Permit (193) CITY OF TIGARD PLUMBING PERMIT
1,1 : COMMUNITY DEVELOPMENT Permit#: PLM2019-00186
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/02/2019
Parcel: 2S103DD00400
Jurisdiction: Tigard
Site address: 13727 SW PACIFIC HWY 300
Project: Brim Hall Dance Academy Subdivision: None Lot: None
Project Description: Replacing(1)backflow preventer.
Contractor: DETEMPLE COMPANY INC Owner: VPT LLC
5636 NE HASSALO STREET 610 SW ALDER ST STE 1221
PORTLAND, OR 97213 PORTLAND, OR 97205
PHONE: 503-227-2641 PHONE: 971-200-4906
FAX: 503-274-7686
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 05/02/2019 $31.27
Specifics: 1 12%State Surcharge- 05/02/2019 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 05/02/2019 $41.23
Plumbing
Class of Work: OTR
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: 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 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
Site Utilities
City of Tigard ' ace'v`d Permit No. rr,,���.,�i e _
1111 r 13125 SW Hall Blvd.,Tigard,OR 97223 Date/By: ` \i S,T ��•"W\3lf�
Plan Review
• I Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No. , kC(-
Inspection Line: 503.639.4175 Date
•
I'I C.r11:I � � Date Re•
Ready:By: .61 ,``� C. "1- rads: ®See Page 2 for
Internet: www.tigard-or.gov Notified/Method: yS •.hmentalInformation
❑New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
C4 Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
: ` ', r ®R^ ,O ® -CI,r4411Z1 , ' ',,,i- SFR(1)bath 312.70
❑ 1-and 2-family dwelling 4 Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
fir ::::7:7n'' '''241!4:.°"0-. I vtl r"ETON" 1V k: a Aix '" Site utilities:
Job site address:13727 SW Pacific Hwy Catch basin or area drain I8.76
City/State/ZIP:Tigard,Or 97223 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:VPT 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:
Tax map/parcel no.: Backflow preventer 1 31.27 31.27
.4.„ "may .W,o 14 Backwater valve 12.51
, „' , , :.'*'1 ,' '' ��. OF a • � ? .<." ,'
Clothes washer 25.02
replace 1-1/2"doublecheck at box behind meter#90022548
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/stunp 25.02
- s; ° .'a! "*.tj l Y,':'-' t `a ^'t, < Expansion tank 12.51
Name: Fixture/sewer cap 25.02
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
„...ii L '4" ( r ^LL lnterceptor/grease trap 25.02
Business name:DeTemple Co Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Suzanne Postula
Roof drain(commercial) 12.51
Address:5636 NE Hassalo St
Sink/basin/lavatory 25.02
City/State/ZIP:Portland,Or 97213 Solar units(potable water) 62.54
Phone:(503)471-5267 Fax::(503)274-7686 Tub/shower/shower pan 12.51
E-mail:s.postnlal®detemple.com Urinal 25.02
'spa- , c Water closet 25.02
.:.L�. s!;•-••••1,•• 's s�- �:Ki, .R,;,<. � � e�,��,.:, Water heater
37.52
Business name:DeTemple Co Water piping/DWV 56.29
Address:5636 NE Hassalo S Other: 25.02
City/State/ZIP:Portland,Or 97213 Subtotal
Phone:(503)471-5267 Fax:(503)274-7686 Minimum permit fee: $72.50 72.50
CCB Lic.:2510 Plumbin Lic.no.:26-25PB Plan review (25%of permit fee) 8.70
State surcharge(12%of permit fee)
C
Authorized signature: d (t d1-i`j-e. TOTAL PERMIT FEE 81.20
Print name:Suzanne Postula Date:4/30/19 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 Servke Board.
L,Building,PennusPLMU-PermiiApp.doc 100109 440-4616T(1002,CO10 WEB)
City of Tigard
Tel: 503.718.2439
Location: Inspection Date:
13727 SW PACIFIC HWY 300, TIGARD, June 13, 2019 at 8:20:44 AM
OR, 97223
Record Type: Record ID:
Commercial - Plumbing PLM2019-00186
Inspection Type: Inspector:
399 Plumbing final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor