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Permit
:ff :'T 1 PLUMBING PERMIT . * 4 CITY OF TIGARD ; :, a r: COMMUNITY DEVELOPMENT Permit #: PLM2009 -00305 rr . : Date Issued: 10/22/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 h, .g,, r,,:. Parcel: 2S 101 AC01300 Jurisdiction: Tigard Site address: 7105 SW HAMPTON ST Subdivision: Lot: 0 Project: Kaiser Dental Project Description: Replace (21) existing standard sinks with electronic sinks, and relocate plumbing to (3) of the sinks. Owner: FEES KAISER FOUNDATION HEALTH Quantity Description Date Amount PLAN OF THE NORTHWEST #838, ATTN: GENERAL ACCCOUNTING 11TH F, 500 NE 21 ea Sink 10/22/2009 $525.42 PHONE: 1 12% State Surcharge - 10/22/2009 $63.05 Plumbing Contractor: GRAY BEAR CONSTRUCTION CO PO BOX 4365 PORTLAND, OR 97206 -436 PHONE: 503 - 282 -2116 FAX: 503- 282 -0349 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $588.47 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. e Issued By: 49 K ry Permittee Signature: . \ \ , —er Call 503.639.4175 by 7:00 a.m. for an inspection that busine - Y p .:y. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. I Numbing Permit Applicat' (.. 4� rn Building Fixtures FOR OFFICE USE ONLY . _. U1, j C t. Received City of Tigard Date /By: /� /�,2 /cY9 Permit No.l�eg _©0•30 a 13125 SW Hall Blvd., Tigard, OR 917,4.-20v Plan Review Phone: 503.639.4171 Fax: 503.598 +96 ' i�ah t$� Other Permit No.: DIVISION f Date /By: Inspection Line: 503.639.4175 BULL D !3 DIV Date Read /B luris: See Pa e 2 for Internet: www.ti TIGARD and -or. ov y y g g g Notified /Method: 77 Su pp l em e ntal Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description 1 Qty. Ea. I Total ® Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 ❑ 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 437.78 . SFR (3) bath 500.32 ❑ Accessory building ❑ Multi - fancily Each additional bath /kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: 7105 SW Hampton Street Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City /State /ZIP: Tigard, Oregon 97223 Footing drain (no. linear ft.: _) Page 2 Suite /bldg. /apt. no.: I Project name: Kaiser Tigard Dental Manufactured home utilities 50.03 Cross street/directions to job site: 217 to SW 72 " Avenue, then cast on Manholes 18.76 Hampton Street. Building is second building on the north side. Rain drain connector 18.76 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: _) Page 2 Water service (no. linear 11.: _) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: 2SIOIAC01300 Backflow preventer 31.27 C , g/ 1 DESCRIPTION OF WORK Backwater valve 12.51 / Clothes washer 25.02 Replace selected sinks and faucets. Gi)J74 e /e C7yjn IC, Dishwasher 25.02 `r CA', 'ca e S at e i.:7 97 (3) XV 'VC Drinking fountain 25.02 (A/✓ Ce[.` e e, / , 9 - nee - E - .6 .64'9 ,v&j Ejectors /sump 25.02 0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51 Name: Kaiser Permanente Fixture /sewer cap 25.02 Floor drain /floor sink/hub 25.02 Address: 500 NE Multnomah Street Garbage disposal 25.02 City /State /ZIP: Portland Oregon 97232 Hose bib 25.02 Phone: (503)813 -4681 Fax: ( ) Ice maker 12.51 ® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Gray Bear Construction Co. Medical gas (value: $ ) Page 2 Primer 12.51 Contact name: John Witty Roof drain (commercial) 12.51 Address: P.O. Box 4365 Sink/basin /lavatory a/ 25.02 City /State /ZIP: Portland, Oregon 97208 Solar units (potable water) 62.54 Phone: (503) 515 -3263 Fax: : ( ) Tub /shower /shower pan 12.51 E -mail: john @gbccoregon.com Urinal 25.02 Water closet 25.02 CONTRACTOR Water heater 37.52 Business name: Cray Bear Construction Co. Water piping/DWV 56.29 Address: Same as above Other: 25.02 City /State /ZIP: Same as above Subtotal ` jam' . 2, Phone: (503) 282 -2116 Fax: (503) 282 -0349 Minimum permit fee: $72.50 CCB Lic.: 151-13 3 Plumbing Lic. no.: 24-15% P 3 Pl review (25 % of permit fee) State surcharge (12% of permit fee) 6 3_ Authorized signature: TOTAL PERMIT FEE 5",1f? Print name: John Witty Date: 10/21/09 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. I: \ Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10/02/COM /WEB)