Permit (174) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2018-00071
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/26/2018
D g Parcel: 2S101DC04300
Jurisdiction: Tigard
Site address: 7180 SW FIR LOOP 250
Project: Upper Cervical Clinic Subdivision: 72ND BUSINESS CENTER Lot: 3
Project Description: Adding(1)clothes washer for TI.
Contractor: LIBERTY PLUMBING Owner: BROWN CASTILLO FAMILY LLC
11124 NE HALSEY, 3534 5750 SW ALFRED ST
PORTLAND, OR 97220 PORTLAND, OR 97219
PHONE: 503-888-8830 PHONE:
FAX: 503-912-0184
FEES
Quantity Description Date Amount
1 ea Clothes Washer 02/26/2018 $25.02
Specifics: 1 12%State Surcharge- 02/26/2018 $8.70
Plumbing
Type of Use: COM 47 ea Minimum Fee Adjustment- 02/26/2018 $47.48
Class of Work: ALT Plumbing
50 Address Fee 02/26/2018 $50.00
Type of Const:
Occupancy Grp:
Stories:
Total $131.20
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 b calling 503.23 1987 or 1.800.332.2344.
Issued By: i y Permittee Signature: ' baVA(2 .
t' (/
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.
Plumbing Permit Application
Building Fixtures RECEIVED FOR OFFICE ISE O\L1
- City of Tigard Datey s ,g 4,6„7,4")„,,,,,e,t No.:f0 ,/�,,,,
I - • 13125 SW Hall Blvd.,Tigard,OR P7E2B 26 2018
Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
TIGARD Inspection Line: 503.639.4175 CITY GF- ;CARD DateReadyBy: Juris: O SeePage2for
Internet: www.tigard-or.go��NNING/ENGINEERING Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
r" For special information use checklist
0 New construction ❑Demolition
DescriptionI Qty. Ea. I Total
, ddition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
0 1-and 2-family dwelling A CommereiaUindustrial
SFR(2)bath 437.78
SFR(3)bath 500.32
0 Accessory building ❑Multi-family Each additional bath/kitchen 25.02
0 Master builder 0 Other: _ Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: 1 180 W U( \Adb - -1,s-D
Drywell,leach line,or trench drain 18.76
City/State/"ZIP: y 011_, Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: J 1 Project name:eea /t ((#47%/` Manufactured home utilities 50.03 .
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
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:
Backflow preventer 31.27
Tax map/parcel no.:
Backwater valve 12.51
DESCRIPTION OF WORK
1 Clothes washer 1 25.02 Ts 0 Z
p,4 ) n(�, ctiLf �,Jal)1,t„( t. 0,rte Dishwasher 25.02
S�o�. f 12,b-/ Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:
Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) _ Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: 25.02
Water closet
CONTRACTOR Water heater 37.52
Business name: ' ,, ,i... PL�n,a�A.A� c... Waterpiping/DWV 56.29
1�`,
Address: , LAJJJJ (�, kSp ,-±Et 314 Other: 25.02
City/State/ZIP: Po.(„.1.44,,a On_ "�_`�C 2_2D J Subtotal
Phone:(93) 8 t g _. Minimum$ 7 Fax:( ) 7/�! / Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.: (11,1,65 (t_fj y l/ Plumbing Lic.no.: 3 -tCi 31,15 State surcharge(12%of permit fee)
Authorized signature: , •1 7,F TOTAL PERMIT FEE
�.. 1,..v.
e/ This permit application expires if a permit is not obtained within 180 days
Print name: % I IAA 0' l_ l �1 1 Date: l I'L���b after it has been accepted as complete
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