Permit 71 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00266
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/16/2011
Parcel: 1 S136DB00600
Jurisdiction: Tigard
Site address: 11635 SW PACIFIC HWY
Project: Taco Bell Subdivision: Lot: 0
Project Description: Installation of water supply for (2) soap dispensers located at 3- compartment sink and mop sink. No change in
EDU's.
Contractor: WATSON PLUMBING CO. Owner: TYSON FAMILY TRUST &
7935 E BURNSIDE ST LARSON, RAYMOND K/EILEEN FRANCIS
PORTLAND, OR 97215 BY TBC #016600
PO BOX 35370
LOUISVILLE, KY 40232
PHONE: 503 - 256 -3720 PHONE:
FAX: 503 - 256 -0811
FEES
Quantity Description Date Amount
50 Misc Other Fee 08/16/2011 $50.04
Specifics: 1 12% State Surcharge - 08/16/2011 $8.70
Plumbing
Type of Use: COM 22 ea Minimum Fee Adjustment - 08/16/2011 $22.46
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 No ion Cen . Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. • ou may obtain a copy of the rules
or dire questions to OUNb by call- • 50 .32.1987 or 1.800.332.2344.
Issu d By: ,1 / / 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.
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONL\'
City of Tigard Received D /_ 1 �
Permit N �/�/{ ay 452
)�(�/�
Date/By: : b dt � ,/ y 09OL VV
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 i TN- r,. "r:+lfX Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 0 a,j. �` J Date ReadyBy: .T° °g: ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
4 0 ° - 5 , ;, ,,,, � TYPE O , , ,, K >,. ,� ,.., t , . ; F t ^ , ..i. ' FEE * #SCAED _ :
❑ 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 ft. for each utility connection)
-" etfia tridVa NSTRIICTION V , -K } ' x
A I D . -''�'V i,� ,,t,,, k..i;, - . . z,1: _ , . ° . ,- 4'm ' - - ;it-,,:.: S FR(1)bath 249.20
❑ 1- and 2 -family dwelling ".Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
ID Master builder Each additional bath/kitchen 45.00
0 Fire sprinkler ( sq. ft.) Page 2
17 ' JOB STTE O AT ION'PX% O C A T UN� ,, ` 4 P .N p
.,,a` k ,7'i. - ° ; .acs =^.'!, *,..,0+. , ;,.,i2 ,e. ,... _ ..., . ..e-S Y%,,, ., '. .. _. . . .S ite utilities
Job site address: / / 6 3 C A I j� `Ci I TT e Catch basin or area drain 16.60
7
City /State /ZIP:' 6 ,, crr' _ C Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. n I Project nam .e, Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
Rain drain connector 16.60
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
r k s _ Absorption valve 16.60
4 4 % ` y` DESCRP ITiON O cfati . �� « ". 4
. : ° _.410 ?; .,-n.. .. r _ ,?, ;..r4.,1 -A l«. ... 141 :v.,`ft , ..._. . . .- z Backflow preventer Page 2
Cb NA-1 -6 T' e-C 0 L M SO4-f r)/ f/3 Backwater valve 16.60
T , f t p Sr /./(fL E' R - i o S / Clothes washer 16.60
04712 /dpLY co 4 p- 541 p �/ F,rJ . Dishwasher 16.60
` E ROPERTI iMelt. IN ' - 't - il isti k4 Drinking fountain 16.60
�.., .....1"� ,4 -. a_ ,... i . -4.4 - � . ,,S",;,--,,,,!_4.:::'-=,'", Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
•
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
` " ®APx PLIC`ANT," ,_ ,,--ii; , `CONTAc F PERS *(4 ' j'' Hose bib 16.60
,..xs. �. v. :, L.. .. . .I I, ,
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
Phone:
( ) I Fax::( )
Tub /shower /shower pan 16.60
E-mail: Urinal 16.60
;w
1 Ut.: X11', :v 4 5 .1 __ ' ° ('ONTRe r ``' • - .1. ,. > . Water closet - -- - - 16.60
Business name: W ater heater
1�/7�'(.SOJ� -E p �- t�-Yy1 Q 16.60
.ter
Address: 7 t g S , is u...0 s /Q 6 Other: � QR p -,, ,,,p, p` p, 0,7 g '�• O- _ 6-
City /State/ZIP: Q Tr ✓1 ( �� CA- 1 77 / Subtotal
Phone: 6-713) Afg - 3 7 9-0 Fax 4o2) zi Q p G Z� �7 ✓ Minimum permit fee: $72.50 ,rT�
.!` 1I Residential backflow minimum permit fee: $36.25 7A'�v
CCB Lic.:/ '/ �S'S A 12 (('> Plumbing Lic. no - 6 Qcpel-5 7 Plan review (25% of permit fee) "�.
Authorized signature: l (
6 l / C/ 7I / tH State surcharge (8% of permit fee) . 76
TOTAL PERMIT FEE gi .,9.0
Print name 6 ✓\4 ( /242,4-c_ 1 c Dater- f6� 11 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 \ennitsWLMF- PennitApp.doc 06/05 4404616T( 10/02/COM/WEB)