Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00019
'� II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/17/2006
PARCEL: 2S101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY 020 ZONING: MUE
SUBDIVISION: TRIANGLE CORPORATE PARK LOT: 002 JURISDICTION: TIG
Project Description: Replace (1) sink.
CLASS OF WORK: OTR 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: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TIGARD TRIANGLE I LLC Description Date Amount
4650 SW MACADAM AVE STE 220
PORTLAND, OR 97201 [TAX] 8% State Surcha 1/12/2006 $5.80
[PLUMB] Permit Fee 1/12/2006 $72.50
Phone : Total $78.30
Contractor:
MARXMEN PLUMBING INC
9665 SW 163RD AVE
BEAVERTON, OR 97007 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503 -579 -2201
PRI 503 -579 -2200
Reg #: LIC 102432
PLM 34 -16IPB
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 • arted within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follovkrules .dopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 -000 -0100. Yo m. obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permiftee Signature: ' _
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.
-- Building Fixtures
Plumbing Permit Ap VED soli Orrlci.: USE ONl..l
City of Tigard M
Datesr / -/ 7 6k, Permit No�p \� (( �OJ 9
13125 SW Hall Blvd., Tigard, OR 97223 "
9 1 7 2006 u, ,, r , Plan Review
Phone: 503.639.4171 Fax: 503.598.196 h; ,. , . , , her Permit No.:
24- Hour Inspection Line: 503.639.4175 ° " + i Daty. _ � -, �I �� Date e R Ready/By: t""' VI See Page 2 for
Internet: www.ci.tigard.or.us 711°-M44130 �® ., Notified/Method )t Supplemental Information
�
NISION FEE* SCHEDULE
1:1 New construction Demolition For special information use checklist.
Description 1 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 (I) bath 249.20
❑ I- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
108 SITE INFORMATION AND LOCATION Site utilities
Job site address: f ? a, ■ ` S. V.I. (0 ip Aq�� j i i k Catch basin or area drain 16.60 .
City / State /ZIP: -- (Act lq M\ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: j * , L , T 1 4/ 4 T Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: t
D t Manholes 16.60 _
I3 woe N.' IBC t' t eu 1.G t \)& 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 BatJt flow preventer Page 2 •
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
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
❑ 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
b
Sink/basin/lavatory t 16.60 ) 0 //
Phone: ( ) Fax: ( ) Tub/shower/shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: M A 2-h poet3 p l u V14 bl u '� Water heater 16.60
Address: q CDrO C sk-u. j b 3 A %-o-- Other:
City /State/ZIP: (e (t,O Subtotal
Minimum permit fee: $72.50
Phone: ( 57 - 2Z.btj Fax: ( C75. 2.20 1 Residential backflow minimum permit fee: $36.25
CCB Lic.: (0 Ll(3 , Plumbing Lic. no.: -3 4 ") b/ Pe Plan review (25 %ofpenult fee)
Authorized signature: 1 -1 _/, State surcharge (8% of permit fee)
I - 1 v I TOTAL PERMIT FEE I
NI'
Print name: M '( -II Date: t - n .0 c 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 \Pennib\PLMF- PennitApp.doc 06/05 440 -46161 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 - 1 l00' 55.00 0 to 2,000 $115.00
•
Footing drain - each additional MO' 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
Storm &Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$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: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher -Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink - 2" Submit 2 sets of plans with any - 3•• P of the above.
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
-industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer -
Water Extractors *Note: If the fixture work under this permit results in an
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
is\ Building \Penniis\PLM- PennitApp.doc 07/06/05
CITY OF TIGARD " _
•gi Pt- t'YI
BUILDING DIVISION PERMIT #: 2006• -0Q0 /9
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: (3 2- Z ( (0 O /2/ 1 0 1 U CLASS OF WORK:
SUBDIVISION: OT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 ° Pour Time:
Code # Inspection Description Confirm # Contact # Message
3q1 f[iaI 971-a (q- 1
Corrections /Comments/ Instructions:
C a r e_ I- L-ti A 1 ,c,.. V Iz i i- P.—k,.< < Le.
PASS • ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 SOU '.. Date: 3 7/o (o Phone #: (503) 718-
CITY OF TIGARD
z
BUILDING DIVISION PERMIT #: PLM2005-00019
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1717/1()():
Phone: (503) 639 -4171 u�� Npu�yp
Inspection Requests (24 Hrs.): (503) 639 -4175 ' °t'' I..
INSPECTION WORKSHEET FOR DATE: 1/18/2006 TIME: 7:01AM PAGE: 86
SITE ADDRESS: 13221 SW 68TH PKWY 020 CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 007 TYPE OF USE:
PROJECT NAME: HEALTH NET OF OREGON
DESCRIPTION: Replace (1) sink.
OWNER: TIGARD TRIANGLE I LLC, PHONE #:
CONTRACTOR: MARXMEN PLUMBING INC PHONE #: 503 -579- 2240
Inspection Request Scheduled For: Date: 1 /1811006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing uncle; slab 025150-01 971 - 2191783 Y
Corrections /Comments /Instructions: •
S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: (/ I g/n6 Phone #: (503) 718-