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Permit ` s CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009 -00173 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/15/2009 Parcel: 1 S133AD16000 Jurisdiction: Tigard Site address: 12744 SW NORTH DAKOTA ST Subdivision: Lot: 0 Project: Key Bank Project Description: Replace existing drinking fountain with ADA drinking fountain. Owner: FEES HALL, DONALD W & GRACE L & Quantity Description Date Amount HALL, JOHN G ET AL, BY FIRST AMERICAN REAL ESTATE TA, 8435 N STEMMONS 1 ea Drinking Fountain 09/01/2009 $16.60 PHONE: 1 12% State Surcharge - 09/01/2009 $8.70 Plumbing 56 ea Minimum Fee Adjustment - 09/01/2009 $55.90 Contractor: Plumbing ENDEAVOR PLUMBING & CONTRACTORS INC PO BOX 28037 PORTLAND, OR 97228 PHONE: 503 - 504 -6846 FAX: 503 - 477 -9159 Type of Use: COM 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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued :•y: / / Permittee Signat Call 503.639.4175 by 7:00 a.m. for an inspection that busin s 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. /254 15034773 9 #2519 P. 001 /003 Plumbing Permit Application l e I d : 1l-f . G • Building Fixtures —7 Fall OFFICE L ;sE ONLY IN City of Tigard J (p Received 13125 SW Hall Blvd.. Tigard, OR 97223. t>�6y: J Permit No.: PI rn2 q.00 Phone: 503.639.4171 Fax: 503.598.1960 Plan /tea • Other t y.` r T' I G A 517 Due RIB (-�� , �� Inspection Line: 503.639.4175 � r Internet: www.tigard -or.gov Y' S See Page 2 for ...YH0.1';j- Notified/Mahal •.�GysC ti2rey i �.' C yr!v . 'T7 Y A : ;•+4 . : �a:� :4' . •.']'� =i .'^�„ � :.'t:'.ti' :i•;:ti• ^•�-•• --r ^: I Supolan ntaI Information •_ . .._. s. .r :"sz.�"' ,n,-. r��..r..� r r r�+,Y F 1 r r . r r. v dr x, ❑ New ccm5tnlction - -t <r� r.'sf..�.� �.. :��P���"�F..`� ❑ Demolition _ Foe special in cane ion use cheer& I Addition/alterationkeplacement El (mien 1 '�' au Ea. Total 4 New I 2-family dwell' `" �.. ,,;,.. ‘:+7:::?..:, . .. Y f a rte ^^ t • -t., Y mgs (includes 100 ft. for each ) :a¢:. x E ' .r 1 _ -- I. ' ' c..;7:,:•-,! 4 --- . '.L L ;"' I f° ` D 4 .:.-u a ( ) —�— 24920 DOrItiCAt10II <.,x, - �;�... -ter �,'..�.,. ;3 -,:a?, Y T $ 1 bath 249.20 ❑ I. and 2- family dwelling EirConuncrcialfmdustrial SFR (2) bath 350.00 • 0 Accessory building ❑ Multi -family SFR (3) bath 399.00 Each additional batit/kitcher, 45.00 0 Master builder ❑ O _.i e` ' . c . ` 2 ' rY •E . • Fire Sprinkler ( sq. ft. " t,. � f �,r d i . r ..',",!.;,k,,,,, . ) Page 2 "`•`�` - -L ""` � '_ ,: S i utlities Job site address: \ 2...,--4.L14 ? j ,v1 QA V50 TA- S 1 Catch basin or area drain 16.60 City/State/ZIP: ( t G 2 !a I O y/?.. 7 . 7,23 Drywell, leach line, or tench drain 16.60 Suite/bldg /apt. no.: Project name: _ ~ Footing drain (no. linear it.: ) p z Cross street/directions to job site: Manufactured home rmiities 110.00 Manholes _ 16.60 _ Rain 'drain connector 16.60 Sanitary sewer (no. linear ft: ) P� 2 Sloan sower (no. linter R: ___) ~_,' Page 2 — Subdivision: Water service (no. linear R: `) Page 2 Tax map /parcel no.: 1 1 , i�� Future or item .a 4 y rS.'... «F ; R± . •, 1,;-„,:‘, , �:, - Absorption valve ' 4V -: :� ' ' :4 ' . ;v.',,;: e , ,5 �` " , � , : ,' te r' : c 16.60 ^' ' Backflow pre-venter Page 22 II 4 1) • _ A / t...44. K 1 — .. _ y _ Backwater valve 16.60 IPM4 b J: ..., . elf u 1� Clothes washy !660 • r Dishwasher �p��] _ ,. C 16.60 � . . / � •i 1Z F My �. A . /, t h- y:ar1 , f V l :n Drinki fo ntam 16.60 Iv- .... �� ^' . k ., x yv -- . . R te ! -- -� . ,...L f ... 2. 1 . _' Y ..l� a n �; Drinking Name: �-e? b A_) E 1 °�A°`� 16 Address: 60 Fixture/sewer tank / 1 Fixture/sewer cap 16.60 City/State/ZIP: Floor drain/floor sink/hub 16.60 Phone: ( ) Fax: (. ) Garbage disposal �. y � 16.60 >'. i •? 813 t' v ", t ,D_ 1 µt i .w% yv5+r' 4 16.60 Business name: .. Interceptor/grease trap Contact name: 16.60 Address: Page 2 Ciry /StateiZIP: Roof drain (commercial) 16.60 i . ( ) 16.60 Phone: ( ) Fax:: ( ) - i Sink/basin/lavatory 16.60 Tub/shower/shower E-mail: P 16.60 ILIA! t. ° s r a ^7 a . u� 16.60 1: '- ' 4 5 .W . " * M ye W ater el et 16.60 Business name: • • 1 2- . V' O/Z Pi_ t,w L / —' 6 Z4.) Water heater 16.60 Address: PQ 43 ox -z r., -3 Other lv Ciry /Starr/ /1 P: • M 1! • . L 'Z © Subtotal !/ (, p Phone: ( Mi l�rt fee: $72.50 �i 0 ) 6 " F ax: (rte i 9 , Residential backflow� p�� : S36-25 'I‘- 5C) CCB Lie.: ` 1 3 t 5 2 I r I, Plumbing Lie. no. /76 26 7 / ii_____ Plan review (?S% of permit fAe) Authorized Signature: State surcharge (12° o See) Ti 1 TOTAL PERMIT FEE Ai _ Z0 Print name: f V r� i-a s,f ,�, O Date: OS, 0 7 This permit aPPli�ation ezpires Ef a partner is not obtained within 180 days afte it has been a ccepted as com plete. *Fee methodology set by Tri-County Building Industry Service goard rTa„aa ma.mwi,,,F -r ap avt7/o6 J 1 _ dS 46leT(ruru2lcosvwEn) SA-U12, L VL, 16.Y1 P , kW ir_e--e- u o L c-r