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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2012 -00226 T I G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/16/2012 Parcel: 2S113AB00500 Jurisdiction: Tigard Site address: 16083 SW UPPER BOONES FERRY RD 300 Project: Therapeutic Associates Subdivision: FANNO CREEK ACRE TRACTS Lot: PT 37 Project Description: Plumbing work for TI Contractor: MARXMEN PLUMBING & CONSTRUCTION INC Owner: G&S FC LLC 9665 SW 163RD AVE 16083 SW UPPER BOONES FERRY RD, BEAVERTON, OR 97007 STE TIGARD, OR 97224 PHONE: 503 - 579 -2200 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Expansion Tank 08/09/2012 $12.51 Specifics: 1 ea Garbage Disposal 08/09/2012 $25.02 1 ea Ice Maker 08/09/2012 $12.51 Type of Use: COM 2 ea Sink 08/09/2012 $50.04 Class of Work: ALT 2 ea Water Heater 08/09/2012 $75.04 Type of Const: 1 12% State Surcharge - 08/09/2012 $21.01 Occupancy Grp: Plumbing Stories: Total $196.13 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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issue By: 4 ' � J 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 ptace on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Plumbing Permit Application Building Fixtures *Citill\i City of Ti and Received `� g 9 24 �2 Dat 8 �/ Permit N o.: ( ,,a -O� a gz 111111 U 1 3125 SW Hall Blvd., Tigard, OR 9722/1\(] Q C a ,a Plan Review n Phone: 5 03.718.2439 Fax: 503.598.1 Date/By: Permit No.: /g .z 17 7 Line: Inspection 503.639.4175 (� ,viG A�� T I G A R D Internet: Line: g 3 or.gov "� g N1,9 3 1 a Ready/By: tuns: 61 See,Page 2 for 1 �� � Notified/Method. Supplemental Information TYPE OF WO L ► FEE* SCHEDULE V ['New construction ❑Demolition For special information use checkli F Description I Qty. I Ea. I Total -b a Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connyction) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 o El 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 437.78 '.., building SFR (3) bath 500.32 ❑ Accessory g ❑ Multi - family Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other. Fire sprinkler ( sq. ft.) Page 2 O JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: Catch basin or area drain 18.76 , 3 S . •a per " 1 (! nn City/ State/ZIP: , "1 � ��� �Q� Drywell, leach line, or trench drain 18.76 , 9 ASSet.. Footing drain (no. linear ft.: ) Page 2 Suite/ bldg. /apt.no.: Projectname:libel-A Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 ^^ �1' ��4�. Rain drain connector 18.76 L�3 Sanitary sewer (no. linear ft.: _) Page 2 Storm sewer (no. linear ft.: _) Page 2 Water service (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Fixture or item: Tax map /parcel no.: a s-4 i 3 f}b Oo 57):, Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 © r Clothes washer 25.02 /t- S "'lam Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank t 12.51 Name: Fixture/sewer cap 25.02 Floor drain/floor sin ub 25.02 Address: Garbage disposal 64i4 I 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker / 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: M AR1l,MleN 13‘ ,y Nq g Medical l gas (value: $ ) Page 2 Primer 12.51 Contact name: t 1g k Brie hefl Roof drain (commercial) 12.51 Address: Olipto5 S..tx) • 1 0 Ave Sink/basin/lavatory 2 25.02 City /State/ZIP: e,e.o V,e.t FB A _O tt, . Solar units (potable water) 62.54 Phone: (5 03) g1q •- zt) ) Fax:: (5 o3 ) 5 t'7-2.t0 i Tub /shower /shower pan 12.51 E -mail: M . S O M A• 1,,`eIN G. MAIL 11„ i . to Urinal 25.02 CONTRACTOR Water closet 25.02 Water heater 2_ 37.52 Business name: Water piping/DWV 56.29 Address: Other: 25.02 City/State/ZIP: Subtotal Minimum permit fee: $72.50 Fax: Phone: ( ) ( ) CCB Lic.: Lb Z43 umbing Lic. no.: 3 6t� Plan review (25% of permit fee) State surcharge (12% of permit fee) Authorized signature: TOTAL PERMIT FEE fr 16, f 3 Print name: M 42K t h Date: 9 lei i 1. Z 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. 1:\ Building \ Permits \PLMU- PennitApp.doc 10 /01/09 44o- 4616T(10/02/COM/WFB)