Permit IN '
f : CITY OF TIGARD PLUMBING PERMIT
•- COMMUNITY DEVELOPMENT Permit#: PLM2015-00402
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/30/2015
T>rGARD Parcel: 25101 BA00101
Jurisdiction: TIGARD
Site address: 7500 SW DARTMOUTH ST 120
Project: Great Clips Subdivision: WEST PORTLAND HEIGHTS Lot:
Project Description: Add(2)sinks
Contractor: REA MECH INC Owner: WAL-MART REAL ESTATE BUSINESS TR
30330 SW GRABEL RD BY PROPERTY TAX DEPT STORE 5935-00
HILLSBORO, OR 97124 PO BOX 8050
ATTN MS 0555
BENTONVILLE,AR 72716
PHONE' 503-969-6252 PHONE.
FAX: 503-640-9344
FEES
Quantity Description Date Amount
2 ea Sink 11/27/2015 $50.04
Specifics: 1 12%State Surcharge- 11/27/2015 $8.70
Plumbing
22 ea Minimum Fee Adjustment- 11/27/2015 $22.46
Type of Use: COM 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.
Issued By: x:f
% ' �/� ,e .CC__ Permittee Signature:
Dal—. K-1,"-177°,-
Call
Call 503.639.4175 by 7:00 a.m.for 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.
Nov. 23. 2015 12:50PM PIGGY BACK PLUS No. 0493 P. 1
Plumbing Permit Application
Building Fixtures lI•OR tlrl i( I:. l-:SF' ONI,�'
`> � Received
City of Tigard DmviSy: /i/ 5-7‘' �, /L Penuit No.:pG� 03-
,11
a 13125 SW Hall Blvd.,Tigard,OR 9�7�3c� Plan Review r�Irl
Phone; 503.718.2439 Fax: 5031.198).196b 3 2015 Other Permit blO.617 a ti-g
n9te/By; _
Inspection Line: 503.639.417
T I t.. y. ruts: ® see Paste 2 for
Internet: www.tigard-or.gov I �}
a4
Ty17tii �': :: ou 1 0 ' Supplemental rrformaHon
F1ti;E'.:SIfiE
CDULE `.: : ... .,._
❑New construction ❑Demolition For special information use checklist.
Description ( Qty. I Ea. 1 Total
. ddition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
' ;'; :CATEGORY OF CONST11UCTTON ':..- SFR(1)bath 312.70
❑I-and 2-family dwelling kr Commercial/industrial SFR(2)bath 437.78
--31111111111111
ElAccessory building 0 Multi-fpm(ly SFR(3)beth
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2 In
JOB:.SITE INFORMAiitTION:.AND LOCATLON. : Site utilities: _ - t
Job site address: 1. (n 1(V \ Catch basin or arca drain 18.76 j
Q DrywelL leach tine,or trench drain 18.76 O
CLty/Statc/ZIP.
`pi Y aFooting drain(no.linear ft.:_) Page 2 Q
Suite/bldg./apt.no.: Project nerve: ILA- 1
�- - 171'L � �p S Manufactured home utilities 50.03 43
Cstreet/dlrections to job site: ^ Manholes _ 18.76
18.76 O
'L." (4 \4Q-'f.�' 3-�15 _ '_), 4(.21Z Raln drain Connector
Sanitary sewer(no.linear ft.:�) Page 2
Storm sewer(no.linear ft.:„_) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision; Lot no.: Fixture or item: l
Tax map/parcel no.: Ot 5/0/On ow prev 31.27
/ DO/0/
.. ..� fl aICI valve _
.....:.. .. . Backw 1 12.51
:;: :„ '::: ..:i; '.;''..... : :D SCRIPTION;OF:WORK:.'::. :;;: ''.`
Clothes washer _ 25,02
S1 _ Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0:PitOPIRT1':OWNER •-:= 0 TENANT::::: : tank 12.51
Fixture/sewer cap 25.02
Name; _.
Floor drain/fluor sink/hub 25.02
Address:
. .-.�.. Garbage disposal II 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
L1CANT..,.:: ::: ' ; •. -`:': ❑ CONJ'Acp PE, 1tSO
FN::::- Interceptor/grease trap 25.02
Business name: \ ik i \ - �l , , Medical gas(value:$ ) Page 2
Contact name;
\"\,[s. �� Primer 12.51
\ �' Roof drain(commercial) 12.51
Address: �'� £ (7' k i Sink/basin/lavatory __ 25.02
City/State/ZIP: \ \ „`c 'Q) C‘‘'N\3:5 Solar units(potable water) 62.54
Phone:W) ) yc'\"\0 25 Fax::(Lj ) Q-iN-C 3\•ILi Tub/shower/shower pan _ 12.51
Urinal 25.02
E-mail. t„ . .C,‘,r.k\M M 9 lA\hQ� . CNe• ' Water closet 25.02
-
Water healer 37.52
Business name:
Water piping/DWV 56.29 -
Address. Other: 25.02
City/State/ZIP: Subtotal
Phone:( ) Fax:( ) Minimum permit fee; $'12.S0 7A.SG
Plan review (25%of permit fee) -----
CCB
Lic.: /LI g 7 Plumbing Lie.n •3i'...51?tonState surcharge(12%of permit fee) $.7e
Authorized signature: \�y AL RMIT g 1,aO
Print name; //� Date; \\ This permit application expires Ira permit Ia not
PEobtainedFEE witbia 180 days
-��\ \� + `�'�nV�Z✓ �� 0 31 i� after It has been accepted as complete.
*Fee methodology sat by Tri-County Building Industry service Board.
I:tttufldtog'iPemdle\FT,Mt1-PermhApp.doc t0/el/09 440-1616T(l0102/COLyw5n1