Permit CITY OF TIGARD PLUMBING PERMIT
IN - 11 1
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00106
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/08/2012
IIGAAD g Parcel: 1 S135BD00100
Jurisdiction: Tigard
Site address: 9600 SW OAK ST 550
Project: Ameriprise Subdivision: ASHBROOK FARM Lot: PTS 5 &
Project Description: Relocate (1) sink, (1) floor drain & (1) water heater for TI.
Contractor: NORTHWEST CENTRAL PLUMBING CO INC Owner: SUN LIFE ASSURANCE CO OF CANADA
2870 SE 75TH AVE # 206 BY NORRIS BEGGS & SIMPSON
HILLSBORO, OR 97123 121 SW MORRISON ST #200
PORTLAND, OR 97204
PHONE: 503 - 642 -2067 PHONE:
FAX: 503 - 642 -5954
FEES
Quantity Description Date Amount
1 ea Floor Drain /Floor Sink/Hub 05/08/2012 $25.02
Specifics: 1 ea Lavatories 05/08/2012 $25.02
1 ea Water Heater 05/08/2012 $37.52
Type of Use: COM 1 12% State Surcharge - 05/08/2012 $10.51
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories: -
Total $98.07
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 OUN fling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: / c0 oA / /y ie9-770 . /
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.
05/02/2012 08:32 15036425954 NWCENTRAL #2703 P.002/003
Plumbing Permit Application
Building Fixtures E R�E IVED FOR OFFICE C SE O\L \`
City of Tigard ' ° °d 5 l)- I Permit No � L M gp! '__U` bl De
13125 SW Hall Blvd, Tigard, OR 97223 , - 2 i 2012 PtanReview
Phone: 503.7182439 Fax: 503_598.1960�V: Y ()therPtamitNo.: a
Inspection Line: 503.639.4175 D ate y /s y : r H Sec Page 2 for I
_ 1GARD
tC �r , T! Internet www.tigard -or.gov }�QFT _ . ., _
.�, ...- _ , .._ ra,�a:+s•nn = 7 1: 0/ ,.. N v �r ny ., r I k e ,. ,•X•' +. _ _S.T .Zs - r'.._wi. Information
d • ' '" r F'n�� r�.fr 7- s�,r' lr tT, Tom- „t•'. "•i;f '..::'�ti::.i 6L C r T �, er
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• ❑ New construction ❑ Demolition • For spedol information use check rat
- - Description 1 Qty. , Ea_ I Total
n Addition/alteration/replacement ❑ Other New 1- 2- family dwellings (includes 100 ft. for each utility connection)
y �� n' �T� fm:' - -ig i
ili T.
r �.'��- ',_:,;. - •M y : c , - _, � VI,„_ ` y ` ,i• " £� I .� } 'rc , :rrg_ T �_ :.`_e SFR(1)bath 3 12.70
a.1 ' • s 1 '�•- .i4'. 'f'' - 1 V -- _' r' -44 ,77'.ili i.:•l 'l it 1„
V 1- and 2- family dwelling P ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 50032
App building ❑ Multr- family Each additional bath/kitchen 25.02
• ❑ Master builder ❑ ()then Fire sprinkler (_.r- sq. ft.) Page 2
,,. rt;_ �", .-,/:,. v ,�, • re er, ' ? xr .• .r r "i J . , i
- - r r. i rI 4- 5 S a -7 `,• trt ! n .� , J •aY • Slue ntnliHes: .
..: "' '...fig .ur:� e.mgi• = : 44'.' uL "� x- .+_ 1 u�• L • ' • , . 3 c w 4'i'
Job site address: ` . q (. J 0 : a `-w+ S5-0 Catch m
tch basin or area drain 18.76
t Drywcll. leach line, or trench drain 18.76
City/State/la `li ;
City /State/Zl n ox. d CDP RI a Footing drain (no. linear ti: _) Page 2
Suite/bldg -apt no.: s b I Project riwr'e: ?) az . \JQ,4 60i: 01■1Ar Manufactured home utilities 50.03
Cross street/directions to job site: Manhokes 18.76
` - Rain drain connector 18.76
Sanitary sewer (no. linear it _) Page 2
' •- Storm sewer (no. linear ft: - ) Page 2
Water service (no. linear ft.: ___) Page 2
Subdivision: Lot no.: fixture or item:
Tax map /parcel no.: Backflow preventer 31_27
'
-�
_ •• �•. -, 12.51
cam..."". .,u.':H' ' ..,.,. � . � •:• _ , .aar•,.� --•-•� Backwater valve
='t! =- �:N -4.7-4-7. 4' 3,:> C t �4�:.,:fG';� ,t
s•'' -7 x t ' , _ r ., n�� .'� h,. .v.;,;tf:s 1 ^.,..{. te l: 1
,•. C tithes viasha 25.02
'. %avn - - w.4 v1_vne.r. -' S■r. :vr.k. Dishwasher 25.02
t,k.i0•12.N. ,,,,, Drinking fountain 25.02
' i j eft 6 Ps Con)74e}e_rodL Ejectors/sump 25.02
x-; r _ _ a , 7; , _ �,'• � -� ton tank 12.51 MI
•
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�`� .,i i �tb. C:h� �j�i�w'�ee�L d.:r`�`,.- ,..6 -•. S.•„ �X- i'E �.
_, a......, ._.. :...emu.;,;;• `'rr F,1 dam'
Name: Fixture/sewer cap 25.02 4.
Floor drain/floor sink/hub 25.02 .0?,
- Address: Garbage disposal 25.02 -.
City/Stale/ZIP: hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker ■ 12.51
i _ t .,_,..,� 5 : ;gig,t , P:'3,".: fn tor/ 25.02
: r; �; � - - . , 5,. �'�.�� ` ti�rr,�}•. -
1 - Medical gas (value: $ ) MN Page 2 IMO
Business name:
�1br : _, r._ .. •; I. primer 12.51
Contact name:
�1 "Vln G.)'F'c. c1Mr��(1 Roof drain (commercial) 12.51 .
Address: a % -/ o Se 5 Ave., On4 44 a'O co - Siak/ba y' avatory 1 25:02 as o g•-
City/StatefZlP: 4; kWoo rc7 Of' ' X71 a-3 Solar units ( water) 62.54 ,
Fax:: (So Gt . CSS 1 � Tub/shower/shower pan ■ 12_51
Phone: (� 03) (o� f -4.. a.o c� J urinal 25.02
E - mail; de - rar+noer -o, e N b ulQ (�v.-krH` ' �ar..� •_ • • C --
r . , -_ Water closet 25.02
S ri
' � �� � ° ' � , • , . ....:..:���" ' �� �. . .. u 4 � :u ' i y Wr; � =; . ;•r. � ^ :a VJatCnc�ater 1 37.52 37•Sa
&laint'ss name; N O- - &) C Q vt* VTh F�l txv401 vt 0 , Water piping/DWV 5629 Other. 25.02
City /State/LW: Subtotal ' 7. 5C.o
'hone: ( ) .i
Fax: ( ) ' �
. um - Minim permit fee: $7250
��r`�� Q Plan review (25% of permit fee)
J CBUc.k a s a yPlambing Lie no.: '3� �('a p u State surcharge 12% of tt fee S /
( per' ) 1 t�'
Authorized signature' �1 -, • TOTAL PERMIT FEE G. Q om ]
E Print l
t name, : �TQ+t�J fi r ' Ca his permit application h as b if g� wirL'w IISO dayrr
after it t has been accepted
*Fee methodology Set by TYFCcunty Building lodvury Service Board
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L\Boildm crontAPLMU- PemitApp.doe 10/01/09 4M0.1610Ta0i021COMrwrB)
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05/02/2012 08:32 15036425954 NY/CENTRAL #2703 P.001/003
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Northwest Central Plumbing Company, Inc.
2870 SE 75 Avenue, Suite 206 HIM! �T � ..,, r n T n r n T n R � O-
� n� l` �" n I n �
Hillsboro, Oregon 97123 I I I t JL 1 L t I I fl }' �l'} �I }l U U
T: 503.642.2067 F: 503.642,9954
CCB No. 72253
Ta City of Tigard Front Northwest Central Plumbing
Fax Na 503.598.1960 Fax No 503.642.5954
Phone Na 503.7182439 Drew May 2, 2012
RE Paget 3 I .
0 txwara ❑ For Rovisw ❑ Ream Comment El use Reply 0 mese Neesde
• Comments:
Please let me !mow if you need any additional information to process this plumbing apphcation.
TII� UDU,
Tamara Stewart
Office Manager
tanmra@northwestoanhal9.com
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