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Permit I TY OF TIGARD PLUMBING PERMIT TU,I D`VELOPMENT SERVICES PERMIT #: PLM2005 -00192 1,L c, �l` DATE ISSUED: 5/4/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 S135AB 01003 SITE ADDRESS: 10300 SW GREENBURG RD 220 ZONING: C -P SUBDIVISION: LINCOLN ONE /RED LOBSTER /CASA L LOT: JURISDICTION: TIG Project Description: Plumbing TI, rough -in coffee maker, remove and reset sink and faucet. No change to sewer EDU's. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 1 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES EQUITY OFFICE PROPERTIES TRUST Description Date Amount ONE SW COLUMBIA ST #300 PORTLAND, OR 97258 [PLUMB] Permit Fee 5/4/2005 $72.50 [TAX] 8% State Surchan 5/4/2005 $5.80 Phone : 503 412 - 4800 Total $78.30 Contractor: MCKINSTRY CO 5400 NE COLUMBIA BLVD REQUIRED ITEMS AND REPORTS PORTLAND, OR 97218 Phone : 331 -0234 Reg #: LIC 40981 PLM 37 -22PB . This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires • e • low rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-0001-0010 throb •h 0 A R ! 2- 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calli • 503- 46 -6699 1 -- 10- 32 -2344. Issu =d By: I ' i d Permittee Signature: 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. r P umbing ., mit Application FOR_.OFFICE USE. ONLY / City of Tigard Date', 5 � � Permit No.: � �019 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.: 24- Hour Inspection Line: 503.639.4175 ■ "'' � . :I I D / By: Date Read /B Jun ® See Page 2 for Internet: www.ci.tigard.or.us W Ready /By: g g Notified /Method: � l� Supplemental Information %ig *S�,><,-, ..,_.• „ ,,at: -e- '' t : - ` 74;' -' ;� -� - x ,i - -i t ; �"�.,z .< 1 T •P ma k nea W ORK- -" �e FEE S CHEDiIE _ _>. z�- _tom _�., ". - - -,_� ^: �•s,.:.: �s- ; W.,.�'" .;..�; ?fit a� � -...� .. - < .. - -r.. .... -. �.- ,. :,va�ewwasLr,.... 5,:.: .:. ,., F- - .. I0 New construction ❑ Demolition For special information use checklist. Description Qty. Ea. I Total A Addition/alteration/ ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGURY bF CONSTRUCTION .. _ r: ��. 1. ' SFR (1) bath 24920 ❑ 1- and 2- family dwelling , Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder t ❑ Other: : a;z � ^3� ., «. Fine sprinkler ( sq. ft.) Page 2 - ; ' < i : .a <_ a JUB BITE I viN - g.. UC, ' ` t ?.° a;: �:.'� ;�:-- a >4��.w`:r_r� = �- ,:::s z�- �.;..., (� ._ �s° �;r,.:�.�.a r; :;...rte -. _f - `.`.` �,...ms:�. '�%Y:.�i Site utilities site address: C 12 1-- o YLe . Catch basin or area drain 16.60 City/State /ZIP: E- u Z c. ,. ti y , C7 P.__ e i 7 Drywell, leach line, or trench drain 16.60 Suite ldg. /apt. no.: Z Z 1 Project name: K - FotC� Footing drain (no. linear ft.: ) Pag 2 - Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: Absorption valve 16.60 mss . ;y ;. tP tESG RIP'TIUN OF �!©RK )t s „„ wgkai H,.;, ` , ° : _ 1,,,, a.<, .,A a5,•:,� ; 4, : ; . ,�; ' _ Backflow preventer Page 2 L {:1J a F E n it A11,6 14,6 Backwater valve 16.60 k eT.04 p Jc - `# - (Ld - j a- lc e si ! x /� 4-fAk ,e-7 Clothes washer 16.60 Dishwasher 16.60 '.emu: <.;. '' ' ! v �:.. .. �; su'= ;° d 'l: Drinking fountain w� 1 O .. .•,PRO "OW :` , . ` ., A-. , ,_,:-.--,,,,,,,-pi,,,:,..-, p Ejectors /sump . i ,,.__.< -. � ,2�,a, „�� ,. _.� -_ �,,.���s,. - -.� . _� .� �,.�,- � •;� -_ - �.. 16.60 Name: Expansion tank 16.60 Address: Fixture /sewer cap 16.60 City/State /ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: ( ) Garbage disposal 16.60 �. Hose bib 16.60 APideA1 .: GONTA P * RS,OI V ��=_. ,� � ��. n -� :- s ��eF ,rte .,* . �. _ • . �� _ � �.a���;:;_ >._,b. _ ,��:d %,, __ - v Ice maker 16.60 Business name: L_k i>usy Ca> , Interceptor /grease trap 16.60 Contact name: p� CLAP Medical gas (value: $ ) Page 2 Address: '. zt q t s- 6 . Lsc 1 ti • A-- - I vD r Primer 16.60 City/State /ZIP: T o -_T ND . 0-4 g7 Z t R� in (commercial) 16.60 7 . . sin/lavatory 16.60 Phone: (gy TS 1 m !9,(, 6 Fax:: ( ) �� /shower /shower pan 16.60 E -mail: Urinal 16.60 ,. F _,' G01�1TIt OO Water closet 16.60 .a ,. r �,_- _ C . ,_ > -- =�. gs4„K��+�;�."<;_�,�a,- ,., -_, � � ����s"e�: __mow .-. s -. Business name: L k X57 �r I Water heater 16.60 Address: S� ►vcs C5) (4_,-,A ba..t- tit/1)i If1) Other: C.,0* IAkl c. ' J.... City/State /ZIP: P c' ?7Z1� Subtotal l Minimum permit fee: $72.50 Phone: (.:-) `t �1 t-c, 7_. y Fax: ( ) Residential backflow minimum permit fee: $36.25 7 n � CCB Lie.: [ Plu t .:ng Lic. no.: 7 � p g Plan review (25% of permit fee) [[[[ State surcharge (8% of permit fee) 5, q(7 Authorized signa iii ''- Illi ti, TOTAL PERMIT FEE 7 , 3D , Print name: /1, tPP�� Date: S ( T ^C:).5 This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri - County Building Industry Service Board. i:\ Building \Permits\PLM - PermitApp.doc 12/03 440-4616T(10 /02 /COM/WEB)