Permit •
CITY OF TIGARD PLUMBING PERMIT
Q . COMMUNITY DEVELOPMENT Permit #: PLM2009 -00067
T I G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/27/2009
Parcel: 2S102CB00302
Jurisdiction: Tigard
Site address: 13285 SW PACIFIC HWY
Subdivision: Lot: 0
Project: 7 -11
Project Description: Install more waste and water line to existing handsink.
Owner: FEES
CJ GLOBAL LLC Quantity Description Date Amount
PO BOX 5668 • 1 ea Lavatories 03/27/2009 $16.60
ALOHA, OR 97006 1 12% State Surcharge - 03/27/2009 $8.70
PHONE:
Plumbing
56 ea Minimum Fee Adjustment 03/27/2009 $55.90
Contractor: - Plumbing
APOLLO DRAIN & ROOTER SERVICE
2208, NW BIRDSDALE #8
GRESHAM, OR 97030
PHONE: 503 - 239 -8801
FAX: 503- 669 -9568
Type of Use:
Class of Work: 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
Issued By: m n.0 /� Permittee Signature: S /) „ li /1 /) •j t��i,/1
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. App
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.
_, Mar. 26. 2009 1:52PM No. 9490 P. 1
Plumbing Permit Applicatio ��
Building Fixtures L �\ / V - • FOR 001Ci USE ONLY '
City of Tigard MAR 2 6 2009 on c i ce iseya 8 Rio. 09 ars J 2� 0((i
Permit No.: QJi.._(100(0
ri 13125 SW Hell Blvd., Tigard, OR 97223 PtanReview •
I d Phone: 503.639•4171 Fay; 503.598.19 Dat Otter Permit No.:
Inspection Line: 503.639.4175 Q OF 71 GARD Y'
'1'1Ci P Date Read �f i ® Sec Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISIO Notified/Metbod: ( I Supp[ementol lnrormation
` TYPE OF WORK . FEE" SCHEDULE • ..: ` .
0 New construction 0 Demolition For special information use checkltse
Description 1-Qty. I Ea. I Total
' ddition/alteralion/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
' . CATEGORY - or CONSTRIftlION .. - SFR (1) bath 24920
0 1- and 2- family dwelling Commercial/industrial SFR (2) bath 350.00
0 Accessory building 0 Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
0 Master builder IJ Other;
-
- , e sprinkler ( ) 2
P
-; • JOB. SITE XIVFOR J&TION AND LOCATTOIY, ' : -.
tr r
.. , - .. � Site utilities _
Job site address: I .s_$D Catch basin or area drain 16.60 •
City /State /ZlP: � Q) 9i r - Drywell, leach line, or trench drain 16.60
. Suite/bldg. /apt. no.: I Project name: U � -9--, 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 ft: ) Page 2
Fixture or item
Tax map /parcel no.: -
Absorption valve 16.60
._ DESCRIPTION OF' rORK Y. ._ - Backflow prevenrer Page 2 •
• . .. ' ..;1 e._.: A , CI Backwater valve 16.60
(j f S,, Clothes washer 16.60
)`'' ) Dishwasher 16.60
`/.. • I - fountain
PROPERTI OWNEII. _ ? _ : ` 0 ..TENANT - .' • Drinking fo i
'
' .: , .:- Ejectors /sump 16.60
Name: . Expansion tank 16.60
Address: Fixture /sewer cap 16.60
-
City /Stale/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 •
1
:..:. - PPLYCANT ..D CONCT
TA.•PERSON'- -
11°Se bib
' Ice maker 16.60
Business name: I J I M/ /. , .i r...
Interceptor/grease trap 16.60
Contact name: E.-/ /- . r . Medical gas (value; $ ) Page 2
Address: Primer 16.60
City / Stale/ZIP: Roof drain (commercial) 16,60
Phone: (�y /) 9a? .1100 1 Fax: : ( ) R Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
.. CONTRACTOR • . -,_ ..
Water closet 16.60
Business name:P . /// v / *t 1 , eta, , Water heater 16.60
Address: • - A A • , • Other:
A / 4 / D�'0
Subtotal
City / Stale/ZIP:
y (�. 070 _ M permit fee: 572.50
Phone: ( ) QQ� Fax: 6f, ?ft 9 , dI 0 � Residential backflow minimum permit fea $36.25
CCB Lic.: Lf i G- VV ���� Plumbing Lic. no. 7 -5 Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized sign e:
1 TOTAL PERMIT FEE
rPrint name: �1Y✓i iF S 31� Date: VP V I 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:\Buldie \PetmiuPI.MF- PermuApp.doc 12/27/06 4I0.4616Y( 10 /O2/COM/WEP)