Permit (179) q CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2016-00014
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/13/2016Parcel: 1S135DA03500
Jurisdiction: Tigard
Site address: 11481 SW HALL BLVD 100
Project: HCC Subdivision: METZGER ACRE TRACTS Lot: 19
Project Description: Adding(1)dishwasher,(1)break room sink&(1)hot water heater.
Contractor: ROTH HEATING&COOLING Owner: BECKAL LLC
PO BOX 1265 7100 SW GABLE PKWY
CANBY, OR 97013 PORTLAND, OR 97225
PHONE: 503-266-1249 PHONE:
FAX: 503-266-3478
FEES
Quantity Description Date Amount
1 ea Dishwasher 01/13/2016 $25.02
Specifics: 1 ea Sink 01/13/2016 $25.02
1 ea Water Heater 01/13/2016 $37.52
Type of Use: COM 1 12%State Surcharge- 01/13/2016 $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 Noti enter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or d r9Kquestions toO by ca g 503.232.1987 or 1,800.332.2344.
Is ued By: Permittee Signature:
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.
Plumbin2 Permit Application
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Building Fixtures
Received
City of Tigard DateBy: / f Penn it No.
'
• 13125 SW Hall Blvd.,Tigard,OI�/P�2 "^tliPG-��9
it pyy''jj�OQQ r� Plan Review r
Phone: 503.718.2439 Fax: 5 1 6 Other Permit No
Inspection Line: 503.639.4175 yy 1 y�I, ty DateBy:
Internet: www.[igard-o[goV�.t{ �/l 16A'6V Dateedf=lhy: loris: s gee Page2(or
/� Notified/Method'. Supplemental Information
TYPFM (p 1111 t FEE- SCHEDULE
❑New construction ❑Demolition For special information use checklist
Description I Qty Ea. Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
❑ I-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingMulti-family y SFR(3)bath 500.32
❑ 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: 11481 SW Hall Blvd Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR.,97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: Page 2
Suite/bldg./apt.no.: Project name:S C Manufactured home utilities 50.03
Cross street/directions tojob site: 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: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Adding lunch room sink
Dishwasher x 25.02 25.02
/, Drinking fountain 25.02
aw . Ejectors/sump 25.02
❑ PROBERTY OWNER " ❑ TENANT t: Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$_) Page 2
Contact name: Primer 12.51
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory x 25.02 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax: :( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater x 37.52 37.52
Business name:Roth heating&Cooling Water piping/DWV 56.29
Address:6990 S.Anderson Rd Other: 25.02
City/State/ZIP:Canby,OR.,97013 Subtotal 87.56
Phone:(503)572-8208 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lic.: 14008 Plumbing Lic.no.:3450PB
� State surcharge(12%o(permit fee) /0•51 I,
Authorized signature: 'TOTAL PERMIT FEE n07
Print name: Kirk Garvey Date: 1/13/2016 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:�aullding�Permlts�Pl.Mt1-PermllApp doc 10/01/09 440-4616T(10/02/COM to Xa I2