Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2012 -00234
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/14/2012
Parcel: 1 S134BC00200
Jurisdiction: Tigard
Site address: 12160 SW SCHOLLS FERRY RD 100
Project: Subway Subdivision: WINDSOR PLACE Lot: 32
Project Description: (2) floor drains and (3) sinks for TI SDC fees paid under SWR2012 -00156
Contractor: EAST WEST PLUMBING INC Owner: GREENWAY CENTER LLC
10610 SE 145TH AVE ANA KALAKAUA CENTER
HAPPY VALLEY, OR 97086 2155 KALAKAUA AVE #602
HONOLULU, HI 96815
PHONE: 503 - 777 -1594 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Floor Drain/Floor Sink/Hub 08/14/2012 $50.04
Specifics: 3 ea Sink 08/14/2012 $75.06
1 12% State Surcharge 08/14/2012 $15.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $140.11
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 OUNC by calling 503.232.1987 or 1.800.332.2344. •
Issued By: O j_ Permittee Signature: /
J
Call 503.639.4175 by 7:00 a.m. for the next available inspection da e.
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.
Plumbing Permit Application RECEIVED
Building Fixtures ilk FOR CA Permit No.: OFFICE USE ()NIA
City of Tigard AUG 1 4 2012 Date/B a /�
V 13125 SW Hall Blvd., Tigard, OR 97223 p Review �' I ��' y C ��_ ,
C Phone: 503.718.2439 Fax: 503.598.1I
0FTGARD Date/By: Other Permit No.: eje,a,p11,- O b24t!
I G n R D Inspection Line: 503.639.4175 D R ®pmenta Information 7
Internet: www.tigard -or.gov BUILDING DIVISIO Noti6ed/Method:
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
x ddition/alterationheplacement ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
❑ 1- and 2- family dwelling Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: I 160 SW SGho 11S & t-v RG f #/00 Catch basin or area drain 18.76
City/State/ZIP: � Q 0 9 Y� 2� 3 Drywell, leach line, or trench drain 18.76
/ Footing drain (no. linear ft.: ) Page 2
Suite/bldgJapt no.: jProject name: BCrry Fa t Y0314 14 r Manufactured Manufaced home utilities 50.03
Cross street/directions to job site: Manholes 18.76
S SW ejle /I.S re r r i n r� Sly/ 12 A e- Rain drain connector 18.76
y Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: ' G - e -1- ,, I Lot no.: Fixture or item:
Tax map /parcel no.: I S 13 ` T e 6_06 200 Backflow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
Clothes washer 25.02
Dishwasher 25.02
In 5+Q I I - F; )(+LtrGS Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I X TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name: 6- rG S it q A G (I
r r Floor draifloor sink/hub 2 25.02
Address: 121(:)Z10 SW Sch 0I I.S �G ry g /00 Garbage disposal 0 25.02
City/ State/ZIP: ••-7--- and f OR q 7 22 3 Hose bib 25.02
Phone: ( 5b3 ) 647 - . ( 9 q Fax: ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
n _/,, Medical gas (value: $ ) Page 2
Business name:
I� er r r Fa r rks YO q 4 r* Primer 12.51
Contact name: // -r te Scan n e i/ l I Roof drain (commercial) 12.51
Address: / 2 /60 SiV Sr.)/aAS Fe r- z Rd st /00 Sin4asin/lavatory 3 25.02
City /State /ZIP: a rd q 9 223 Solar units (potable water) 62.54
Phone: (503) S L!- ! - 5 9 9 Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: SGO n n e) I L- 0 r0 rlt,'C f .Cori-% Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: ' r p s ; f' P( i J/-t�. 1-01C--
T
` I U-'C� Water piping/DWV 56.29
/
Address: Q6 SE fit'- 4 Other: 25.02
City/State/ZIIP: J` t�/I"y (J J/y c-J• Q7,33.-6 Subtotal
Phone: (?7() 5 . 6-7/3- Fax: (*0 )777 _/5 C� Minimum permit fee: $72.50 ��. ��
Plan review (25% of permit fee)
CCB Lic.: /per S j. / Plumbing Lic. no.:,2 ( 5 ea
7 1 t I State surcharge (12% of permit fee) i.S.D
Authorized signature: TOTAL PERMIT FEE l 40 .
Print name: icL ,74,e Date: 2 -/y- /L y /,L This permit application expires if a permit is not obtained within 180 days
i after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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