Permit CITY OF TIGARD PLUMBING PERMIT
Il
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00099
TI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/27/2009
Parcel: 2S 112AD01000
Jurisdiction: Tigard
Site address: 7007 SW CARDINAL LN 135
Subdivision: Lot: 0
Project: North American World Trade
Project Description: TI - Relocate (1) breakroom sink.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY 1 ea Sink 04/27/2009 $16.60
#300 1 12% State Surcharge - 04/27/2009 $8.70
PHONE:
Plumbing
56 ea Minimum Fee Adjustment 04/27/2009 $55.90
Contractor: - Plumbing
ADDISON PLUMBING
•
27425 S BEAVERCREEK RD
MULINO, OR 97042
PHONE: 503 - 740 -8116
FAX: 503 - 632 -1168
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. T os- r es are set forth in OAR 952 -001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
Issued By: /
Permittee Signature: r
� � I % V
Call 503.639.4175 by 7:00 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.
Rpr 22 09 06:58p Jay ��•C� 503 -786 -0447 p. 1
Plumbing Permit Application
•
Building Fixtures APR 27 2009 FOR OFFICE, ('SE OBI A '.
City of Tigard 0[' 111.1 D Dat e/By: and �/ r r� ((�� �p Dat ei "ea ^ 1
a4 07 Permit No.: I gk t y .. /e ii7
13125 SW Hall Blvd., Tigard, OR S1Li33a Plan Review v w 1 vw
Phone: 503.639.4171 Fax: 50 L3 4GDIVISIO Date/By: Other Permit No.:
Tl GA R D Inspection Line: 503.639.4175 D v • Date Ready /By: Air's: IA See Page 2 for
Internet: www.tigard or,gov Noti fied/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
For special information use checklist.
El New construction ❑Demolition
Description J Qty. I Ea. ( Total
Addition/altcration/replaccment ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
Cl 1- and 2- family dwelling [ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
• Each additional bath/kitchen 45.00
❑ Master builder ❑Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 700 "7 S W Cd l r e I 1 ./ L K Catch basin or area drain 16.60
City/State ZIP: Lt Q V o , ,r1 -2_7 Z Drywcll, leach line, or trench drain 16.60
Suite ld /apt. no.: 0 Project name: / ( e ) A'r 1,,do ` id 'rte__ Footing drain (no. linear ft.: „ J Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: S-r1 i (D l r,,,, . t r Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK � Backflow preventer Page 2
p ,p . J - y � , ✓ f p ir `-'�, Backwater valve 16.60
,y. { "�G� Clothes washer 16.60
/ y Dishwasher 16.60
f PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: -rtz ( 7 y 14 5 t 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
APPLICANT ❑ CONTACT PERSON Hose bib 16.60
/ Ice maker 16.60
Business name: 'VIA lf S ! 41, l c- Interceptor /grease trap 1 6.60
Contact name: c 1 Je Ailet ja Try / Medical gas (value: $ ) Page 2
Address: (,` 5 D 6, u 4 . Few w , G. S f r t. /2 Primer 16.60
City/State/ZIP: ` ! R (drain (commercial) 16.60
�� Cax ` _ u Srn1.`basin/lavatory / 16.60
Phony
(5 3 ) ( J ) 2 �3I J ub /shower /shower pan 16.60
E -mail: ' 2 e j 4 LW +4S NG : G 49 41 Urinal 16.60
CONTRACTOR Water closet 16.60
Business names A4 a,:so",. Q k„lc.,^ t-L C_ Water heater 16.60
Address: 2 42. Other;
y,A�, w�� Subtotal
City/State/ZIP:
� t D12 °l -(6`EZ Minimum permit fee: $72.50 ��
t 3
Phone: (S ) '7 -4CI i�o Fax: (Sa•y ) „L 3 - tek,8 Residential backflow minimum permit fee: $36.25
CCB Lie.: I S t 7 5", 11° Plumbing Lie. no.: j -- y-.4 9 f Plan review (25 %of permit fee) e -
l . - l I r �� State surcharge (12% of permit fee) '. 7 )
Authorized signature: ` _ , A i t TOTAL PERMIT FEE g / ,,, AD
Print name: r)o /� - Date: q - z -0 9' 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: 1nuilding\PermitsTLMP- Permit App doe 12/27/06 440- 4616T( IO /02/COM/WEO)