Permit (194) 0 ,
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00290
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/14/2009
Parcel: 2S115BA02500
Jurisdiction: Tigard •
Site address: 16200 SW PACIFIC HWY X
Subdivision: Lot: 0
Project: Marshalls
Project Description: Replace water heater.
Owner: FEES
SN PROPERTIES PARTNERSHIP Quantity Description Date Amount
1121 SW SALMON ST 1 ea Water Heater 10/14/2009 $37.52
PORTLAND, OR 97205
PHONE: 1 12% State Surcharge - 10/14/2009 $8.70
Plumbing
35 ea Minimum Fee Adjustment - 10/14/2009 $34.98
Contractor: Plumbing
COMMERCIAL PLUMBING SERVICES
21185 NW EVERGREEN PKWY SUITE 105
HILLSBORO, OR 97124
PHONE: 503 - 439 -9999
FAX: 503 - 439 -1999
Type of Use: COM
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: ' . Q Q C J I� O . _ Permittee Signature: \ n , p
Call 503.639.4175 by 7:0
7:0 a.m. for an inspection that business day. —
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.
•
10/14/2009 14:19 Mechanical Services, Inc. (FAX) P.0011002
Pluming Permit Application D
Building Fixtures CENT FOR OFFICE USE ONLI .
City of Tigard 2005 Dee/ive P ermit No.:
Y 13125 SW Hall Blvd., Tigard, OR 9722fC 1 7 4
/� �' �� " " rte / D ����
Phone: 503.639.4171 Fax: 503.598.1960 ' r[G P,S � Date/By: Plan Review
OtherPennitNo.:
Inspection Line: 503.639.4175 . Q
l( F
Ti O A RD rill( t [S[QN Dale Ree d y /B y : huir 0 See Page 2 for
Internet: www.tigard - or.gov `'It [ Notified/Method: Supplemental Information
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:: TYPE OF W FEE•• SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
® Addition/alteration /replacement ❑ Other. New 1- 2- family dwellings (includes 100 R. 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 building ❑ Multi - family SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler (_ sq. R) Page 2
. , ; JOB SITE INFORMATION AND LOCATION , . , . Site utilities:
Job site address: 16200 SW Pacific Highway Catch basin or area drain 18.76
City /State/ZIP: Tigard, OR 97225 Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: Marshalls 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: l Lot no.: Fixture or item:
Tax map /parcel no.: 13ackilow preventer 31.27
. ,DESCRIPTION ;OF: WORK _ Backwater valve 12.51
Clothes washer 25.02
Replacement of commercial water heater Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
.. pg. PROP RTY.;OWNER, - ❑ _TENANT ' . ` • • Expansion tank 12.51
Name: K P¢ ell 4 S PPI SR I P Fixture/sewer cap I 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
. ,, • - ❑ APPLICANT - , , -; ❑ :CONTACT :PERSON' - Interceptor /grease trap 25.02
Business name: Medical gas (value: $ _ ) Page 2
Primer 12.51 •
Contact name: -
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
CONTRACTOR . " Water closet 25.02
Water heater 1 37.52 37.52
Business name: Commercial Plumbing Service Water piping/DWV 56.29
Address: 21185 NW Evergreen Pkwy Ste 105 Other: 25.02
City/State/ZIP: Hillsboro, OR 97124 Subtotal 37.52
Phone: (503) 439 -9999 Fax: (503) 439 -1999 Minimum permit fee: $72.50 72.50
Plan review (25% of pennit fee)
CCB Lic.: 126015 Plumbing Lie. no.: 37421PB
State surcharge (12% of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 81.20
Print name: Natalie Partipilo Date: 10/12/09 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.
1A13uildingV 'etmitaLMU- PcrmitApp.doe 10/01/09 440-0616T(10 1O2/COMAVE8)