Permit C TY TIGARD PLUMBING PERMIT
r DEVELOPMENT SERVICES PERMIT #: PLM2004 -00179
DATE ISSUED: 10/26/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 07357 SW BEVELAND RD PARCEL: 2S101AB -01606
SUBDIVISION: HERMOSO PARK ZONING: MUE
BLOCK: LOT: 017 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES: 4
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 4 WATER LINE: 75 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Building plumbing for new office building. Other fixtures are (1) backwater valve, (2) hose bibs & (1) primer.
FEES
Owner:
Description Date Amount
TOM CLARKE
12448 SW ORCHARD HILL RD [PLUMB] Permit Fee 10/26/2004 $287.40
LAKE OSWEGO, OR 97035 [PLMPLN] Plan Review 10/26/2004 $71.85
[TAX] 8% State Surcharl 10/26/2004 $23.00
Phone : 503 293 - 1226 Total $382.25
Contractor:
HOLLINGSWORTH PLUMBING
13624 DUANE ST
OREGON CITY, OR 97045 -2869 REQUIRED INSPECTIONS
Water Service Insp
Phone : 503
Underfloor /Underslab
Reg. #: L1C 65325 Top -out Insp
PLM 26 - 324PB Final Inspection
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 -000 -1010 through • R
952 - 0001 -0100. You may obtain copies of these rules or direct que• ions t• OU ►'C ,y calling (503)
246 -6699.
Issued By: 1 Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed th ext business day
DP -9bo3 -cool (o 1
. Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
• City Of Tigard Received
Date/By: a'/ 0 4 A Permit ut No.: titp _00 1 77 •
13125 SW Hall Blvd., Tigard, OR 97223 - Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit '.,�2^ Date/By: to I Ia CPA �� w�� � en�S
24- Hour Inspection Line: 503.639.4175 c�2 d j. e�'
_ Date Read / By: <� L `� �u l See Page 2 for
Internet: www.Ci.tigard.or.us Notified/Method: /D of / � / / ,. Supplemental Information
TYPE OF WORK 15 FEE* SCHEDULE
® New construction ❑Demolition / �lr� For special information use checklist.
Description Qty. Ea. 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 gi 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. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 73 67 3c.� 13t= VELAt.4. 741, Catch basin or area dram 16.60
City/State /ZIP: 7 t {.., p _„ I OrL 9 7 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: C(rfrP.-1 DY e - 6L1 6 Footing drain (no. linear ft.: ) Page 2
- Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
7) .k q e 7 0 , Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: ( Lot no.:
Water service (no. linear ft.:�) Page 2 55:00
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
NEA T. 1 DPP' LE- lZ t.-„ S. Backwater valve 16.60 /4, 410
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: T 121 ,,„ ‘ C L As_ l� Expansion tank 16,60
Address: 124 et rg 5..) 0 Ze.i}s}.zD t}7 L c- /24,(. Fixture /sewer cap 16.60
City/State/ZIP: Floor dra /floo sink/hub 1 16.60 G ./p0
�' Tt�t <M7 D/� 9 �
Phone: (_5713) 7 el - 2f,'?_ t Fax: (S�,3) -2_5 3 -- i_S'3 Garbage disposal 16.60
❑ APPLICANT Hose bib i 16.60 O' g, AD
[� CONTACT PERSON
Ice maker 16.60
Business name: i y Ft_ s i GiE7j e cyos re.,.` Co CD Op- ne. Interceptor /grease trap 16.60
Contact name: j q v∎ C.t_AQ.a. - Q_ Medical gas (value: $ ) Page 2
Address: / 2 44 $ S,,.> 2e -04i2 m LL • - Primer r ' 16.60 /6 . &?'
City /State /ZIP: (p k E 9 I t:›36
Roof drain (commercial) 16.60
O s,,a,.„o t o� -
Sink/basi /l avato 1.. 16.60 6
Phone: (gps, ) 2q 3 / LZ ( - Fax: : (SZ3) 2`1 / 63,6
Tub /shower /shower pan 16.60
E -mail:
Urinal igilk. 16.60
CONTRACTOR Water closet LOIS 16.60 66),
Business name: I ad r 9.--n+ W4.1.0-461 _Water heater I 16.60 / (p .
Address: E- Other: •
_\ i/ G 6 Subtotal
City/State/ZIP:
*t;tp� N p O � ` 7 M inimum permit fee: $72.50 � ��
7 V
Phone: 6D3) /„SS -. Soso Fax: ( ) Residential backflow minimum permit fee: $36.25
t SS
/� 7 / • CCB Lic.: �� 3 a`J Plumbing Lic. no.: L7�P 3� r�j Plan review (25% of permit fee)
State surcharge (8% of permit fee) A3. oop
Authorized signature , S . 6 %:-.1.b...."...,,,,Id TOTAL PERMIT FEE 3SA9 A.54
Print name p - � r ND S , lM p „ Date: JZ( / ot This permit application expires if a permit is not obta within
/ 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Permits\PLMF- PemvtApp.doc 12/03 440- 4616T(10 /02 /COM/WEB)
I
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 - l" 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' 1 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
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
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
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:
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rii CITY OF TIGA ••
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1 Approved 1i -4-c- e'p✓ 91.4i. . f 71 '.
_ s 5� ' Conditionally Approved „►...•e... ...... ( •
~ � For only the work as described�iM; • ,�,.• . •
0 T�`" K,,� y W c PERMIT NO. PLM 2004 - Zb 71 • • . •� '
z See Letter to: Follow t••j •
J Attach . 1:
0 c� 0 Job Address: 7357S'I (....JRo/. ;
0
t�� By: 1b 11,A...∎∎%1. Date: /a/14 10Y,
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. OFFICE COPY
Accumulative Sewer Tally Parcel # 2S101AB -01606
Tenant Name: Clr Cifice Building This SW R# 2004 -00305
Site Address: 73 SW Beveland St This PLM# 2004 -00179
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
•
- 3 inch 5 0 0 1 5 1 5
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 4 8 4 8
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 4 24 4 24
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 9 37 9 37
Current Fixture Value 37 divided by 16 = 2.3 Current EDU 1 EDU = $ 2,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 37 divided by 16 = 2.3 over (under) $ 5,750.00
Enter EDU Change Here 2.3
Notes:
Signa ure: Date: IO //y
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
hich must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
i:\Building\Sewer Tally \SewerTallySheet.xls 7/1/04
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200400179
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/76/2004
Phone: (503) 639- 4171'1����1��
Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 9/15/7005 TIME: 7:03AM PAGE: •104
•
SITE ADDRESS: 07357 SW BEVELAND RD CLASS OF WORK:
SUBDIVISION: CLARKE BUILDING LOT #: 017 TYPE OF USE:
PROJECT NAME: CLARKE OFFICE BUILDING
DESCRIPTION: Building plumbing for new office building. Other fixtures are (1) backwater valve, (2) hose bibs & (1)
primer. 5/25/2005
OWNER: CLARKE, TOM PHONE #: 503 - 293-1226
CONTRACTOR: HOLLINGSWORTH PLUMBING PHONE #: 503 - 655 -5050
Inspection Request Scheduled For: Date: 9/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 015E43 -01 503-7932621 N
Corrections /Comments/ Instructions:
kj "ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1 ` ector Date: 0 Phone #: (503) 718-
CITY OF TIGARD - 24 -Hour
BUILDING Inspection Line: (503) 639 - 4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
�f /� BUP
Received f 3 V Date Requested /c —? AM PM BUP
Location 7 5 7 Suite MEC l 7 /
Contact Person Ph ( ) -- 7q 3 4 a I PLM 2.66 60 <�
Contractor Ph ( ) SWR
BUILDING Tenant/Owner '_y ELC
Footing
ELC
Foundation
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
'oug -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fin
PART FAIL
CHANI'CAL
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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line ,
ADA
Approach/Sidewalk Date 4 6 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL