Permit (193) CITY OF TIGARD PLUMBING PERMIT
,1111 COMMUNITY DEVELOPMENT Permit#: PLM2017-00288
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/19/2017
Parcel: 2S112DC00701
Jurisdiction: Tigard
Site address: 15965 SW 72ND AVE
Project: Lee's 1 Hour Cleaners Subdivision: FANNO CREEK ACRE TRACTS Lot: 39
Project Description: Remove backflow preventer.
Contractor: MOLALLA PLUMBING Owner: PACIFIC REALTY ASSOCIATES
119 CENTER STREET ATTN: N PIVEN
MOLALLA, OR 97038 15350 SE SEQUOIA PKWY#300
PORTLAND, OR 97224
PHONE: 503-829-2225 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 07/19/2017 $31.27
Specifics: 1 12%State Surcharge- 07/19/2017 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 07/19/2017 $41.23
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 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: Permittee Signature:
.arlah?ce/7047
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.
Plumbing Permit Application
Site Utilities RECEIVED I< i Ort,1< t l 'i' (/N1,1
City of Tigard Received
Received
M111111 Date/i3 ; i l
114
tt3125 SW Hall Blvd. Tigard.OR 97 g 27 Plan i ' Phone: 503.718.2439 Fax: 503.59Dalo/B ; Other ParmiNo,
__
1 1 i 1t 1 Inspection Linc: 503.639.4175f �y Data Matey/11y: lurin: ® Seo Page 2 for
Internet. www.tigard-or.gcw fm...,...",IVr_ 1 k ,ARu Notified/Method; I
Supplemental Information
TYPE 01 Pht Gi0IUISICTI . FEE" SC[IEDULE� ,
o New construction RI Demolition For special information use eheckliza
Description I I Qty, i Ea, J Total
❑Addition/alteration/replacement 0 Other: New 1.2-famil dwellin a(includes 100 ft.for each utility connection)
CATEGORY OF coNs : . "• . SFR(1)bath 312.70
❑ 7 n 1-and 2-family dwelling Conumercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
El Accessory building I u to-family - -..
bruit additional hath/kitehcn 25.02
0 Master builder El Other: Piro sprinkler( sq.ft.) Page 2
' • . • 3011 SITE INFORMATION AND LOCATION Site utilities,;
Joh site address: rp 'yv 7,:24,27--Al/ Catch basin or ar a drain 18.76
City/State/Lll': 1"1 cy 4/i� �' Drywetl.leach li c,or trench drain 18,76
Footing drain(n..linear ft.:_J Page 2
Suite/bldg/apt.no,: Project name: Manufactured ho c utilities 50.03
Cross street/directions to job site: -er , .„ i tr RA Manholes 18.76
Rain drain corm.tor 18,76
Sanitary sewer(i..linear It.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
-- Water service(n..linear It.:___) Page 2
Subdivision: Lot no.: Fixture or Item:
Tax map/parcel no.: Backflow preven er III 31.27
DESCRIPTION OF WORK Backwater valve 12.51
'c.es,./c.. 1, 2 45 1:8-6/64-4__
2 v _ �/ Dishwasher
hwer 25,02
�L.fy (,� r6 (+�,� Dishw�her I 25.02
Drinking founteit 25.02
Ejectors/sump 25,02
ID-PROPERTY OWNER ; Q 'TENANT Expansion tank jM
Name: Fixture/sewer ca. 25.02
Floor drain/floor ink/hub 25.02
Address:
- - Garbage disposal 25.02
City/State/ZIP: _•_ Hose bib 25.02
Phone:( ) Fax:( ) ice maker 12.51
. ❑ APPLICANT •. - In CONTACT PERSON I Interceptur/grecs trap 25.02
Business name: Medical gas(vallc:$ ) Page 2
Primer 12.51
Contact name: Rnnf drain(coma racial) 12.51
_Address: (A) 4.-LF 6 Sink/basin/lavat•Mill 25.02
City/State/ZIP: g=1'' pX_ 77.22-t/ Solar units(pota 62.54
Phone:( ) Fax::( ) Tub/shower/An ■ 12,51
E-mail: Urinal 25.02
' CONTRACTOR ; ; • , • • .
Water closet 25.02
114 Water heater 37.52
Business name: , Water piping/[) V 56.29
Address:
1 I Cep,- p,G�. a Other, 25.02 el=
City/Stalc//IP: IL./ ., J' 9/ ' Subtotal
Phone: Se 4 ) -;':./9,.., (SP1 ). fe D 7f Minimum permit fee: $72.50lEle
�� Nu Ai/A.0. _•L Plan review (25%of permit feeMOM
)
i,� t� �� g Lic.no.: 3— •�� State surcharge(12%of permit fee)
Authorized signal ‘l'i� /� TOTAL PERMIT FEE g •sio
Print name: � , • Date:'1.,/7—/7 'This permit apps cation expires If u permit is not obtained within IRO days
-NILatter It has been accepted n templets.
"Fee methodo ogy set by Tri-County Building Industry Service Board.
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City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15965 SW 72ND AVE, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2017-00288
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Back flow device has been removed, interior of bldg. is now just a shell only, all
fixtures have been removed.
Violation Summary:
Inspector Contractor