Permit tM7 •
•
•
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00048
J 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/04/2009
?IGAR . g Parcel: 1S 136AD04300
• Jurisdiction: Tigard
Site address: 11477 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Bannings
Project Description: Install grease trap.
Owner: FEES
BANNING, MARK A & PATRICIA E TRS Quantity Description Date Amount
3895 TAMARACK LN
LAKE OSWEGO, OR 97035 1 ea Interceptor /Grease Trap 03/04/2009 $16.60
PHONE: 1 12% State Surcharge - 03/04/2009 $8.70
Plumbing
56 ea Minimum Fee Adjustment - 03/04/2009 $55.90
Plumbing
Contractor: •
BARRICH INC
PO BOX 33585
PORTLAND, OR 97292
PHONE: 503- 253 -1393
FAX: 503- 241 -6565
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.
Issued By: Pormittee Signature: Z E L 0 Ol 111.9
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.
1
4-."4, F4.b. 27. 2009 4:08PM No. 0109 P. 1
>; r
'
PIumbing Permit Applica CE FOR OFFICE USE ONLY •
City of Tigard Recei
- q 7 balds
20 09 Y a '7 '� �p ,, Penni! No.: Ai�. q ex) �
u 13125 SW Hall Blvd., Tigard, OR 978 �+ y �( yg
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Daley Other Permit No.:
Inspection Line:
Internet: .639.4175 CITY OF TIGRR,., Data Resdy/Ay: /uric ; See Page a for
T I GA It l7 Internet: www_tigard- or.gov 'I c'
�! Y r • ! Su lementat information •
{�.plMG Notifted/Metbod: tI c11 PP •
• • • • .. • • TYPE OF Itit PEE' 'SCHEDULE . • ❑ New construction ❑ Demolition For special irlforntaf /ort use checklist,
Description I Qty. 1 Ea. I Total
:I Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
• • ., CATEGORY OF C ONSTRUCTION:.= SFR (1) bath 249.20
❑ I. and 2- family dwelling ) :t CommerciaVindustriel SFR (2) bath 350.00
• ❑ Accessory building ID Multi family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
- . '.'JOB ST1E INFORMATION A ND . LC CA11ON Site utilities
,lob site address: `I `1 l S∎ Pt t PI C, H W "1 Catch basin orarca drain 16.60
City /State/ZIP: t o tl . , ' Drywell, leach line, or trench drain 16.60
Suite/bldgJapt. no Project name; A i N k is-r. 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
Subdivision. I Lot no.: Water service (no. linear fl.: ) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCR1PTXON OF WOO'
' . , _ Backflew preventer Page 2
1' k / ri+ ,� iw Backwater valve 16.60
-
Clothes washer 16.60
Dishwasher 16.60
r -- r , ,,�,�' ,`� Drinking fountain 16.60
':'...lift PROPERTY OWNER; ..... : [O'.TEb1 .: ..�;r:. , '
1 OF .. �.,.. >.,.... Ejectors/sump 16.60
Name: ' git 1I, 1 0 leg i k \ 0 Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Oarbagc disposal 16.60
• 1 APF L],CAN(T 0 ; CONTA CT; IP 1N Hose bib 16.60
Business name: T / I S 0./ ice maker 16.60
Interceptor /grease trap / 16.60 r (9 , (pj
Contact name: 1
• V _Medical gas (value: $ ^ ) Page 2
Address: t p 2a�i/ / Primer 16.60
I I Ji , , ! _Roof drain (commercial) 16.60
Phone: (4) 1.0 - / Fax: : ( �) [/7.1 r J//�l n�.�- Sink/basin/lavatory 16.60
u l/ Rib/shower /shower pan 16.60
E -mail: ■ 1 C/ Tr y ' i 11 L Urinal 16.60
• _ CON CTO . _ . ` • ; .. • Water closet •
• '� � � � R .. ,... .:��.. ��:•� 16.60
Business name: / $ 5 ',VI l f Water healer 16.60
' Address: 7 1 f/ A i 6 Other.
City/State./ZIP: rz>P: 1li/ / � l Subtotal - I le, t f 4
Phone: A* Z � I / Fax: r�-O) I. ) p Mimu p $72.50 '1 (1 co ( ( /4 I u Residential backflow minimum nim rmit ermit fee: fee: $36.25 co
CCB Lie.: r r Plumbing Lie. no.: Ziff • e ; Plan review (25% of permit fee)
Authorized signature: ` ,J� Slate surcharge (12% ofpemril fee) % , � o
d a 1 TOTAL PERMIT FEE % ( r iti
Print name: r 1 A Date: M )/ 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. •
t:t Pulldieg Wenniu1PLM.P°rmiiApp.doc 0626106 410.16161(Iw07/COMMaD)
l