accepted as complete. n1,,,C,,�' .e, "Fee methodology set by Tri•County Building Industry Service Board. I',tau1Ii1sij� Itt\PLM MmirAVP,000 Ot+nM08 440.46167(10.lU; /COM/WLa) •'Jur•, 2009 4:28PM HP LASERJET FAX to.2 plumbing Permit App i aatian = City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Su .. ression S stems: ( L `�ty'��`�, xi p ( { + 1 s x1 4V11N , • r 1 �: yrW 9 Crti, � : " . 41: - yE d • .., e ,,, S Mt. - . lk�Af�l } J t d : u-h` { 1: :..y. ,c.,2,/,',.. , { , 1 s .a t.+A.G;i / . 5 ' .1 , Footing drain - 1" 100' • MI 55.00 ,O O2 t 3,600 S t 15 .00 Footing drain -each additional 100' 06,40 3,601 to 7,200 5220.00 Sewer - lot 100' OM 55.00 7,201 and greater $309.00 -_ Sewer • each additional 100' MIN 46,40 Water Service - 151100' MIMI 55.00 Medical Gas S ste m t� p` • !` : Water Service • each addhlonat 100' 46,40 �'� '' t,Rt ";. "-r'T Gi ,, Storm & Rain Drain -1st 100' 55.00 � . - _ � $L00 to 5,000.00 Minimum fee $72.50 Storm & Rain Drain -each additional 100' EN 46.40 iii. $5,001.00 to S 10,000.00 $72,50 for the first $5,000,00 and $ 1.52 for each �, , •r ark '1t'4 ! ' F Y ;i,` }� TN x : -, "' { ti�r"R additional $100.00 or fraction thereof, to and i .1 a��itG �� : i 19 5 t 1 includin. $10000.00• Commercial Back • low Prevention Device Mill 46.40 II= $10,001.00 to $25,000.00 5148.50 for the first $10,000.00 and 51.54 for Residential 13ackflowPrevention Device r each additional $100.00 or fraction thereof, to inimaan • -mat fee $36.2 and inoludin 25 000,00• Rain Drain, single family dwelling 111111111 65.25 M 5,001.00 to $50,000.00 537'. 0 or the first $25,000.00 and 51.45 for Inspection of existing plumbing or each additional 5100.00 or fraction thereof, to s.eciall r- . nested Ins. ections- .arhour IN 71.50 $ .0 fix the 000.00 _� 550,001.00 and up $742.00 i the fl 100.0 0 fta and 51,20 for each additional 100.00 or fntct l• thereof. Fi xture Work i'.<r M r v n a g,r µTr t R r • ;. t r : _ it Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the tbliowing. please indicate work performed by fixture, Failure to Please check all that apply. accuratei re . ort fixtures could result in Increased sewer rfeee's*. ❑ Any new commercial building with water service 2" and p ' r C r. 4: 'j1,a ;r+ r t l e Y t l ! t 7r err ^ �l 4 m l + rl i l l ti l �t t , ' k:Y1FlI greater, except systems designed and stamped by licensed . . tti ,: d .� w b' ° 'r "i�1' ��t '-11 engineer, a ....:,,1, / tC y l ' � 4 - 1 '11 : 10, t " ditgl.t.RI F ' ' ` i y r . 1 s , 1 1. ` ,t ❑ An new exter plumbing site utilities. B •tls /Font ❑ Medical gas and vacuum systems for health care facilities. El Any multipurpose fire sprinkler system. �� ❑ Any complex structure as defined in OAR9IS•7S0.0040. Car Wash - Each Stall P Drive ihru Submit lasts of plans with any of th e above. Cus • idor , IL- :. 'inter ` Dishwasher - Commercial .; t, r : i, b Vi 4°Td•17'� ; f ,B1 t01C�.e i\1 .' ', ( " 4'4 r q "i,u� 'Domestic • Isometric or riser diagram is required for new buildings Drinking Fountain - E e Wash that meet the ' ualifications above. Floor Drain/sink - 2" M11111 • 3 " - a" Comments regarding fixture work: Co Wash Drain Garbage - Domestic Disposal -Commercial - •Industrial - -- Ice 6 ech./Refri: Drains Oil Separator pas Station) - - Rec. Vehicle mp Station Shower -Dena "Note: If the fixture work under this permit results In an - Stall increase of sewer EDUs, a sewer permit will be issued and Sink - Bar/Lavatory Mil fees assessed for the sewer increase must be paid before the -Bradley - Commarola! ' plumbing permit can be Issued. 'service Swismmin* Pool Filter Weaher - Clothes Water 13xtractor IMMNIU r eta Closet -Tor at aIIIP Urinal Other Fixtures: - 7 ) te_le : 40e 4 ilI7 :y/ /--