Permit C ITY O TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2005 -00578
'�" 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/19/2005
PARCEL: 25101 AB -01606
SITE ADDRESS: 07357 SW BEVELAND RD 200 ZONING: MUE
SUBDIVISION: CLARKE BUILDING LOT: 017 JURISDICTION: TIG
Project Description: (2) sinks.
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TOM CLARKE Description Date Amount
7357 SW BEVELAND STE. 100
TIGARD, OR 97223 CITY OF TIGARD MEIN 10/19/200E $72.50
[TAX] 8% State Surcharp 10/19/200E $5.80
Phone : 503 793 - 2621 Total $78.30
Contractor:
HOLLINGSWORTH PLUMBING
13624 DUANE ST REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97045 -2869
Phone : 503- 655 -5050
Reg #: LIC 65325
PLM 26 -324PB
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. ATTENTI o : Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those u e -re ._ , orth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or dire ft .; ue•.tions to OUNC by
calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: ', Z t ;h < Permittee Signature: 41 1k _
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.
Building Fixtures
l _
Plumbing Permit '�' , . G E ,, 1 FOR. OFFICE USE ON1 `> ,
City of Tigard R eceived /� n/
Permit N
o.: Q
13125 SW Hall Blvd., Tigard, OR 97223 7 1 a 201 Date/By..AL/ �� � � j j�� � �,� . '
nn[[`` 1 1 Plan Review Other Permit No • '�;//0 3/
Phone: 503.639.4171 Fax: 503.598.1960)x+ %inr „. +; DateDate/By: Oh P i "�"
24- Hour Inspection Line: 503.639.4175 TG . T -:: . -`.• 1.. Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us .. T � 1� 1 � ® No tified/Method: � [6""
t3 Supp l emental Information
�1 _ Ll
Y FEE* :SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. 1 Total
❑ Addition / alteration /replacement , 2 Other: ` New 1 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
El Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION I Site utilities
Job site addre � lA,n St l {7� Zug Catch basin or area drain 16.60
City /State /ZIP: ( Alf; r(>6 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
7 CY
Cross street /directions to job site: ,Al2_ Al home utilities 110 -
/� ?� • Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
' DESCRIPTION OF WORK - Back flow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
. Drinking fountain 16.60
' ❑ PROPERTY OWNER 10 TENANT .
Ejectors/sump 16.60
Name: CCU Expansion tank 16.60
Address: 1 211 cit 3, .) -7 2 L Fixture /sewer cap 16.60
City /State /ZIP: l g os,W C1 0 O.., Floor drain/floor sink/hub 16.60
Phone: ( b 19 3 2 f o g 1 Fax: ( ) ' : 2 13 153 (n Garbage disposal 16.60
Hose bib 16.60
.PLICANT� - CONTACT PERSON
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: • Urinal . 16.60
CONTRACTOR Water closet 16.60
1 1 \�/t�� �r Water heater 16.60
Business name: r ,.' y
-
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
10 State surcharge (8% of permit fee)
Authorized signature: ' (�
""Ali, _ TOTAL PERMIT FEE 7 n (1' X3
Print name:' cn e o C` f l .:_. :ate: loin )05 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.
i:\ Building \Permits\PLMF- PermitApp.doc 06/05 440-46t 6T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard • ' '
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems: • Site Utilities - Qty. Fee (ea) Total Square Footage: .,PermitFee : ...,
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
Water Service - each additional 100' 46.40 Medical Gas Systems:
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee: -
_ $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 Back flow 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 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Complex' Structures
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
-Jacuzzi/Whirlpool providing services to human beings.
Car Wash -Each Stall ❑ Plumbing installations, alterations or additions to food service
-Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic. dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
-4
Car Wash Drain Isometric orRiser Diagram - . -
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase.of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
is \Building\Permits\PLM - PermitApp.doc 07/06/05
',� CITY OF TIGARD
BUILDING DIVISION PERMIT #: f'1 ";1slQ "� 00;i 713
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/19/2006
Phone: (503) 639 -4171 4/04/,,,,,,, f i l
Inspection Requests (24 Hrs.): (503) 639 -4175 s
INSPECTION WORKSHEET FOR DATE: 1/17/2006 TIME: 7:05,Aivi PAGE: ./
SITE ADDRESS: %, im, —,/ E:;v4 i i7 ;'',VE: L AN ja RD 200 CLASS OF WORK:
SUBDIVISION: CLARKE BUILDING LOT #: 017 TYPE OF USE:
PROJECT NAME: BEVELAND 1 .L.LNE S CENTER
DESCRIPTION: (2) sink&
OWNER: CLARKE., '1OM PHONE #: ! :,(Ey7B 26 21
CONTRACTOR: g" HOLLING;;WORTIH PLUMBING PHONE #: 50 ..661,
;64,,';050
Inspection Request Scheduled For: Date: 11111 2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
9 Plumbing final 025084 -o1 E43:193- 2621 N
Corrections /Comments /Instructions:
i / / / , ii
/ham % ) r .1 W . _ '�/
i 7 e q- / _ 4_ _ l am _'�
❑ PASS , ►A • ■ RTIAL APPROVAL CANCEL _ NO ACCESS
n FAIL • CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: 1 I // 1 Phone #: (503) 718 -
i
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005- 00578'
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/19/2005
Phone: (503) 639-4171 ' A,
Inspection Requests (24 Hrs.): (503) 639-4175 s 4.
INSPECTION WORKSHEET FOR DATE: 10/20/2005 TIME: 7:09AM PAGE: 6
SITE ADDRESS: 07357 SW BEVELAND RD 200 CLASS OF WORK:
SUBDIVISION: CLARKE BUILDING LOT #: 017 TYPE OF USE:
PROJECT NAME: BEVELAND WELLNESS CENTER
DESCRIPTION: (2) sinks.
OWNER: CLARKE, TOM PHONE #: 503- 7932621
CONTRACTOR: HOLLINGSWORTH PLUMBING PHONE #: 503 - 655.5050
Inspection Request Scheduled For: Date: 10/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 018863-01 503-793-2621 N
Corrections /Comments /Instructions:
2 A-d( A t k J,..011 S J .A4,r 12. o t,. t ,.A 'ay.
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1 1 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: VI ►..Le■ i (t ,,.- Date: 1 0 / 24 / 067 Phone #: (503) 718-