Permit 111 ` a CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2009 - 00039
DATE ISSUED: 2/25/2009
TIGARD
1 3125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S113AB - 00300
SITE ADDRESS: 16037 SW UPPER BOONES FERRY RD 175 ZONING: I - L
SUBDIVISION: FANNO CREEK PLACE LOT: JURISDICTION: TIG
PROJECT: ZIP REALTY
Project Description: Add breakroom sink and water heater.
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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
OPUS NW
1500 SW FIRST AVENUE #1100 Description Date Amount
PORTLAND, OR 97201 [PLUMB] Permit Fee 2/24/2009 $72.50
[TAX] 12% State Surcha 2/24/2009 $8.70
Phone : 503- 916 -8963 Total $81.20
Contractor:
MARXMEN PLUMBING INC
9665 SW 163RD AVE
BEAVERTON, OR 97007 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -579 -2200
FAX 503 -579 -2201
Reg #: LIC 102432
PLM 34 -161 PB
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 dired questions
to OUNC by calling 503.246.6699 or 1.800.332.2344.
•
Issue By: I _ ■ - ' � � l _,_ Permittee S ��,_ _; i���»
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.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY Received
City of Tigard : CE�D Date/By y Pe rmit No.. '
: � 0 13125 SW Hall Blvd , Tigard, OR 9 7 Plan Review
C Phone 503.639 4171 Fax 503 598 1960 4 Date/By: Other Permit No '1,4A.,241:/-•
Inspection Line: 503.639 4175 : 2 4 2009
T I G A R D Date Ready/By ei ten< RI See Page 2 for
Internet www tigard-or.gov Notified/Method. (a Supplemental Information
TYPE OF WORk OFTIIGAKU FEE' SCHEDULE
❑ New construction ❑ DemVi V1SI0N For spedal information use checklist
Description I Qty I Ea I Total
❑ Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249 20
❑ 1- and 2- family dwelling RiommerciaUindustrial SFR (2) bath 350 00
El Accessory building ❑ Multi- family SFR (3) bath 399 00
❑ Master builder Each additional bath/kitchen 45 00
❑ Other:
Fire sprinkler (_ sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION gol-/ Site utilities
Job site address: ! ( 2 0 3 ' 5J () , Gtpp -tY` IO1- 1/ Catch basin or area drain 16 60
City /State /ZIP: ' T `i • _ N Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: 1 7 1 I Project name: z p F e �, / Footing drain (no linear ft.: ) Page 2
t '^ 7
Manufactured home utilities 110 00
Cross street/directions to job site:
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.: A 5 I / 3/:1.6 — Absorption valve 16 60
DESCRIPTION OF WORK Backflow preventer Page 2
T T.. Backwater valve 16 60
Clothes washer 16.60
Dishwasher 16 60
?
PROP RTY OWNER I 0 TENANT Drinking fountain
T Ejectors/sump 16 60
/sump 16 60
Name: ('� S Expansipansion 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
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
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: Sink/basin/lavatory ( 16.60 / (0, 60
( ) Fax::( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16 60
CONTRACTOR Water closet 16 60
Business name: 1,A,No ) ion( 60 0 !per e. Water heater / 16 60 11
944 Address: � r..5 3 �" Other:
City /State/ZIP: Ow/ WO _ Subtotal
(vi) a _ � Minimum permit fee. $72 50
Phone: 4 ^ W" y) F ax: ) Residential backflow minimum permit fee $36 25 72,•
CCB Lic.: 102,44 1 Plumbing Lic. no.: Vt. /(� Plan review (25 % of permit fee) Q-
Authorized signature: 4 / a _ State surcharge (12% of permit fee) t. 7O
/. , TOTAL PERMIT FEE ' l . d.Q
Print name: wpm_ Date: 2-1S-0 el 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 \Budding\Permits\PLMF- PermitApp doe 12/27/06 440- 4616T(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: Permit Fee:
Footing drain - I n 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
Valuation: Permit Fee:
Storm &Ram 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
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
Fixture Work: Plan Review for Plumbing Installations
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
Fixture Type: 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/Whiripool ❑ 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
Dunking 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
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 I 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
Unnal
•
Other Fixtures.
i \Buiiding\Permits\PLM- PermitApp doe 12/27/06
'ITY OF TIGARD
BUILDING DIVISION PERMIT #: I' 1- 000"39
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ;1 G ' 1 lr .
Phone: (503) 639 -4171 o R�I � I 4 ) i 0
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/26/2Q09 TIME: 7:03AM PAGE: 10
SITE ADDRESS: 16037 SW UPPER E300Nt=S FERRY RD 175 CLASS OF WORK:
SUBDIVISION: FANN° CREEK PLACE LOT #: TYPE OF USE:
PROJECT NAME: LIP REAL fY
DESCRIPTION: Add breal -room sink and water heater.
OWNER: OPUS NW, PHONE #: 503916.13963
CONTRACTOR: MARXMEN PLUMBING INC PHONE #: 503- 573.2200
Inspection Request Scheduled For: re Date: 2/26/2009 Pour Time:
Code # Inspection Description e Confirm # Contact # Me- • •'-
330 Water service
080864 -01 503-679-2200
Corrections /Comments /Instructions:
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❑ PARTIAL APPROVAL 'CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: J C./l� Date: e2 A / Phone #: (503) 718- 2-'12 y