Permit (84) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00425
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2017
T t c"�R P' g Parcel: 1 S 135BC00900
Jurisdiction: Tigard
Site address: 10855 SW CASCADE AVE
Project: Paulson's Floor Coverings Subdivision: None Lot: None
Project Description: Backflow preventer installation.
Contractor: HAPPYS PLUMBING INC Owner: PAULSON LIMITED LIABILITY CO
418 SE 89TH AVE BY RICHARD G PAULSON SR
PORTLAND, OR 97216 10855 SW CASCADE BLVD
TIGARD, OR 97223
PHONE: 503-788-6947 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 10/16/2017 $31.27
Specifics: 1 12%State Surcharge- 10/16/2017 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 10/16/2017 $41.23
Type of Use: COM Plumbing
Class of Work: OTR
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 btain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available ins ction date.
This permit card shall be kept in a conspicuous place on the job site ntil completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
BuildingFixtures
hoa ()IN( tse cl��l,v
City of Tigard � EIV E- 'eceived n
Permit No.:,9 M "7t 1 7- ist y>
+ 13125 SW Hail Blvd.,Tigard,OR 97223 Date/By: Xi/� t 1 '" t7� )'
C Phone: 503.718.2439 Fax: 503.598.1960 (� Plan Review
0 C T 1 C 2 0 1 7 DateBy: Other Perini[No.:
T I G A R D Inspection Line: 503.639.4175 Date Read B
Internet: www.tigazd or gov r t y y Juris Supplemental
See Page 2 for
a of fil ethod Supplemental Information
'::.4. • k .,;a�« d'' • ' µ rd s r• .• ,r..
❑New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
E,Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
1 � ' • SFR(1)bath 312.70
❑ 1-and 2-family dwelling ot Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen
n 25.02❑Master builder 0 Otheri Fire sprinkler( sg.ft) Page 2
itzgp i4:2. . � � j � • Site utilities:
Job site address:t Vq
S' C,,L, U J (' r k, G Catch basin or area drain 18.76
City/State/ZIP: ��`�t� Drywell,leach line,or trench drain 18.76
C 0-v O� Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: 3 Project name:
ULG1l',S Fie,/f eve,,, ) 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 3/.017
�' �' Backwater valve
12.51
gg `` � , � t)-q.- Clothes washer 25.02
k(\S &1A C to"lam U (e�'.( ( 0 k Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
;. Expansion tank 12.51
Name: 0 P(JL.;Ui/ I- .. Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
D (t'' S' C 5 C/17/74/- L-V`. Garbage disposal 25.02
City/State/ZIP: 7 7 6,,2 /D 0(1C 0 c- Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
;rte‘1,:,`,„ - • 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 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
t •4 t Water closet 25.02
;P. � � � Water heater 37.52
Business name: 04,F
" i'Q v�J P l xr b � tIh`
Water piping/DWV 56.29
Address: ` (cr - ?crrliz ( � L Other: 25.02
City/State/ZIP: ^( / tb
f7 4\17- ' Subtotal 31�,�"7
Phone:(5 ji )-1;iq .Lot,it'd �l Fax:( , )-1"SR (f1 L.jC1 Minimum permit fee: $72.50 7). 1
CCB Lic.: lsti �i Plumbing Lic.no.:3 -(4 v 496 Plan review (25%of permit fee)
4� L� State surcharge(12%of permit fee) T•7.)
Authorized signature: TOTAL PERMIT FEE ir 1.4-0
Print name: l ,[�1,� ' ✓lI` 111_ 7.,- .3. I Date:&0 jkiylei I This permit application expires if a permit is not obtained within 180 days
l / after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:�Building�Permits�PLMU-PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
10855 SW CASCADE AVE, TIGARD, OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2017-00425
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . 2" Watts DC, model LF007M1 QT, serial # 036545, for domestic water to Bldg, located
at SE side of bldg. by water meter - ok with test
Violation Summary:
Inspector Contractor