Permit (43) CITY OF TIGARD PLUMBING PERMIT
1.. COMMUNITY DEVELOPMENT Permit#: PLM2017-00010
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/18/2017
Parcel: 1 S 135BA00100
Jurisdiction: Tigard
Site address: 10205 SW WASHINGTON SQUARE RD
Project: Thirsty Lion Subdivision: None Lot: None
Project Description: Installation of(1)grease trap.
Contractor: WOODBURN PLUMBING INC A CORP OF WASHING1 Owner: PPR SQUARE TOO LLC
PO BOX 827 PO BOX 847
CAMAS,WA 98607 CARLSBAD, CA 92018
PHONE: 360-834-2889 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Interceptor/Grease Trap 01/18/2017 $25.02
Specifics: 1 12%State Surcharge- 01/18/2017 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 01/18/2017 $47.48
Class of Work: ALT Plumbing
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 .oc i work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Util Notification -+ter. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
direct questions to OU\ • call • 503.232.1987 or 1.800.332.2344.
Issued By: Permittee S nature:
Call 503.639.4175 by 7:00 a.m.for the next available inspecti 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.
From: 01/10/2017 16:46 #894 P.001/001
Plumbing Permit ApplicafionECEI
Building Fixtures JAN 1 0 2017
FOR nrFl(i. tSF oSl.l'
City of Tigard 1-1-Y Off: I A $D E
d / / PermitNo1111 a 13125 SW Hall Blvd Tigard, t2 view / /g /7 L f
Phone: 503.718.2439 Fax: 1g UNC-,1 DIVISION!A/ ns1e/$y Other Permit No.:
r i t.A R li Inspection Line: 503.639.4175 Date Ready/By: tuns: Pi See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE OF"WORK PEE* SCHEDULE
El New construction 0 Demolition For special information use checklist.
Description J Qty. f Ea, I Total
®Addition/alteration/replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
El 1-and 2-family dwelling eel Commercial/industrial SFR(2)bath - 437.78
SFR(3)bath 500.32
El Accessory building ❑Multi-family
CI Master builder ❑Other: Each additional bath/kitchen 25.02
Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION.. . Site utilities:
Job site address:10205 SW Washington Square Rd Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/Z1P:Tigard,OR.97223
Footing drain(no.linear ft._ ) Page 2
Suite/bldg./apt.no.: Project name:Thirsty Lion Manufactured home utilities 50.03
Cross street/directions to job 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 #VORK Backwater valve ®IIIIIII
Clothes washer 25.02
Instal Grease trap
Dishwasher I 25,02 11
Drinking fountain 25.02
Ejectors/sump 25.02
❑ 'PROPERTY OWNER • ig TENANT Expansion tank 12.5)
Name:Thirsty Lion Pub&Grill Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:10205 SW Washington Square Rd
Garbage disposal 25.02
City/State/ZIP:Tualatin OR 97223
Hose bib 25,02
Phone:(503)352-4030 Fax:( ) Ice maker 12.51
.� APPLICANT 1 ❑ CO NTACT PERSON Interceptor/grease trap 1 25.02 25.02
Business name:Woodburn Plumbing,Inc. Medical gas(value:5 ) Page 2
Primer 12.51
Contact name:Mickey Johnson
Roof drain(commercial) 12.51
Address:PO Box 827 Sink/basin/lavatory 25.02
City/State/Z1P:Camas,WA.98607 Solar units(potable water) 62.54
Phone:(360)600-0661 Fax::(360)833-2889 Tub/shower/shower pan 12.51
E-mail:woodburnplumbing@woodburnplumbing.com Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Woodburn Plumbing,Inc. Water piping/DWV 5629
Address:PO BOX 827 Other: 25.02
City/State/ZIP:Camas,WA.98607 Subtotal
Phone:(360)834-2889 Fax:(360)833-2889 Minimum permit fee: $72.50 7.A•Std
Plan review (25%of permit fee) r"--
CCI3 Lie.:97064 Plumbing Lic.no.:37-385PB
State surcharge(12%of permit fee) u...
Authorized signature:(..,,,,,,e/„.. 2 _ TOTAL PERMIT FEE g(..Pc)
Print name Victor Compher Date:1/10/2017 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.
):`Building`Pcrmity,PLMU-PemtitApp,doc 1001/09 440-4616T(10%02(COMWEB)