Permit q
CITY OF TIGARD PLUMBING PERMIT
II • • COMMUNITY DEVELOPMENT Permit #: PLM2013 -00021
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/15/2013
Parcel: 1 S136CD00100
Jurisdiction: Tigard
Site address: 11701 SW PACIFIC HWY
Project: Arby's Subdivision: 2006 -016 PARTITION PLAT Lot: 3
Project Description: (1) grease trap remove and install
Contractor: CASCADE MECHANICAL SYSTEMS INC Owner: PACIFIC CROSSROADS PROPERTIES IN
PO BOX 399 BY WYSE INVESTMENT SERVICES CO
ESTACADA, OR 97023 1501 SW TAYLOR ST STE 100
PORTLAND, OR 97205
PHONE: 503 - 630 -4492 PHONE:
FAX: 503 - 630 -5510
FEES
Quantity Description Date Amount
1 ea Interceptor /Grease Trap 01/15/2013 $25.02
Specifics: 1 12% State Surcharge - 01/15/2013 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment - 01/15/2013 $47.48
Plumbing
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. f
Issued By: ) `^' V�4�.` r
Permittee Signature: O/0 PI p ` L L 4 I
Call .4 7 for 503.639 1 5 by 7:00 a m. fo the next available inspection date.
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.
Jan. 14. 2013 11:05AM No. 9277 P. 1
Jan. 9. 2013 912AM RECEIVED No. 9226 P. 1
Fiuluuill>k rerun', NuUlleatioln
Building Fixtures JAN 1 4 2013 r•�irl•rii:rtr• , 1. ONLY
19125 HJgBl'd D1W /� 1 � P r�iltb:Pue? i3 - a c7 J f
19125 SW Hall Blvd., Tigard OR 97I2CITy GFTIG P e>� , e ,v
'. Phone; 503.619.4171 Fax! 50o.s9�> I DNISI I '' t OceerrerrahNo.:
f l Gil 11.0 bl'pcoiloh Lino 503.639.4175 , e ROW* EI Soo Page 2 fer
mime!: srnxligiudor.gov Holined/MWiod: Supplealenl411nrormtrloe
•
1'YPB OF WORK FEE' SCHEDULE i
[j Haw construction Per special l use chae
10 /modes lrllrr. f
Q b emolllion rt Q Ito, , of
• bcsetr. non
. ' Addrlronfolicrellon/replacemeor ❑ Other: NeW 1 -2- family dweillugs(Includes 100 0. (brooch ulility connection) 1
CATEGO /W OF CONSTIFUCr'ION SFR (1) Nub 249.20
❑ I- and 2•famt(ydwelling j ' CommcrolelMdusfrlal SFR(2) 950.00 j
0 Accuser). building ❑ Mu1t1•lamlfy SPR (J) bstb 199.00 I
Each addplonal bath/kitchen 45.00
[] Mosier builder El Olbor;
Fire sprinkler aq, fl.) Page 2
SOB SITE INFORMATION AND LOCATION Site ulllllle
i
Job elle address: e e 11 catch bean or ean drain T 16.60
CityIS(atePLTP: anti �e is ,P' blywcll, leach Tina, or trench drotn 16.60 i
Suilclbldglapt.no.: Projeol A rk ' Footing drain(no.linear( :_1 Paget I •
.2. Menufhcturcd home utilities 110,00
Cross street/dime/ions so job silo: 5 (.J 1ke1 'c 1 r 78 Ai + . ii
Manholes 16.60
Rain drain connector 16.60 i
■ Sanitary sewer (no. Haan IL -) Page2
S(orm :ewer (no. llmor R.: _ _.) Pa 2
80
Subdtvialono Lot d0.; Water nuke (no. linear It _1 Peso 2 I
I
Tax maplpaveel no S .13(, 00:/00 FUND) or l lem
Absorption valve 16.60 '
b1ESCRYP OF WOR
x 1 ' BaeMtoly prev utter Pogo 2 1
/ ! �1. (.v in 1 1 w l 8acklvatervptve 16.60
BMW= tl• Clothes washer 16.60
Dishweshcr 16.60 i
►: - PROPERTY omen p TES Drinking fou ntain 16.60
Name: L) Lje M M G fu v 7co Ejectors/amp , 16.60
/o � I � ' B}rpulelatrank _ 16,60
Address 1G 7 1, ,2u ( Ile kit, Pfxturersowercap 16,60
City /Slate/ZlP : „„„k, (A /.i / I Floor dlelnlfloorsfn(dbob • t6.60
Phone: (9/( ) IV - YCX)IS Fax ( ) Garbage disposal , 16.60 1
❑ APPLICANT ❑ CONTACr PE1tgON Hase bib 1 16,60
Business name: - lac maker 16,60
)ntea cpiollgrcaso trap 16.60
contactnamo: 1----- i
Medical gas (value: S Page 2
Address: Primer _ 16.60
City /Shire/ZIP: Rooidrele (commercial) 16.60
Phone. ( ) ]c e I
Sinklbasirdlavaroey 16.60
)?rmei(; - 1111irho /shower pen ~___, 16.60
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 4 4 a l' • L - Water heater 16.60 •
•
Address: 1 l A • • - Other: QV aw
T gy0L a Subtotal -----
Phone; 4 (0 F - di Fax: ( ) (! Mln lnsum pemitl It:e: S 6 .50 / Z r
`Q I V Rosidamlel b aoldloty minlmUm permit fee: $36.25
CCB Y.lo : i Z D Plumbing Lie, no,: �e. • e y Plan review (25% orpermit Ro) I
Au(horizcd signature: ASP!'" /ss j�f .. r State surcharge (12%eofpennitfee) Q
•
�`. r TOTAL PERMIT FRB Os
1
printmune: p�, • • paw (. 13 1 Th( t permit application expiresifa permit Is not oblanrd
l(Alin
` 180 days otter It has been aceepied as complete,
'Pee methodology set by Tel- County Building In dotal Service Board.
Received Time' °Jan. 9.' 9;2IAM No. 84554e-I61erpooncomnvrnl