Permit CITY TIGARD PLUMBING PERMIT
r - jik DEVELOPMENT SERVICES PERMIT #: PLM2004 -00519
�' l l ��^ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/18/2004
SITE ADDRESS: 11565 SW HALL BLVD PARCEL: 1S135DD-01800
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -P
BLOCK: LOT: 026 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of vacuum pump for dental chair.
FEES
Owner:
Description Date Amount
PANG, KEIKO TR
46 - 442 HOLOLIO ST [PLUMB] Permit Fee 11/18/2004 $72.50
KANEOHE, HI 96744 [TAX] 8% State Surchar! 11/18/2004 $5.80
Total $78.30
Phone:
Contractor:
D + F PLUMBING
4636 N ALBINA
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: LIC 465
PLM 26 -23pb
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-.2•9.
Issue By: , � t! = � v - Permittee Signature: X
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the n xt bAiri ss day
iiuitaing r fixtures
FOR OFFICE USE ONLY
Plumbing Permit Application
Received , t/
. - - Date/By: / / 404( Cab Permit No.: L4[�p4/ -50579
Cit of Tl and Planning Approval Sewer
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
//a ian f ' t� Date/By: No.:
Internet: www.ci.tigard.or.us - ^. � '�1 Contact El See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: 1 /4, Supplemental Information.
: ;. • ' ' TYPE OF WORK. . • - • .,FEE * (for special forina"tion use checklist)',
❑ New construction ❑ Demolition Description 1 Qty. 1 Fee(ea) 1 Total
fft Addition/alteration/replacement ❑ Other: New 1 - & 2 - family dwellings .
• s: CATEGORY. OF CONSTRUCTION. " (Includes 100 tt foreach utility connection)
" " SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00
Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder '"Other: t)E -071 1_ Each additional bath/kitchen 45.00
30B'SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: / /S - CIA/ ( 03L Site Utilities '"
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: F-- 6,0&x.„-r4,26:7706.) Footin Drywell/leach line/trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
;� a . : ' .: `• ',` Fixture'oriItera5 x ::. .
.. DESCRIPTION OF WORK Absorption valve 16.60
TA/57 9-/ / VA-GU(J/6 i it= 0r171%' Backflow preventer Page 2
rr)f D /v 01-11114 4 Backwater valve 16.60
Clothes washer 16.60
7),1H 64-5 Dishwasher 16.60
OT Drinking fountain 16.60
1 1PROPERTY'OWNER 0 TENANT . Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
Cit /State /Zip: Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
: ® APPLICANT• , CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City/State/Zip: Primer 16.60
y p Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
"Y?' CONTRACTOR Urinal 16.60
Business Name: D eLlitioy /6- 60. Water closet 16.60
r Water heater 16.60
Address: lit,3c, W. 4- / - /,/9- Av6 Other:
City /State /Zip: - ) 0 0/Z17-4,/l' 9 7 Other: ✓4 ,'(Jm PUrl1P -064 f
Phone: ,2_,E,-,2-,01-3 Fax: 91/49r-o b a Plumbing•Permit Fees* .
Subtotal $
CCB Lic. #: f lost Plumb. Lic. #: (24,7-,e?-/°6 Minimum Permit Fee $72.50 $
Authorized ill/)W 7 7/4Ofo Residential Backflow Minimum Fee $36.25 0.7e9.,
Signature: - Date: Plan Review (25% of Permit Fee) $
lzR,vA. y 04 State Surcharge (8% of Permit Fee) $ 6 $0
1 (Please print name) TOTAL PERMIT FEE $ 7g , 3
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
i: \Dsts\Permit Forms\PlmPermitApp.doc 0 /03
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' 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 Medical Gas Systems:
Water Service - each additional 100' 46.40 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
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea). Total 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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 Comments regarding fixture work:
Fixture Type:. Replace
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2"
- 3"
-4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
•
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 •
INSPECTION DIVISION Business Li (503) 639 - 4171 MST
BUP
Received r Date Requested /1 _a f AM � PM _ BUP
Location 1 r J 7 S- Suite MEC
Contact Person � Ph ( ) E6O 6g.3? PLM ,4z626/_ 06S/ 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain -
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling '
Roof
Other:
Final
PASS PART FAIL
PLUMBING.
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
• Other:
Ina
DART FAIL
NICAL
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 /J/ 7 y/� Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
•