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Permit C ITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2003 -00295 � .� �! DATE ISSUED: 8/29/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 12665 SW 69TH AVE PARCEL: 2S101AD -02800 SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE BLOCK: LOT: 031 JURISDICTION: TIG CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: site utilities for new 6,340 sq ft, 2 -story office building. FEES Owner: Description Date Amount CEDAR ENTERPRISES MARTY GOLDSMITH & RON ENYEART [PLUMB] Permit Fee 8/29/03 $332.80 4004 KRUSE PLACE [PLMPLN] Plan Review 8/29/03 $83.20 LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 8/29/03 $26.63 Phone : Total $442.63 Contractor: KSM PLUMBING INC DBA SUNSET PLUMBING PO BOX 628 REQUIRED INSPECTIONS WEST LINN, OR 97086 Sewer Inspection Phone : 503 - 570 - 3427 Water Service Insp Reg #: LIC 141154 Storm Drain Insp PLM 34 - 366PB Storm Drain Insp Storm Drain Insp Rain Drain Insp 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 Issu (� Permittee Signature: /���VA" Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Site Utilities Plumbing Permit Application . . FOR OFFICE USE ONLY eceve,� CO S ())), Plumbing , � `^^5_C 5 Date/By: Q PO /0 j.J✓ Permit No.: O Planning Approval Sewer City of Tigard Planning y: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503 -639 -4171 Fax: 503 -598 - .1960 Post- Review Land Use fiud�lti,}ip �+� Date/By: Case No.D3'q '-- Internet: www.ci.tigard.or.us .- 1 J. r ' i 1 I Contact r�; s 1E1 See Page 2 for 24 - hour Inspection Request: 503 639 - 4175 Name/Method: 1 t -v Supplemental Information. '"...„. TYPE OF WORK FEE* SCHEDULE (for special information use checklist) ❑ New construction ❑ Demolition Description J Qty. I Fee(ea.) I Total El Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) 1 & 2-Family dwelling Commercial/Industrial SFR (1) bath 249.20 ❑ Y g ❑ il/Id SFR (2) bath 350.00 ❑Accessory Building ❑ Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and L CAT ON Fire sprinkler - sq. ft.: _ Page 2 Job site address: !a(o (p5 1 Ltd (c . eta �C-, Site Utilities Suite #: Bid! . /A.t. #: Catch basin/area drain 2 16.60 33, ,A0 Pro Name: BS��G • • ., Drywell /leach line/trench drain 16.60 Footing drain (no. linear ft.) l QQ _Page 2 SS OCR Cross street/Directions to job site: Manufactured home utilities 110.00 C „ o� , e' `� Manholes L 16.60 1(o. GO � //_L 'T s , -> Q 14 Z i Rain drain connector 16.60 , a ht) S l Sanitary sewer (no. linear ft.) 100 _Page 2 5 co Subdivision: 1 Lot #: Storm sewer (no. linear ft.) 100 Page 2 11W19 55 Tax map/parcel #: Water service (no. linear ft.) 51:2 Page 2 55 Fixture or Item DESCRIPTION OF WORic Absorption valve 16.60 � ire- l zr 1 LITI £ F A-U3 Backflow preventer / Page 2 zit,. y() a _ -C -(2 OFF I t ,b t L 1 a Backwater valve 16.60 77 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ❑PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60 Name: C e, Oa, f.-1-)TEA i n A i f-- f Expansion tank 16.60 Address: i h b N, K'kl�b to hi rV 57) Fixture/sewer cap 16.60 City /State /Zip: Ora1of- OR q1035 10 Floor drain /floor sink/hub 16.60 _ Garbage disposal 16.60 Phone: 1 r W157 1 Fax CO `9 Hose bib 16.60 ❑ APPLICANT l ❑ CONTACT PERSON Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 City /State /Zip: Primer 16.60 Roof Roof drain (commercial) 16.60 Phone: 1 Fax: Sink/basin/lavatory 16.60 E -mail: . Tub /shower /shower pan 16.60 CONERACTOR Urinal 16.60 Business N e: 1y1 �h, W, kat3a-r- _ Water closet 16.60 Water heater 16.60 Address: Q 6x t.Z Other: Cit /State /Zip:lt5r L., 1J? 0f&-- 97060 Other: Phone: 650-676 30 Fax: Plumbing Permit Fees* Subtotal $ CCB Lic. #: / ill /6 Plumb. Lic. #:3q 0.6 Minimum Permit Fee $72.50 $ Authorized Residential Backflow Minimum Fee $36.25 • � 3, ..W) Signature: Date: Plan Review (25% of Permit Fee) $ 3 3, State Surcharge (8% of Permit Fee) $ 02 ( . (0 3 (Please print name) TOTAL PERMIT FEE $ 6W, („ 3 Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri -County Building Industry Service Board. is \Dsts\Permit Forms\P1mPermitApp.doc 01/03 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 ' 100' 55.00 55 — 0 to 2,000 $ i 15.00 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 & 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 Fee Total additional $100.00 or fraction thereof, to and Fixture or Item Qty. (ea) ) 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 Comments regarding fixture work: Fixture Type: Replace New Moved Existing Capped 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 *Note: If the fixture work under this permit results in an Garbage - Domestic Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains - plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor • Water Closet - Toilet Urinal Other Fixtures: i:\Dsts\Permit Forms\PlmPernitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP q Received Date Requested 7 — / 01 v PM BUP Location 1 a S r' 9 Suite MEC Contact Person ) Ph ( ) c 1 S 7/ 1 PLM 3i23 " o dc:27.5 , Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC 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 Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Othe i,t11 • = S PART FAIL CHANICAL 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 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA , /� Approach/Sidewalk Date Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL CITY OF TIGARD 13125 S.W. HALL BLVD. lain 2003 6c2CS TIGARD, OR 97223 IMPORTANT PERMIT NOTICE KSM PLUMBING INC DBA SUNSET PLUMBING PO BOX 628 WEST LINN, OR 97086 Plumbing Signature Form Permit #: PLM2003 -00295 —_ - Date - Issued: - 8/29!03 - Parcel: 2S101 AD -02800 Site Address: 12665 SW 69TH AVE Subdivision: WEST PORTLAND HEIGHTS Block: Lot: 031 Jurisdiction: MUE Zoning: TIG Remarks: site utilities for new 6,340 sq ft, 2 -story office building. 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: CEDAR ENTERPRISES KSM PLUMBING INC MARTY GOLDSMITH & RON ENti DBA SUNSET PLUMBING 4004 KRUSE PLACE PO BOX 628 LAKE OSWEGO, OR 97035 WEST LINN, OR 97086 Phone #: Phone #: 503 -570 -3427 Reg #: L1C 141154 PLM 34 -366PB ,/ AN INK SIGNATURE IS REQUIRE N THIS FORM X " vivid Signature of p thorized Plumber If you have any questions, please call 503.718.2433.