Permit a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00434
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/21/2008
PARCEL: 2 S 102 DA -0 0401
SITE ADDRESS: 13125 SW HALL BLVD PD ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: CITY OF TIGARD
Project Description: Replacing (3) shower pans in police department.
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: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 3 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
TIGARD, CITY OF
13125 SW HALL Description Date Amount
TIGARD, OR 97223
• Total
Phone :
Contractor:
STANDARD PLUMBING + HEATING
PO BOX 19205
PORTLAND, OR 97280 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 246 -3338
FAX 503- 244 -1279
Reg #: LIC 00007309
PLM 26 -72PB
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 rtes 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 . - Permittee Signature: 411M411/
e
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 pr. ect.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application 65` •- Z l ..a , z z w D
Buijding Fixtures .
;t` FOR ;OFFICE ; USE . ONLY
City of Tigard C �jjDD��'' Received l ( Permit N �! m ?cos.
�}// IQ�� } !, /
11 111 1
I q 13125 SW Hall Blvd., Tigard, OR 9 DateBy: 1 y `� , "�� /J "f
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 1 /At
Date/By: Other Permit No.:
Inspection Line: 503.639.4175 k` Date Ready/By: Ions HI Pa e 2 for
TIGARD 6394175 `�+® r A �( Y Y B
Internet. www.tigard- or.gov ®" GIN eit` Notified/Method: 70 Supplemental Information
TYPE. OF WORK �+ �� 1 V1, FEE* SCHEDULE
❑ New construction ❑ 5 : I r on For special information use checklist
Description I Qty. [ Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
. CATEGORY OF CONSTR CTION SFR (1) bath 249.20
❑ 1 -and 2- family dwelling CONSTR
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: ,/,41 _ /44 c / Catch basin or area drain 16.60
City /State /ZIP: Ti ' e-f d 61 f` 9 72- Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: p , Project name: e� ` ;� 1
drain (no. linear ft.: _) Page 2
2� Manufactured home utilities 110.00
Cross street/directions to job site: Cam!/ t U- v'� 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 Backflow preventer Page 2
Is C-/ / Sli pq,Uci/ 0a"/5' (3) Backwater valve 16.60
Clothes washer 16.60
-
Dishwasher 16.60
❑' PROPERTY OWNER' Drinking fountain 16.60
❑TENANT
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( )
Garbage disposal 16.60
D APPLICANT - ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
0 Business name: l 17- O 7t 7- / f ft,,
Interceptor /grease trap 16.60
Contact name: io 4 Gk / 57,-.5 62-J Medical gas (value: $ ) Page 2
Address: / 3 / i ...1-..0 Ai" / / Primer 16.60
City /State /ZIP: 1 / - 4, ti ® f- Roof drain (commercial) 16.60
Phone: (503) 7/ S 2 4 6,4:25 - Fax:: (53) SQ L / / fegYe. Sink/basin/lavatory 16.60
Tub /shower /shower pan 3 16.60 liir T,r
E -mail: N 6 7/ Ccx,c7' / '_ d e ;:, Ag a G e, ,
1 ``
�
. CONTRACTOR Urinal 16.60 Water closet 16.60
Business name: 5 Y/4 /U f i /47 7-.-ii Water heater 16.60
Address: / Other:
City /State /ZIP: AP j f.ti-s a/ CP q 7 Subtotal
Minimum permit fee: $72.50
Phone: ' 5 0 3 2 4 / 6 7 . - 3 , 3 ) 3 Fax: re. Li i ii -/ 279 Residential backflow minimum permit fee: $36.25 7)- ?
/�
CCB Lic.: Q 7c1 Plumbing Lic. no.: � �ij.'jarr -� Plan review (25% of permit fee)
State surcharge (12% of permit fee) y_'id
/�`i _
Authorized signature: ,,/ I C �`
_ / * /j -� TOTAL PERMIT FEE
Print name: r � D , 4 511 This permit application expires if a permit is not obtained within
730 *Fee methodology set by Tri- County Building Industry Service Board.
I \ Building\Permits\PLMF- PermitApp doe 12/27/06 440- 4616T(I0 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site' Utilities Q ty ., , Fe e (ea Total, r : Square Foo tage;•,. 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' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 •"
Valua
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
Flxtil)i'e OTItelil Qt : ; 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
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan,'Re"view for Plumbing Installatio :.
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed
; greater, except systems designed and stamped by licensed
mss; . -.._.w
•FlxtureType.:,•„ 4 " . "i, r Replace . engineer.
-' ��Previous Capped Added ' Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi /Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain
Isometric or Riser Diagram, ,
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall -
Sink - Bar /Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet •
Urinal
Other Fixtures:
i Building \Permits\PLM- PermitApp.doc 12/27/06
City of Tigard
TIGARD Tidemark Journal Entry Request
This form is used to request a journal entry for Tidemark case fees to: 1) correct revenue accounts
of paid case fees, or 2) transfer fees between revenue accounts to pay case fees. Receipts and
documentation must be attached when applicable. All Tidemark journal entry requests must be
routed to the Tidemark System Administrator for processing. The Tidemark System
Administrator will route the request to Accounts Payable and a copy of the journal entry will be
returned to the Tidemark System Administrator to adjust or pay case fees.
DA "1'E: November 26, 2008
REQUES 1'ED BY: Dianna Howse
CASE NO.: PLM2008 -00434 /24 � ' ` vim
RECEIPT NO.: N/A DATE:
EXPLANATION: Plumbing permit for City of Tigard project; replacing 3 showers in police
department.
Posted ":Aec'ount Description" ,,j Posted "P,os(To"'AceoiintDe
; on°
Posf To =r
(Account ; currently,reside:) "M - $,Am aunt " (Account:fees aie;to be transrred to.)t a $,
` -, ,L . � ,,. Ai11Pink t,
• "Exam , 24:5-90VO413000 : Example ' 245 0000 - 432000
_.... a'_ [BUPPLN] ' [BUILD] Permit Fee
$81.20 245 - 0000 - 431000 $72.50
650- 2160 - 622000 [PLUMB] Permit Fee
100 - 0000 - 207020 8.70
[TAX] 12% State Surcharge
TOTAL: $81.20 TOTAL: $81.20
'?':P O,R TIDEMARK SYSTEM. ADMINIST
Case Fees Ad'usted: E #: 1" . Date: /,2 /a O. B
I: \Buil ding \Refunds \IoumalEntryRequest.doc 09/15/06
General Ledger
Journal Entry Proof List
User: Phyllis
Printed: 12/02/2008 - 9:37 AM
Account Number Account Description Debit Amount Credit Amount Line Description System Reference Project Management
Journal Entry: 000435 05 2009 Journal Entry Date: 11/30/2008 System: General Ledger
100 - 0000 - 101000 Cash & Investments 181,625.00 0.00 West Hills Dev /Sub2004 -00008
100-0000-417000 Tree Replacement Revenue 0.00 181,625.00 West Hills Dev /Sub2004 -00008
Fund Total 181,625.00 181,625.00
Fund Balance 0.00
225- 0000 - 101000 Cash & Investments 0.00 181,625.00 West Hills Dev /Sub2004 -00008
225- 0000 - 229011 Tree Mitigation Cash Assurance 181,625.00 0.00 West Hills Dev /Sub2004 -00008
Fund Total 181,625.00 181,625.00
Fund Balance 0.00
Journal Entry Totals 363,250.00 363,250.00
Journal Entry Balance 0.00
GL - Journal Entry Proof List (Printed: 12/02/2008 - 9:37 AM) Page 1
Account Number Account Description Debit Amount Credit Amount Line Description System Reference Project Management
Report Totals 363,250.00 363,250.00
Report Balance 0.00
GL - Journal Entry Proof List (Printed: 12/02/2008 - 9:37 AM) Page 2
, , CITY OF TIGARD 11/26/2008 � '
Fees Associated With I:27:05PM •
C 13125 SW Hall Blvd.
TIGARD Tigard, OR 97223 503.639.4171 Case #: PLM2008 -00434
rx s h . , mac r, , .. to r n � n W.414-. €
-• :; .,., > ss _ �X .?4 "A'. S.` ::n t
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ee �. , n Start -.: „It- d `��, t k e ,9 - < - ? , ? F- ', - c •
�-.z ;",.:�,.s'.Y . :�s t a"^�k,•;.. c a.. .: � .• . �Ak.v., ,. ` ... .�. d:' T m . � r ated � a -,f` �. �._
a . T e : -Dat �. , a „Date oelt . Descript�on.x N . , g a '., r ` � 8 pate3 A moud Due :
,Accou t umtier , e
PRMT '1/1/1990 12/31/2020 [PLUMB] Permit Fee 245- 0000 - 431000 BLD 11/21/2008 72.50 72.50
SUR1 12/31/2007 12/31/2020 [TAX] 12% State Surcharge 100 - 0000 - 207020 BLD 11/21/2008 8.70 8.70
Total Due: $81.20
Page 1 of 1 CaseFees..rpt
CITY OF TIGARD - 22 e 001139
BUILDING DIVISION - :, 1/A x- 5,7 PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 Air i ,,,\ .�
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: i 2/2/01( TIME: PAGE:
SITE ADDRESS: I?) Zc A-a.A.1 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: G0 V Qs-a i ki: C-4,_,
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message gf/YKI•
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O
Corrections /Comme s /Instructions:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL _ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
1
Inspector: Date: , �/ Y pho #: (503) 718- Z
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