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Permit CITY OF TIGARD PLUMBING PERMIT 111 II • COMMUNITY DEVELOPMENT Permit#: PLM2018-00014 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/14/2018 Parcel: 2S 101 AB03100 Jurisdiction: Tigard Site address: 12115 SW 70TH AVE 201 Project: Advanced Endodontics Subdivision: 2012-009 PARTITION PLAT Lot: 3 Project Description: New medical gas system. Contractor: CASCADE PLUMBING CO Owner: TIGARD TRIANGLE PARTNERS LLC 15765 SW 74TH AVE 18187 SIERA DR TIGARD, OR 97224 LAKE OSWEGO, OR 97034 PHONE: 503-289-7095 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Medical Gas 02/01/2018 $140.90 Specifics: 1 Plan Review 02/01/2018 $35.23 1 12%State Surcharge- 02/01/2018 $16.91 Type of Use: COM Plumbing Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $193.04 Required Items and Reports(Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules or direct questions to O by calling 03.232.1987 or 1.800 332.2344. Issued By: , Permittee Signature: / ‘ Call 503.639.4175 by 7:00 a.m.for the next available inspection date. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building FixturesRB: ED FORFOROFFICE t SE oMLl City of Tigard t DateBy: I Gt ' / i7 Permit No.:: `yr Cyt)t II 13125 SW Hall Blvd.,Tigard,OR 97223 8 7 pi$ Plan Review k%/, Vd i j t ' ■ Phone: 503.718.2439 Fax: 503.598.1960Ar� Other Permit No. Cyd Date/By: �-,Z Q-!� � �l'�l/�',�al(�� 1�GY9/ 've Inspection Line: 503FIGARO .639.4175 ��,,}}0 Date Read/B lnas: H See Page 2 for Internet: www.tigard-or.gov CITY Y [ �y Notified/Method: r/ b 1I/1 J/ur Co Supplemental Information TYPE OF Wf ii.--- I�I�tIe1��/ t, . � FEE* SCHEDULE Mlieste-cs0 New construction 0 Demolition For special information use checklist Description I Qty. I Ea. ( Total -ffAddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(1)bath 312.70 ❑ 1-and 2-family dwelling commercial/industrial SFR(2)bath 437.78 ❑Accessory buildingSFR(3)bath 500.32 0 Multi-family Each additional bath/kitchen 25.02 ❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: \`2,115 S W T O-woe. Ata.,2O 1 g O.1A Catch basin or area drain 18.76 '" Drywell,leach line,or trench drain 18.76 City/State/ZIP: '1J..O-t 9 0 tZ- 41 Footing drain(no.linear ft.: ) Page 2 Suit Id /apt.no.:2011 C I Project name:O- 't .11, Eiyuk43 -�-O Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 I $Vs) Sk g S N%).1(' Rain drain connector 18.76 Sanitary sewer(no.linear ft.:_) Page 2 4 Z O,., -O©q q Storm sewer(no.linear ft.: ) Page 2 Water service(no.linear ft.: ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 'D_E�SCR_IPnTION(OF WORK l Backwater valve 12.51 .�h -0- G ).Ywa Sy�U A ws (�A/��) V - Clothes washer 25.02 3 0-t. /�h Dishwasher 25.02 Il` ^ s13'Ylt(�M Jvvl. t3- I Ot. AAA-8-1-1/4(2, Drinking fountain 25.02 pv‘, 1 6- t-.-t , Q7,9A, ibLat G Ejectors/sump 25.02 0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51. Name: Fixture/sewer cap 25.02 - Floor drain/floor sink/hub 25.02 Address: - Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone:( ) Fax:( ) Ice maker 12.51 (V]'APPLICANT 0 CONTACT PERSONpp Interceptor/grease trap ��yy++�� 25.02 Business name: Q W - as R C.0- P,Qjyy,st,, Medical gas(value:$ Page 2 1 41).gt) idAJ)66 Primer 12.51 Contact name: Elh Roof drain(commercial) 12.51 Address: 1 tj-(is 5 Sp W 141 - (IAA- Sink/basin/lavatory 25.02 City/State/ZIP: .1r.,1 O,.ti,p. e5 C - Q 1 7...Z.'4 Solar units(potable water) 62.54 Phone:(s o3) 2$g-locks Fax::(503) 283-RS ILL Tub/shower/shower pan 12.51 - OAP-,E-mail: �'L�y�,q (� OAP-, , t g-y1-- Urinal 25.02 6 CONTRACTOR Water closet 25.02 Water heater 37.52 Business name: 0 utLQAVZA.ryC +Q,Q,y„l,- 4141/4 (..OAic.tleuri pQ�nl,- Water piping/DWV 56.29 Address: 151 (p S S'03 14 141' C3 °- Other: 25.02 City/State/ZIP: DA-O- ) 0 R-.- RI z E.L.1 Subtotal Phone:(cos) 2 g of.--10 Q,.5 Fax:(Vb.S) . $3 •5 S l 14 Minimum permit fee: $72.50 140,go CCB Lic.: zpat$Q'L, Plumbing Lic.no.:R5 1S2 S Plan review (25%of permit fee) 35,23 �(,,,�� State surcharge(12%of permit fee) J( . ea ,r Authorized signature: \�,, S, J:A`�' ppll TOTAL PERMIT FEE 191,of Print name: (V\\C V (2 0 SS Date:(2.‘'o61 I So 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:\Building\Permits\PLMU-PermitApp.doc 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: 12115 SW 70TH AVE 201 , TIGARD, OR, 97223 June 19, 2018 at 9:17:12 AM Record Type: Record ID: Commercial - Plumbing PLM2018-00014 Inspection Type: Inspector: 399 Plumbing final Aaron Cillo-Gobel Result: PASS - NoCofO Comments: Previous corrections completed. Violation Summary: Inspector Contractor