Permit y n CITY OF TIGARD PLUMBING PERMIT
1114 II COMMUNITY DEVELOPMENT Permit#: PLM2014-00104
T[C±ARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/09/2014
Parcel: 1 S 134AA01900
Jurisdiction: Tigard
Site address: 10115 SW NIMBUS AVE 850
Project: Bellagio's Pizza Subdivision: IKOLL BUSINESS CENTER,TIGARD Lot: B
Project Description: Replace approximately 80'of interior water line.
Contractor: JACK HOWK PLUMBING/RESCUE ROOTER Owner: ROBINSON,CONSTANCE A
PO BOX 2830 BY KILLIAN PACIFIC LLC
CLACKAMAS, OR 97015 500 EAST BROADWAY, STE 110
VANCOUVER,WA 98660
PHONE: 503-850-3100 PHONE:
FAX: 503-491-2932
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 04/09/2014 $56.29
Specifics: 1 12%State Surcharge- 04/09/2014 $8.70
Plumbing
Type of Use: COM 16 ea Minimum Fee Adjustment- 04/09/2014 $16.21
Plumbing
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 Notif"i enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may •• -'n a copy of the rules
or direct estionns to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B • }/ � y/ji i Permittee Signature:
•
Call 503.639.4175 by 7:00 a.m.for the next available inspection !.te.
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 Ap ) eatin AIQ 9NI41II1
Building Fixtures 61111911A°AID FOR OFFICE USE ONLY
1/1 - City of Tigard Received /� /
n 13125 SW Hall Blvd.,Tigard,OR 9721$1OZ 6 1dV Dare/By: 9 �y �,yj Permit No: L� � jp
Phone: 503.639.4171 Fax: 503.598.1960 Plan Review
Date/By: Other Permit No.:
TI GA RD Inspection Line: 503.639.4175 Date Ready/By: Juris ® See Page 2 for
Internet: www.tigard-or.gov I Notified/Method:
r i Supplemental Information r x
❑New construction ❑Demolition For special information use checklist
Description Qty. Ea. 1 Total
A.Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
9:. ` s,.y `( ., at ,c "° 'TM e " s ,�� i:. q•, , s SFR(I)bath 312.70
7:4:-',S" .pl y .4iing A/ /��•jf/,� ,,., .';ndustrial SFR(2)bath 437.78
❑Accessory building .re i .to am SFR(3)bath 500.32
El builder �y �� �/� /r Each additional bath kitchen 25.02
Fire sprinkler( sq.ft.) Page 2
M` , . . Q E 'a e zii :iow P � r Site utilities:';,° qq _
Job site address: /A /! S Ni / 1- /��' Catch basin or area drain 18.76
�.. well,leach line,or trench drain
City/State/ZIP: � � 4W3 . s4 ry 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: Project name: `r"�o� 5' Manufactured home utilities g
50.03
Cross street/directions to job site: ' kA Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
(..�ti Backwater valve 12.51
„ b �.f. if.
ili , ' ru` -lmi Clothes washer 25.02
/�/irji' , - Dishwasher 25.02
ipir Drinking fountain 25.02
tiff ■ Ejectors/sump 25.02
L..: .,;I ?'', -�a ; a •Expansion tank 12.51
�//�I,I� 40174111
Fixture/sewer cap 25.02
`mil + �
Address: //7�/� n - i „s ., ' Floor drain/floor sink/hub 25.02■vv .Garbage disposal 25.02
City/State/ZIP: G�Q� / - ,, S 4 _
• � ose bib 25.02
Phone:( ) ('-:- ,, /'i . ) Ice maker 12.51
is.E = i a, ., Interceptor/grease trap 25.02
Business name:ARS dba JACK HOWK/RESCUE ROOTER Medical gas(value:$ ) Page 2
Contact name:JOYCE DENNIS Primer 12.51
Roof drain(commercial) 12.51
Address:P.O.BOX 2830
Sink/basin/lavatory 25.02
City/State/ZIP:CLACKAMAS,OR 97015 Solar units(potable water) 62.54
Phone:(503)850-3100 I Fax::(503)491-2932 Tub/shower/shower pan 12.51
E-mail:JDENNIS@ARS,COM Urinal 25.02
,j:.. Water closet 25.02
Water heater 37.52
Business name:ARS dba JACK HOWK/RESCUE ROOTER
Water piping/DWV 56.29
Address:P.O.BOX 2830 Other: 25.02
City/State/ZIP:CLACKAMAS,OR 97015 Subtotal
Phone:(503)850-3100 Fax:(503)491-2932 Minimum permit fee: $72.50
CCB Lic.: 127325 Plumbing Lic.no.:34-168PB Plan review (25%of permit fee)
C/ a(12%of State surchar
g ( permit fee) I /,
Authorized signature: TOTAL PERMIT laff~lgi
Print name:JOYCE DENNIS Date: of teb This permit application expires if a permit is not obtaine 1 wit ip :1 ays
after it has been accepted as complete.
�1 �I Q� � � i
*Fee methodology set by Tri-County Building Industry• - •card.
1.1Buildinng1Perrmii ss1PLMU-PermiiApp.do -1001 - 440-4616T(l0/027COM/WE�B)`� � �
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10115 SW NIMBUS AVE 850, TIGARD, OR,
97223
Commercial - Plumbing
399 Plumbing final
2014-04-11 00:00:00
PLM2014-00104
PASS - No C of O
Violation Summary:
Inspector Contractor