Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00489
I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/19/2006
PARCEL: 2S 1048 B - 07900
SITE ADDRESS: 14350 SW BARROWS RD 002 ZONING: C -C
SUBDIVISION: RUSSELL'S SCHOLLS FERRY SUB LOT: 002 JURISDICTION: TIG
Project Description: Replace only fixtures.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 0 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ALBERTSON'S INC #576 Description Date Amount
PO BOX 20
BOISE, ID 83726 [PLUMB] Permit Fee 10/19/200€ $72.50
[TAX] 8% State Surcha 10/19/200€ $5.80
Phone : Total $78.30
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 691 -6166
FAX 503- 691 -6771
Reg #: LIC 87906
PLM 34 -250PB
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 or 1- 800 - 332 -2344.
Issued By: � .�� Permittee Signature: Z:5 iJNN—
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
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Plumbing Permit Application `' - -- - ? r� - ' n 3 4 7.4 .-. 4.
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x . City of Tigard OCT 18 2006 R " e d i o/i ? /t;� L»1a - $
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'''',': *4 ; Inspection Line: 503.639.4175
# :s.%dTd lfc:%i 1 G`A K D', ‘......1 :i y 01. '1'�5 i i-1 `Date Ready/By: J O See Page 2 or
+k�lu' Internet: www,ligard or.gov ,t rI ,-r q r1Notifin'✓Meihod: Supplemental I
gi.,„ . .
TYPE OF IV FEE' S('HEDU1.E
0 New construction ❑ Demolition For special information use checklist
I)‹...ril 1 matt. I Ea. j Tntal
Addition/alteration/replacement 0 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF (ONST RV( TION SFR(1)bath 249.20
❑ I - and 2- family dwelling . 0 Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( - sq. R) Page 2
JOB SITE IAFORr 1.4TION AND LO('ATION 8
Site utilities
Job site addn:ss: 14350 SW BARROWS RD Catch basin or area drain 16.60
City /State/ZIP: TIGARD, OR 17rywell, leach line, or trench drain 16.60
Suite'bldglapt. no.: 2 1 Project name: CPS Footing drain (no. linear 11.: ) Page 2
Cross street /directions to job site:
Manufactured home utilities 1 10.00
Manholes 16.60
Rain drain connector €6.60
Sanitary sewer (no. linear It.: ) Page 2
Storm sewer (no. linear ft.: ) Pag 2
Subdivision: Lot no.: Water service (no. linear ft-: ) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
DES('RIPT[ON OF WORK Backllow preventcT Page 2
Back valve ! 6.60
TENANT IMPROVEMENT Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER ❑TEN: \NT
Ejectors /sump 16.60
Name:
Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City / State /ZIP: Floor drain/floor sink/huh 16.60
Phone: ( ) Fax ( ) Garbage disporxil 16.60
Hose bib 16.60
❑ APPLICANT ❑CONTACT PERSON I _
Ice makes 16.60
Business name:
[mcra:ptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City: Siatc /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) Sink/basin/lavatory r 16.60 (k/. G 0
Tub%shower /shower pan 16.60
E -mail:
Urinal /6.60
C'ONTILJ.(1 OR Water closet / 16.60 1 i ,. 6 0
Business narne: MODERN PLUMBING CO. Water heater / 16.6(1 l !o b 0
Address: 11120 SW INDCSTRIAL WAY Other:
i
G Cty/State/Z_[P: TUALATIN, OR 97062 Subtotal
Minimum permit lee: 572.50 Z,
Phone: (503) 691-6166 Fax: (503) 6914771 Residential hacicflow minimum permit fee: $36.25 ' .S
CCB Lic.: 87906 Plumbing Lic. no.: 34 -250PB Plan review (25% of permit fee)
State surcharge (8% of permit fee) 4
Authorized signature: ��jt �7 SO
/� -- ------ TOTAL PERMIT FEE 7 s' 3 0
Pont name: 0.66.1--62 e h _ C P8 r 9 Date: /3, gry permit ,' This permit application expires if a peit is not obtained within
(( '' 180 days after It has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:1 Ruhr '_uigWrnmas\PLM- PeunitApp.doc 06/26/06 440 - 46161(10 /02iC:OMAVEII)
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Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee lea) Total Square Footage: Permit Fee:
Footing drain -1'100' 55.00 010 2,000 $115.00
Footing drain - each additional 100' 46.40 2.001 to 3.600 $160.01)
Sewer- 1st 100 55.00 3 .601 to 7200 $
7,201 and gjeater
Serer - each additional 101) 46.40 $309.00
Water Service - 1st 100' 55.00
Water Service - each additional 100' Medical Gas Systems:
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$1.00 to 35,000.00 ; Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 lo 310,000.00 $72.50 for the first 35,000.00 and $1.52 for each
•
Fixture or Item Q4'• Fee (ea) Total additional S100.00 or fraction thereof, to and
Commercial Back plow Prevention Device including $10.000.011.
46. 0 310.001.00 to $25,000.00 $143.50 for the first. $10,000.00 and $1_54 for
Residential Backflow Prevention Device cach additional $100.00 or fraction thereof. to
(minimum permit fee $36.25) 27.55 and including 325.1100.011.
Rage Drain, single family dwelling 65.25 $25,001.00 to 550,000.00 $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: 350,001.00 and up $742.00 for the first S50,000.00 and $1.20 for
each additional 3100.00 or fraction thereof.
•
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Ilan review is required for any of the fullowinrg.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new conunercial build ut_ a ith water a rvice 2 and
Quantity by (Fictnre)11 Work Performed greater. except systems desi_ncd and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ Any new exterior hlunit in_ Site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub/Shower - ❑ Any multipurpose fire sprinkler system.
- Jacuzzi/Whirlpool ❑ Any complex structure as defiled in OAR918- 780 -0040.
Car Wash - Each Stall
- Drive T"" Submit 2 sets of plans with any of the above.
Cuspidor Water -aspirator
Dishwasher - Commercial
- D. >rneatic Isometric or Riser Diagram
[winking Fountain 0 Isometric or riser diagram is required for new bnildin2s
Eye Wash that Meet the qualifications above.
Floor Drain/sink - 2"
a" Comments regarding fixture work:
Car Wash Drain
• Garbage - Domestic
Disposal - Commercial
- industrial
lee Mach.iRefrig_ Drains
Oil Separator ((las Slationl
Rec. Vehicle Dump Station
Shower -tang *Note: If the fixture work under this permit results in an
- stall increase of sewer EDUs, a sewer permit will be issued and
Sink - Bar/Lavatory I fees assessed for the sewer increase must be paid before the
- Bradley
Commercial plumbing permit can be issued.
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
\\'ater Closet - Toilet
Urinal
Other Fixtures:
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CITY OF TIGARD .
BUILDING DIVISION PERMIT #: RN2O06-00409
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/19/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 - - a.....- ■ ftL.L.
INSPECTION WORKSHEET FOR DATE: 11/2712006 TIME: 7:06AM PAGE: 30
SITE ADDRESS: 14350 SW BARROW S RD 002 CLASS OF WORK:
SUBDIVISION: RUSSELL'S SCHOLLS FERRY SUB LOT #: 002 TYPE OF USE:
PROJECT NAME: CPS
DESCRIPTION: CPS. Replace only.
OWNER: ALBERTSON'S INC #676, PHONE #:
CONTRACTOR: MODERN PLUMBING PHONE #: 503-691-6166
Inspection Request Scheduled For: Date: 11/27/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Plumbing final 040231-01 503-691-6166 Y
Corrections/Comments/Instructions:
I
7 \\ •
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/
V.1 PASS n PARTIAL APPROVAL 1] CANCEL NO ACCESS
1 1 FAIL 0 CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: pt1/1(/(- Date: I ,,e,41 1 , Phone #: (503) 718- (
CITY OF ��wm n n�"m� om�����m��
BUILDING DIVISION ~�~°"~~~=""~~� ~°"""~,"~~"" PERN1[T PLM2006-00W89
13125 SW Hall Blvd., Tigard; OR 97223 DATE ISSUED: 10/19V2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503 ) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/2172006 TIME: 7:01Ah4 PAGE: 22
SITE ADDRESS: 14360 SW BARROWS RD 002 CLASS OF WORK:
SUBDIVISION: RUSSELL'S 3CHC/LLS FERRY SUB LOT #: 002 TYPE OF USE:
•
PROJECT NAME: CPS
DESCRIPTION: CPS, Replace only.
OWNER: 8LBERTS0N'S INC #G76. PHONE #:
CONTRACTOR: MODERN PLUMBING PHONE #: 503-691'6166
. Inspection Request Scheduled For: Date: 1027/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough-in 058939-01 603-891'6160 Y
Correodona/Cornrnantn/|nstructiona:
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PASS | APPROVAL CANCEL
( | FAIL FOR INSPECTION 1 1 ADDITIONAL / / / / // '
Inspector: / t'9,C �� O��e� Phone#� G�O3> 7
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