Permit CI TY OF TIGARD PLUMBING PERMIT
14 DEVELOPMENT SERVICES PERMIT #: PLM2004 -00412
II ' r 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/25/2005
SITE ADDRESS: 09975 SW FREWING ST PARCEL: 2S102CB -03200
SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G
BLOCK: LOT: 021 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 3
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: 170 ft
WATER CLOSETS: WATER LINE: 20 ft
DISHWASHERS: RAIN DRAIN: 360 ft
Remarks: Site utilities for new office building. Other fixtures =2 manholes.
FEES
Owner:
Description Date Amount
KAMELIA MASSIH
1831 SW DICKINSON LANE [PLUMB] Permit Fee 2/25/2005 $433.60
PORTLAND, OR 97219 [TAX] 8% State Surcharl 2/25/2005 $34.69
[PLUMB] Permit Fee 2/25/2005 $108.40
Phone : Total $576.69
Contractor:
CRAFT RITE PLUMBING INC
4812 SE MELDRUM AVE REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97267
Phone : 503- 327 -4975
Reg #: LIC 162040
PLM 3 -526PB
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
Issue • By: - / Permittee Signature: Call (503) (503) 639 -4175 by 7 :00 P.M. for an inspection needed the next business day
, eLllilities ,1
lambing Permit Applicat' i 1 FOR OFFICE USE ONLY
Received a 9 , /
City of Tigard Date/By: / 7 �Y Permit No.: , .'
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Ea
503.639.4171 Fax: 503.598.1960 A � t Date/By: 1 .-.74A) Other Permit No.:
24- Hour Inspection Line: 503.639.4175 elf I Date Ready/By: See Pa ge 2 for
Internet: www.ci.tigard.or.us Notified/Method: ` f 1�. Suppleme Information
TYPE OF WORK FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist.
Description [ Qty. ( Ea. 1 Total
❑ 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 >kommercial /industrial SFR (2) bath 350.00 i
1:1 Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( _ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION i Site utilities
1
Job site address: `7 R 5 �
- Y (I-) / (_ (O Catch basin or area drain 3 16.60 q9. Si.) ,
City/State/ZIP: 1 1 U l/ f+ r ' g ---1 731 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: �j�1� 6 Footing drain (no. linear ft.: ) Page 2
P" ' (((�� r_ p1 Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60 (.
Sanitary sewer (no. linear ft.: ) ?d ) Page 2
Storm sewer (no. linear ft.:30 &) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Pro c(� �i`IC'l (/-P G` �'1't,Q { �j � l,(( II
- Backwater valve 16.60 t `
JJ / Clothes washer 16.60 '..'�
Dishwasher 16.60
ROPERTY OWNER ❑ TENANT Drinking fountain 16.60
i Ejectors /sump 16.60
Name: a g ar g ( { fU ( C 4 , 1 E pansion tank 16.60 �
Address: / _ _ r d o( 0 Al .� 44 - 4 1 . • e /sewer cap 16.60
City/State /ZIP: Bi2A.,V>e__,1'% y 1 0 g✓ g 1 (J �J Floor drain /floor sink/hub 16.60
Phone: ne7,22,.._ c- & «7 Fax: ( 5 4 (f .__9 q q_ - Garbage disposal 16.60
PPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: 51CtA'r�..4- SI3 qv -99v 9 _ Interceptor /grease trap 16.60
N
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/Z1P: Roof drain (commercial) 16.60
Sink/basin /lavatory 16.60
Phone: ( ) Fax::( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: GscS}1 _� \. �Q rig ‘Water
heater 16.60
Address
1 Other:
City/State/ZIP: Subtotal !{ 3.& 4
Minimum permit fee: $72.50
Phone: Fax: i Residential backflow minimum permit fee: $36.25
i •• 1 ``v ■ w I
CCB Lic. / (/0 it • . no.:. - 5 1 Plan review (25% of permit fee) /0,S?
State surcharge (8% of permit fee) r3 4. ky
Authorized signature� TOTAL PERMIT FEE ,57 . /
Print name: �j{ ,M t S % D ate: _� T his permit application expires if a permit is not obtained within
l >� r I �r�- 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\ Building \Pemtits\PLMU- PermitApp.doc 12/03 440- 4616T(10 /02 /COM/WEB)
A
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr. 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 5 7,201 and greater $309.00
Sewer - each additional 100' 46.40 416, 4
Water Service - 1st 100' 0 20 ' 1 55.00 .$ . Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
Storm &Rain Drain - 1st 100' 55.00 SS $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 3 46.40 /35 7 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Q 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
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: 3 7 by 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 Thru
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 Isometric or riser diagram is required if fixture quantity
- Commercial
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:
is \Building\Permits\PLM- PermitApp.doc 3/03
CITY OF TIGARD
BUILDING DIVISION - ERMIT 4 -/-0 f 12_,
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175 _ _-
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 5 q 7S- ,12 -1-C -) CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 -7 — 4 Pour Time:
Code # Inspection Description Confirm # Contact # Message
? 7 ? - a 3 95
Corrections /Comments/ Instructions:
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212 y / 0 121 �K —ro g-e p,,o. A,
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La ( ■ ( ; u per✓ (.6 � � Lo Pfa al e" A-r E,,, �'fr
n PASS g PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: (Tt i► ∎\ Date:, ) Q Phone #: (503) 718-
Feb" 24 05 05:25p Bryan Nelson 5036573622 p.
02/24/2005 13:07 FAX 5035981960 CITY OF TIGARD lt001
CITY OF TIGARD • P I ill -
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE •
CRAFT RITE PLUMBING INC FEZ r \
4812 SE MELDRUM AVE O �
MILWAUKIE, OR 97267 CXC� .
Plumbing Signature Form
Permit #: PLM2004 -00412
Date Issued:
Parcel: 2S102CB -02800
Site Address: 09975 SW FREWING ST
Subdivision: FREWINGS ORCHARD TRACTS •
Block: Lot: 021
Jurisdiction: C -G
Zoning: TIG •
Remarks: Site utilities for new office building. Other fixtures =2 manholes.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for
the plumbing permit to be valid, please have the appropriate individual from your company sign below and
return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building
Division.
No plumbing inspections will be authorized until this completed form is received
•
OWNER: PLUMBING CONTRACTOR:
KAMELIA MASSIH CRAFT RITE PLUMBING INC
1831 SW DICKINSON LANE 4812 SE MELDRUM AVE
PORTLAND, OR 97219 MILWAUKIE, OR 97267 •
Phone #: Phone #: 503- 327 -4975
Reg #: LIC 162040
PLM 3 -526PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signaturethorized Plumber
If you have any questions, please call 503.718.2433.
•