Permit (4) C ITY OF TIGARD PLUMBING PERMIT
1 � , DEVELOPMENT SERVICES DATE ISSUED: 2/8/2005
11
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT #: PLM2005 -00052
SITE ADDRESS: 11674 SW PACIFIC HWY PARCEL: 1S136CD -01600
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 300 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 300' line work for sewer connection. Septic system to be pumped and filled or removed.
FEES
Owner:
Description Date Amount
DOUGHTY, J PAUL LILLI
10150 SW CANYON RD [PLUMB] Permit Fee 2/8/2005 $287.00
BEAVERTON, OR 97005 [TAX] 8% State Surchari 2/8/2005 $22.96
Total $309.96
Phone:
Contractor:
MOORE UNDERGROUND INC
29243 SE STONE RD
GRESHAM, OR 97080 REQUIRED INSPECTIONS
Phone: 503 663 - 0212
Reg #: LIC 126605 •
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: , � zi_ Permittee Signature t4i ii
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
/ S c - / & 0
•,`
Plumbine Per _I , •
City of Tigard
� . 3 6 PemtitNo.: � 5 - (9 ( , b�Z
13125 SW Hall Blvd., Tigard, u 2 "�J / /�
Phone: 503.639.4171 Fax: 5 " l9 0 i,., : , Plan
24 - � Other Permit No. �� - 00C, j7
Flour Inspection Line: 503.639.4175
Internet: www.ci.tigard.or.us Y p F T .. I .. Date Ready/By. ®See Pa 2 for
(��� �t(�N Notified/Method: r Supplemental Information
BUIq$n WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For spedai information use checklist
Description I Qty. I Ea. I Total
A l Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00 .
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION LOCATION Site utilities
Job site address: a l 71) Pp ci J� I Catch basin or area drain 16.60
City /State/ZIP: J ' • { �A/ � 4 , 31 k Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name : t4 TV 1 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: P 4_, Nosy W Manholes 16.60
0 4V''�vtkax'Lt I k1 K / Rain drain connector 16.60
Sanitary sewer (no. linear II: . „3Q r Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear R: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK N L Backftow preventer Page 2
4. t�(C� j �t1K� ° j-d ft ,. -t (rfj Backwater valve 16.60
J �f / Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: 61- �/ '^r/1
C ���p Expansion tank 16.60
Address: 1/10.71/ .5 i P , ! l / Fixture/sewer cap 16.60
City /State/ZIP: "r �C / Floor drain/floor sink/hub 16.60
Phone: (503 ) ( c i.e..C3 Fax: (.3•3) 4,14 Lf 1 Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: V4�(Ui"�� ( Interceptor /grease trap 16.60
Contact name: (314,1,,,,A Y ►t Medical gas (value: $ ) Page 2
Address: /9a Z6Y.7r Primer 16.60
City / State/ZIP: /ALA v <DR e ) 4 Roof drain (commercial) 16.60
Phone: ( j 3 )46 ^9'a I Fax: : (spa )46 --8579 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
4. E-mail: ' 3 Sy y _ (=) - CD Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 30/1/1c•
Water heater 16.60
Address: �� Other: /)!tP(• 6.Q'tic_,
Subtotal S
City / State/ZIP: / Minimum permit fee: $72.50
Phone: ( ) \? Fax: ( ) Residential back flow minimum permit fee: $36.25
CCB Lic.: j 2 Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: "ZIP?' State surcharge (8% of permit fee) 01. Gj l�
• TOTAL PERMIT FEE , �0 /
Print name: L. i614Aum jw� �e I Date: 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.
is\ Building \Permin\PLM- PernitApp.doc 12/03 440- 4616T(10/O2ICOMIWEB)
.. 1
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 63/ Medical Gas Systems:
Water Service - each additional 100' 5 -- 46.40 U0 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item
Qty. Fee (ea) Total additional $100.00 or fraction thereof to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub/Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Then
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2°
-3
- 4°
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ BuildingPennib \PLM- PennitApp.doc 3/03
r
. CITY OF TIGARD , _ .. I-
i BUILDING DIVISION PERMIT #: PLM2005 -00052
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/8 /2005
Phone: (503) 639 -4171 v 1 1
Inspection Requests (24 Hrs.): (503) 639 -4175 ° `__..
INSPECTION WORKSHEET FOR DATE: 6/9/2005 TIME: 7:09AM PAGE: 5
SITE ADDRESS: 11674 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: STANDARD TV & ALLPIANCE
DESCRIPTION: 300' line work for sewer connection. Septic system to be pumped and filled or removed. Recorded
easement will be required before final approval.
OWNER: DOUGHTY, J PAUL LILLI, PHONE #:
CONTRACTOR: MOORE UNDERGROUND INC • PHONE #: 503-663-0212
Inspection Request Scheduled For: Date: 6/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 008861 -01 503-309-5750 N
Corrections /Comments/ Instructions:
C(04/ -..---- /
W /4)—) V
❑ PASS ❑PARTIAL APPROVAL
KcANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-
CITY OF TIGARD 24 -Hour
BUILDING Inspection - tine: •(50$) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 J
MST 1.„
CO A/ BUP
Received Date Requested a 16 AM PM BUP
Location `/ Suite MEC
Contact Person Ph ( ) 5 (-/ ' / 2 PLM alloo Qo d Sa,_
Contractor Ph ( ) / SWR
BUILDING Tenant/Owner I/ ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear PA) �+ f C rr
vo c L .
Framing l�� v, a.rcH .t� a.,, c. 2wt✓ � ✓a
Insulation �
Drywall Nailing (Eoure- !'^Q�'I >Z P µ: ,�I l F° ✓e �" ~ b ", c ✓+�.rT ' �'=� )
Firewall
Fire Sprinkler
Fire Alarm
Ceiling � h� S i< � - r t< F it or Ro c (c (ii T I�u�p�
Roof Co ��t A( .1.. l s 1 r c 3 7 / F. 2. LI 24
Other:
Final
PASS PART FAIL
PLUMBING `' y � I 303 N c Sri, �w� �'� wc/ �,,�r -lz< < l� i e r -Fc✓�, d-
Post r Beam
Slab � Pvo gt.: 1 d �,�b I L t..,,T� 'r
Under Slab � u S 7"0 .0; 6
Rough -In
Water Service 11 C 9 1 J f� ,�'
- Ylrfl/� d-. fr.„,„ To Co RAL I (L , e • ' {/.
Rain Drains II
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PAR FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date 21 1 0 l 0< Inspector 01 \ -A i 111 Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
•
CITY OF TIGARD 24 -Hour
k, BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Busines ine• (503) 639 -4171 MST
BUP
Received D.te Requ• ted M PM BUP
Location / / C uite � MEC
Contact Person h ( ) 511 �/ -/ )- 0 PLM9OS
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT Sr
Post & Beam P
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 'k /Ai/ e / G e � 470
Drywall Nailing
Y CJ
Firewall
Fire Sprinkler
Fire Alarm J� � r C fl// C/' /DN/NC—
Susp'd Ceiling '\
Omer: ,A/ leS
Final 114 - --
PASS PART FAIL
PLUMBING _C-Zt 4/2.5
Post & Beam /�j� - ry / N
Under Slab • (' 0 ?� L
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL f ._1 '41E0E /eh/
Service
Rough -In . / ) /F/6 t =
Low olt
Low Voltage
Fire Alarm
Final D Reinspection fee of $ required before inspectio - • at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE LI Please call f r rein ection RE: �'I� Unable to inspect – no access
Fire Supply Line / ��iTtaila
ADA /I AMA
Approach/Sidewalk Insp or� w
Other:
Final DO NOT REMOVE t Is Inspection record from the Job site.
PASS PART FAIL