Permit ( •
CITY OF TIGARD PLUMBING PERMIT
` COMMUNITY DEVELOPMENT Permit #: PLM2009 -00196
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07!20!2009
Parcel: 1S135CA01202
Jurisdiction: Tigard
Site address: 9900 SW NORTH DAKOTA ST
Subdivision: Lot: 0
Project: Fir Terrace Apatments
Project Description: Backflow preventer
Owner: FEES
F TA INC Q uantity Description Date Amount
BY C &R REALTY, 1440 SW TAYLOR ST
PORTLAND, OR 97205 1 ea Backflow Prevention - 07/20/2009 $48.40
COM
PHONE: 1 12% State Surcharge - 07/20/2009 $8.70
Plumbing
26 ea Minimum Fee Adjustment - 07/20/2009 $26.10
Contractor: Plumbing
MILWAUKIE PLUMBING CO
PO BOX 393
CLACKAMAS, OR 97015
PHONE: 503 - 655 -9161
FAX: 503- 655 -1726
Type of Use: MF
Class of Work: ALT Type of Const:
Occupancy Grp: R -2
Stories:
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Total $81.20
Required Items and Reports (Conditions)
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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.
Issued By: Permittee Signature:
A✓ SEE App,_.3r.A
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.
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, ,-.% FROM (THU) JUL 18 2009 8:17/ST. 8: 18/No.7500000886 P 2
Plumbin Permit APPIlea � CEIVED
Building Fixtures JUL 1 * 6 2009 I 1 IZ t t 1 1 II 1: I ,1 (t \ 1.1
U
City Received of Tigard Date/)) - Penn" p n fl. M 1 od ii - 001.46
13125 5w Hall Blvd., Tigard oR F TIGARD Plan Review other Permit No,:
Phone: 503.639.4171 Fax: 50 „ • f ,
I , I:1 Inspection Line: 503.639,4175 • i
Date/BDate/By: Date/By: G DIVISION Date Ready/Br kris: 63 see Page 2 for
Internet: www.tigand -or.gov Notified/Method: S . tai loformatlon
�:'JI 4 � �. ,.a *err. rare r.r f. 1- ,a t, ' - ' 4 0' J f M • ' ; 4
s i 1 4 7 'wiii; . 'I L 1.• .., .i, ;rt S : [ � t �i k 1 ,9 , r7-plirn - -? la�iilii ".110,�+' „ , i3 Nf , - , . : 4! { "t iiM.. "Sn��
. - a r:,,do::,,b uWi I+ ., },d 1 . -. _. 5,..„' o ,,tlN. tti�' { H ,.d *., I .. � 4, ,i4., , .-4 ., !t ">nS'i..o , « ,.. :_, r„ t �hfi• .
l� flGl c r:r �•
❑ New Construction ❑ Demolition For special rnjotslradoe,.se checklist.
Description J Qty. 1 Ea. ) Total
': s Addition/alteration/replacemcnt ❑ Other New 1- 2 - famuy dwellings (includes 100 ft. for each utility connection)
1Yu9Aa y u Y�,f 'f2.''..27.11)' 2 4 F S3a ruu• n r 5'-';'''' 9 t I t M110, �1, 7; 41
1 v r al it. -A17i A. . r I .. ,,u , !s, Lts 4 e „,, ;� -` . ; �,,,,- Srlt( bath 249.20
. �..,, ,.o) t ,.a a tt�,.r,S„4 „I{,t. di,it [„l i„ E ., . a, .. ii � ,.0
' ❑ I - and 2 - family dwelling 0 Commercial/industrial SFR (2) bath 350.00
❑ Accessory building Multi- family SFR (3) bath 399.00
CI Master builder ❑ Other Each additional batNkitchcn 45.00
r ht. >, , 1 P1�Y5d ', D., ,t • .+u d, ;' '1 l,;tq)114 r' i '0,4----.'" v, rr /� � ' i sprinkler �1 ) Page 2
.Via i!„ �P Y r 7. t * r I ` il�� 1 r S+
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Job site address: 9 9 p d at›.) T D b $k . Catch basin or area drain 16.60
City/ State/ZIP: 9, , Oct_ Q17 2 Drywall, leach line, or trench drain 16.6(1
Suitc/bldgJapl. no.: 1 Project name: r r' ■ Taxi n(,o._ A -fors. Footing drain (no. linear R.: _) 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 11.: _) Page 2
Storm sewer (no. linear fl: ) Page 2
Subdivision: I Lot no.: Water service (no linear R.: _) Page 2
Fixture or item
Tax map /parcel no
v hi +' t t r i t R ) e ue1 r + p tsr1 t 4{ { c v< , 1} a , Absorption valve 16.60
AV (lkt∎,)4CnMo S i+aStl }vlr I T i j t ' . l ) A t l4 ' t y , 1, g -
Yedn' 1 }n x "4 , i � ' 1 I r ' !: I I P r u, , i1 h: r * r r, ,,.,, ,, i I .;. ,4 el A IjaCk I10W (new ilia ` Page 2 4(i,
uc a2n,.W, w.,,s,.wxu,.n, ,?�,ir,:.,, cr � r:.:urt +iuri ,.�,tr::J:,nla f r 1.�a .0 n:,l{lia., , , ..
nt1 t `
1 n )^ta.X9 '�' a1' e1et,/i cat` / (17 ca.,^I-ch Backwater valve 16.60
rr.4 p (or it...i•n-s ix) A- OF Gr`eextiov.1 Cc-( S 1 L- Id a e Clothes washer 16.60
Dishwasher 16.60
I t)dtr nex -lea t
.%,^',/,',491V/;', ; + s e �'R! n 7l + , � . S 17 f51 t ;i F F ((r'!{{i' ( 1 / f f i '+ ti!t 171, I; m l r fly , ' * i •r , Drinking fountain 16.60
,1111 , '4 ; ::1 ,. r r c �{ r 11 , , r ,4 r i C r ir . ..
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t . . 1 Ir { . i,.t` .� . ` r , ' , 7,-.-' . . ,,.. ,' .'� Y? 6 , li d h t •i r '' r,,, '
Ejtxtors/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 1 6.60
r., " P I fi L Q .,4, oil lIT . .,• t ' u ' Siren '"!� tF it (1i uli l af:i f *ry � .IPI ' '1'4H; �,✓ 11°Se bib 16.60
{ r + 4.
S * f ��4.�mr t! {, �. ,� 3w w,tlra+, M ,,,v > a2 „ Sk+ 1 ' f Ji Kldfi4, . , , .. a •tt ,rf e, ,t:- we maker 16.60
Business name: t.A'p - )ut- "bl tet Interceptor /gmasetrap 16.60
Contact name: i y C. ,}Lk Cb F Medical gas (value: $ ) Page 2
Address: 'gip auk 3 � `" Primer 16.60
City/State/ZIP: CX 0. ej„L r.vt,t,,,..5 , gr.-. 9 7b(c Roof drain (commei(commercial) 16.60
Sink/basinllavatory 16.60
Phone: (( ) (655 -it (of I Fax: : (563) (e SO - 70 1 V Tub/showerlshower pan 16.60
E -mail:
yy t Urinal 1 6.60
' u$,,i± `d7 pwct I �n.F „g4 Y ,"' §t �'� ,t1i r. °:, ar lT Agli gi -�'14 a. ll ;ll i iji".. . 6 40, if.d,T4,,'2,) W�eloset l b,ti0 -
Business name: y -- e I u 1(\ Water heater 1 ti.60
Address: [0_ 'ac,.„, 393 tj Other.
CV
�� .1 [71
Subtotat 4/(,
City/ State/ZIP:
L.�Lt�C�(it..+>`� S , Minimwn pemtie fee: $72.50 � n Su
(,,
r Phone: (50, ) - 1 ( ( e t Fax: ( WO ) - 70c421 Residential backflow minimum permit fee: 536.25
, Lie.: 5502- Plumbing Lie. no.: 3 ` 1 7 113 Plan review (25% of permit fcc)
State surcharge (t2 %of permit fee) _ 0
Authorized signature: -23171.-
TOTAL PERMIT FEE
I Print name: i ` b. _ & ,-b,W I Date: 7/)6/61 1 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:l 5uildiatllamirta \PLMP•Permiapp.doc 12/27/06 440.4616T(10/02KOMM'Ca)