Permit •
C ITY OF TIGARD PLUMBING PERMIT
�r� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00152
•
,.� I - ' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/15/2005
PARCEL: 1S136DA-02600
SITE ADDRESS: 11140 SW 68TH PKWY ZONING: C -G
SUBDIVISION: MLP1999 -00011 LOT: 002 JURISDICTION: TIG
Project Description: Site utilities for new veterinary clinic. (2) manholes, (2) rain drain connectors and 300' of footing
drain.
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 5
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 45 ft
WATER CLOSETS: WATER LINE: 20 ft
DISHWASHERS: RAIN DRAIN: 650 ft
Owner: FEES
WEBSTAR VI, LLC Description Date Amount
610 GLATT CIR.
WOODBURN, OR 97071 [PLUMB] Permit Fee 7/15/2005 $773.80
[PLMPLN] Plan Review 7/15/2005 $193.45
Phone : 503 - 981 -0155 [TAX] 8% State Surcharl 7/15/2005 $61.90
Total $1,029.15
Contractor:
WOODBURN PLUMBING
LELAND FOSTER REQUIRED ITEMS AND REPORTS
PO BOX 252
WOODBURN, OR 97071
Phone : 503- 981 -4053
Reg #: LIC 51140
PLM 24 -156PB
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 .I ' • ough OAR 952 -0001 -0100. You may obtain copies of these rules ' r direct uestions to OUNC by
calli n • 03-246-66 '. r :Al a 332 -2344.
Issue • By: , / s' ., , Permittee Signature:
CaII 503 -639 -4175 by 7:00 a.m. for an inspection that busine 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.
'Site Utilities •
Plhmbing Permit pliEleetAdED FOR OFFICE USE ONLY
City of Tigard Received /t Permit No.: ,
13125 SW Hall Blvd., Tigard, OR 9722V 1 9 20 0 Da � Q � �Q�l s�
1 � Plan n Re vie
Phone: 503.639.4171 Fax: 503.598.1 0 /iyta w ,� y �\ Date/By: 124 0 Si.) Other Permit No.:
24- Hour Inspection Line: 503.639.467
Internet: www.ci.ti ard.or.us SY OF TIGARD t _ I Date Ready/By: ]uric: 63 See Page 2 for
g ��` f �� ' a' a " Notified/Method: Supplemental Information
TYPL �F WORKY ' . FEE* SCHEDULE
'New construction ❑ Demolition For special information use checklist.
Description [ Qty. 1 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 XCommercial/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 I Site utilities
Job site address: 11140 5 y (494844' 0%24v�RY Catch basin or area drain 5 16.60 83. 00
City/ State/ZIP: -n 6 oR, ci 1 223 _ 16.60
Suite/bldg. /apt. no.: Project name:�c NAey RALcse Footing drain (no. linear ft.: 3C12) Page 2 /�', 8Q
110.00
Cross street/directions to job site: egor fATZEcr is 91' , Manholes 2 16.60 32, 2c)
• A4'( ore 6 1 6 14 ibv IP1 Z 1 -5 Ill &wr pN 54 (obi 4 ' Rain drain connector Z. 16.60 33.
Sanitary sewer (no. linear ft.: LJS) Page 2 5c, , D p
Storm sewer (no. linear ft.: Page 2 3 . 3 . i.tD
Subdivision: 1 Lot no.: Water service (no. linear ft.: 20 ) Page 2 S$. 00
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK.' Backflow preventer Page 2
kI i 2 5 rbM v4 R Verwzi.WAVA Backwater valve 16.60 J3.9-0
eefeRRaAL ( S0& F1r.coe, Clothes washer r' 16.60
Dishwasher 16.60
' ,.PROPERTY. OWNER , ❑ TENANT Drinking fountain 16.60
. I Ejectors /sump 16.60
,
Name: J EP fPe. 77 _ 4 -11 - l Ll.. C.. Expansion tank 16.60
Address: (Q IV & Liem Q , Fixture/sewer cap 16.60
City/ State/ZIP: W opetkiti‘j / OE q 101 f Floor drain /floor sink/hub 16.60
Phone: ( 5103 ) (Hi 066 Fax: (4 fg / 0103 Garbage disposal 16.60
APPLICANT 5/ CONTACT .PERSON Hose bib 16.60
IX
Ice maker 16.60
Business name: - rese(Etr v iEwt rnl /NC:
Interceptor /grease trap 16.60
Contact name: IJ rz . visuivift14 Medical gas (value: $ ) Page 2
Address: 1117 Mokl r Gn^ 4 v ,‘ Primer 16.60
City/State/ZIP: Id000et I OR 1701( Roof drain (commercial) 16 -
(5 0 3) 4 s2 0340
Sink/basin/lavatory 16.60
Phone: ( 403) 9 62 q198 Fax:: Tub /shower /shower pan 16.60
E -mail: A I Ck44'(`l91.Q,itk,Liw►Q,IA.GOIIVI Urinal 16.60
' CO)TRACTOR . -- •
Water closet 16.60
Business name: d4 ,Q� V _e �4.0 , �R./ C_ Water heater 16.60
o Q / as
Address: � ��, ._. Other:
City/ State/ZIP: t 4 7 611 _ c p4 F eaS� Subtotal
7 Minimum permit fee: $72.50
Phone: ( 603 ) / - /� S J ? Fax: (5y02�) R backflow minimum permit fee: $36.25 7 7
�B
CCB Lic. , 5"7/ yd \., Plumbing Lic. no.: a - /56 PB Plan review (25% of permit fee) Q 3. 1/
State surcharge (8% of permit fee) 90
Authorized signature: �Q r
TOTAL PERMIT FEE . !b
Print name: NJe/Z L ii1 Date: 1 0q Olj 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\PLMU- PermitApp.doc 12/03 440- 4616T(10 /02JCOM/WEB)
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site_Ut lities, Qty. , pee fea) Total Square Footage: Permit
Footing drain - 1" 100' i pp i 55.00 55 . 0 to 2,000 $115.00
Footing drain - each additional 100' . t 46.40 12. 2,001 to 3,600 $160.00
Sewer - 1st 100' t� S / 55.00 oD 3,601 to 7,200 $220.00
� 5 7,201 and greater $309.00
Sewer - each additional 100' _ 46.40
Water Service - 1st 100' Zp . 55.00 55 Q9_
Medical Gas Systems:
Water Service - each additional 100' 46.40
Storm &Rain Drain - 1st 100' �pp� 55.00 SS Valuation:',. •,.. Permit Fee:'
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 650/ 46.40 M g& $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
' Q. Fee (ea To tal additional $100.00 or fraction thereof, to and
Fixture, or Item : ty ) 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
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
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
Fixtuie Type,: eplace
•1vew 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
Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
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
Commercial Isometric or riser diagram is required if fixture quantity
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 \ BuildineemtitAPLM- PemutApp.doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200C -00152
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/151200'■
Phone: (503) 639 -4171 /rsoa
Inspection Requests (24 Hrs.): (503) 639 -4175 W `'I I..
INSPECTION WORKSHEET FOR DATE: 5/1/2006 TIME: 7:00AM PAGE: F l
SITE ADDRESS: 11140 SW 60TH Pt<WI' CLASS OF WORK:
SUBDIVISION: MLP1999 -00011 LOT #: 002 TYPE OF USE:
PROJECT NAME: CASCADE VETERINARY REFERRAL CE
DESCRIPTION: Site utilities for new veterinary clinic. (2) manholes, (2) rain drain connectors and 300' of footing
drain.
OWNER: WEBSTAR VI, LLC, PHONE #: 503.981 -(1Th
CONTRACTOR: WOODC3URN PLUMBING PHONE #: ':j03- 901.40b3
Inspection Request Scheduled For: Date: 5/1 /2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 028082 -01 971 - 235.1353 N
Corrections /Comments /Instructions:
Tj...EASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Pi ( ;Ll . Date:)/i/ � ' � - Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: PLM200.5.0n
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/1 ,200/=',
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 '`:L
INSPECTION WORKSHEET FOR DATE: 2/7/2006 TIME: 7 :02AWi PAGE: 48
SITE ADDRESS: 11140 SW 68TH PKWY CLASS OF WORK:
SUBDIVISION: ML P1399 LOT #: 002 TYPE OF USE:
PROJECT NAME: CASCADE VETERINARY REFERRAL CE
DESCRIPTION: Site utilities for new veterinary clinic. (2) manholes, (2) rain drain connectors and 300' of footing
drain.
OWNER: WEBSTAR VI, LLC, PHONE #: 503-981-0155
CONTRACTOR: WOODBURN PLUMBING PHONE #: 503 - 981.4063
Inspection Request Scheduled For: Date: 277/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
S0S Sanitary sewer 02€.39t3 -01 603-401-7310 N
Corrections /Comments/ Instructions:
g i ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
� FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: IN t1 1.6.e Date: c)' 1 - ) l l 6( Phone #: (503) 718- /4//
CITY OF TIGARD . - - • --
BUILDING DIVISION PERMIT #: PLM200S.00152
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7116/2005
Phone: (503) 639 -4171 . 41/00 / l l
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/16/2005 TIME: 7:06AM PAGE: 2 /-
SITE ADDRESS: u 1140 SW 68TH PKWY CLASS OF WORK:
SUBDIVISION: ••1LP1999 - 00011 LOT #: Q02 TYPE OF USE:
PROJECT NAME: CASCADE VETERINARY REFERRAL CE
DESCRIPTION: Site utilities for new veterinary clinic. (2) manholes, (2) rain drain connectors and 300' of footing
drain.
OWNER: WEBSTAR VI, LLC, PHONE #: 503-981 -0155
CONTRACTOR: WOODBURN PLUMBING PHONE #: 503-981.4053
Inspection Request Scheduled For: Date: 12/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanirary sewer 023639 -01 503 -734 -7541 Y
Corrections /Comments/ Instructions:
( - /
❑ PASS ❑ PARTIAL APPROVAL di..GP( ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: fl 11.4 Date: ) Phone #: (503) 718-
CITY OF TIGARD 4
BUILDING DIVISION PERMIT #: PLM2005"00152
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/15/2005
Phone: (503) 639 -4171 Ake 't
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/10/2005 TIME: 7:04AM PAGE: 1
SITE ADDRESS: 1140 SW 68TH PKWY CLASS OF WORK:
SUBDIVISION: 1LP1999 -00011 LOT #: 002 TYPE OF USE:
PROJECT NAME: CASCADE VETERINARY REFERRAL CE
DESCRIPTION: Site utilities for new veterinary clinic. (2) manholes, (2) rain drain connectors and 300' of footing
drain.
OWNER: WEBSTAR VI, LLC, PHONE #: 503- 981 -0155
CONTRACTOR: WOODBURN PLUMBING PHONE #: 503 - 981 -4053
Inspection Request Scheduled For: Date: 10/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
335 Rain drain 017890 -01 503 - 481 -7310 N
Corrections /Comments/ Instructions:
1, y / / /
".-. #' r
P
. t ,' /
,I _- fit.4 ,/ A tL 4.-
1 /'
P.',/' .,- 3/2'76? --- -.ie,
----
..,_
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector � Date: /4/1416/ Phone #: (503) 718-
CITY OF TIGARD ° • •�
BUILDING DIVISION PERMIT #: PLM2005-00152
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/15/2005
Phone: (503) 639 -4171 hop' (
Inspection Requests (24 Hrs.): (503) 639 -4175 "'II�
INSPECTION WORKSHEET FOR DATE: 10/4/2005 TIME: 7:13AM PAGE: 2
SITE ADDRESS: i 1140 SW 66TH PKWY CLASS OF WORK:
SUBDIVISION: MLP1999- 00011 LOT #: 002 TYPE OF USE:
PROJECT NAME: CASCADE VETERINARY REFERRAL CE
DESCRIPTION: Site utilities for new veterinary clinic. (2) manholes, (2) rain drain connectors and 300' of footing
grain.
OWNER: WEBSTAR VI, LLC, PHONE #: 503 -981 -0155
CONTRACTOR: WOODBURN PLUMBING PHONE #: 503- 981 -4053
Inspection Request Scheduled For: Date: 10/4/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm drain 017243-01 971 -237 -3942 N
Corrections /Comments /Instructions:
� r
/
4 pASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: irn Date: 1 1/ y I/ Phone #: (503) 718-
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
WOODBURN PLUMBING
LELAND FOSTER
PO BOX 252
WOODBURN, OR 97071
Plumbing Signature Form
Permit_ #:_ PLM2005- 001
Date Issued: 7/15/2005
Parcel: 1 S136DA -02600
Site Address: 11140 SW 68TH PKWY
Subdivision: MLP1999 -00011
Block: Lot: 002
Jurisdiction: C -G
Zoning: TIG
Remarks: Site utilities for new veterinary clinic. (2) manholes, (2) rain drain connectors and
300' of footing drain.
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:
WEBSTAR VI, LLC WOODBURN PLUMBING
610 GLATT CIR. LELAND FOSTER
WOODBURN, OR 97071 PO BOX 252
WOODBURN, OR 97071
Phone #:503- 981 -0155 Phone #: 503- 981 -4053
Reg #: LIC 51140
PLM 24 -156PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Authorized Plumber
If you have any questions, please call 503.718.2433.