Permit CITY OF TIGARD PLUMBING PERMIT
• �' COMMUNITY DEVELOPMENT Permit #: PLM2009 -00093
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639 4171 Date Issued: 04/16/2009
Parcel: 1S1260000300
Jurisdiction: TIGARD
Site address: 9724 SW WASHINGTON SQUARE DR F06
Subdivision: Lot: 0
Project: Gap
Project Description: Replace (2) lays.
Owner: FEES
PPR WASHINGTON SQUARE LLC Quantity Description Date Amount
BY THOMPSON PROPERTY TAX SERVUCES, 2 ea Lavatories 04/16/2009 $33 20
2235 FARADAY AVE STE #0 1 12% State Surcharge - 04/16/2009 $8.70
PHONE
Plumbing
39 ea Minimum Fee Adjustment 04/16/2009 $39 30
Contractor: - Plumbing
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062
PHONE: 503 - 691 -6166
FAX:
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
Issued By: L\_ I Permittee Signature: i
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.
• - �Apr.13. 2009 2:53PM Modern Plumbing No. 1421 P. 1/3
Plumbinn Permit Application R
City of Tigard APR 13 2009 Reeenrd
nits Bl per., Na
. 13125 SW Hall Blvd, Tigard, OR 97223 ` "�, m 2 al
Phone: 503.639.4171 Paz 74m lest m1C
503.598- I9t 5h I�OFTIGARD 1- '''''' ' thcr Ptmut No
I' 1 i ^ , ti I) ion Line: 503.639.4175 v Dow Ready/By; PI See page 2 far
Internet www.t -or - tom BUILDING DIVISI0I9 d. �' ' ' Sp pteracatatloror matron
TL°YE OF i1'OR1C FEE" R iill. 1
❑ New construction ❑ Demolition Far special iyar'marian tae checklist
Desaion I 01r- I Ea. I Total
X Addition/ailtemIion/replacement ❑ Other. , New 1-2-family dwellings (includes 100 ft for each utility connection)
. CATEGORY'
ATEC30Rl''OF C.ONfrl'Rucrlt7N SPR (I) bath 249 20
- 1- and 2- family dwelling _N Commercial/industrial _ SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family Si�R (3) 399.00
Each additional bath/kitchen 45.00
❑ Master buildcr ❑ Other -
P re aprinlder ( sq. ff.) Page 2
JDB� -SITE J1NFORll'1AUON• Al;11) ' tavioN" "
Stec ndHMes
Job site addrad )
+ G �(� (A) ,�l S a � / p.4 � Catch basin or area drain 16.60
• y
City/State/DP: Ti 4 . - (7 ' nd 3 Dr'well. (each link or trench drape 16.60
Suite/bldg./apt. no.: Project name 6
FM* drain (no. linear it: , . ) Page 2
Cross street /directions to job site: Gtr a Ski L T L1j �-e J m
_- lea ad home utilities 116.60
Q Ma 16.60
L AAA ., X // L. t . e - -r) v Rain drain connector 16.60
_ pA.e P F O (' Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer Collinear It.: ) _ Page 2
Subdivision: I no,: _ Wes' service (no. linear ft: _) Page 2
Tax map /parcel no. : tUrS or Item
!; , , , Absorption valve 16.60
; DESCllli41ON- OlriVORK. .
Badtgow preverda Page 2
1 g
In Ii // 0 ife.-/PYLe.er • Backwater valve 16.60
e{ /1∎19X ( AQI • .-. . d ,£ L.A/S Clothes washer _ - 16.60 M
Dishwasher 16.60
. i' U PROPtl n, l OW1 ' . , � ;Q TENANT„ '' Drinking min 16.60
Nana: Ejectors/sump 16.60
. - Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City / State/ZIP: Flea drain/floor sink/hub 16.60
Phone: ( ) Fax; ( ) Garbage disposal 16 -60
Hose bib 16.60
-❑ . _11y l ❑"C CiNT 1CT RER80N
Business � name .
Ice maker 16.60
Interceptor /grease trap 16.60
Contact name: Medial gas (value: S ) Page 2
Address: Primer _ 16.60
City/ State/ZIP: Roof drain (commercial) 16.60
Phone: ( )
- ' as:: ( Sink/basin/lavatory 1660 33
E-mail; Tub/shower/ahawerpan 16.60
-
• U 16.60
C:ONTRAC'TIDR . • Wader closet 16.60
Business name: Modern Plumbing Co. Water heater 16.60
Address: 11120 SW Indristrial Way Omen-
City /State/ZIP: Tualatin, OR 97062 • Subtotal
Minimorn permit foe: $72.50
Phone: (503) 6916166 Fax: (503 ) 6916771 Residential bacddlow minimum permit fee: $36.25 7 a
CCB Lie.: 87906 Plumbing Lie. no.: 34 250PR Plan review (25% of permit fee)
,, // Stine surcharge (12% of permit fee) 870
Authorized signatures: _-Z 61,,,t, thcy,sr / c.
TOTAL, PERMIT FEE
Print name: if . • - Date: (. / 3 l - Thls permit application expires If a permit is not obtained withi
r 180 days after tt has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board,
llbuldinglPerroMPLM- PemulApp -doe 06(2006 440-461erpa02/cOM(WBB)