Permit P In
CITY TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: PLM2003 -00503
A � I I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/29/03
SITE ADDRESS: 13535 SW 72ND AVE 165
PARCEL: 2S101 DC -00200
SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
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: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install (1) sink.
FEES
Owner: Description Date Amount
PACIFIC NW PROPERTIES LTD PTNSHP
9665 SW ALLEN BLVD STE 115 [PLUMB] Permit Fee 9/29/03 $72.50
BEAVERTON, OR 97005 [TAX] 8% State Tax 9/29/03 $5.80
Total $78.30
Phone :
Contractor:
REQUIRED INSPECTIONS
Phone : Rough -in Insp
Final Inspection
Reg #:
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 \ C
Issued y: , �� ,.! C pl /i Permittee Signature: �_ jidM1(1 /
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
B Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
Received y Plumbing
RECEIVED Date/By: /`( Permit No k 2, -of) 52
City of Tigard Planning Approval Sewer
`J g Date/By: Permit No.:SW Q-Oy 3 -(- 3 7
13125 SW Hall Blvd. r Plan Review Other
Tigard, Oregon 97223 SEP 2 , .e 2003 Date/By: Pemnit No.:3 J/) l') D3 - Oa�Xq
j Post - Review
Phone: 503 - 639 -4171 Fa�C.l� 81 Q /as� '' Date/By: Land Use
Case No.:
lr
Internet: www.ci.tigard.C4fLO n t � L f o r .' I I Contact Juris.: El See Page 2 for
24 -hour Inspection Request: 503 - 639117 " ""
P Q Name/Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description 1 Qty 1 Fee(ea.) I Total
a Addition /alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft for each utility connection)
❑ 1 & 2- Family dwelling IT Commercial/Industrial SFR (1) bath 249.20
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 LOCATION Fire sprinkler - sq. ft.: _ Page 2
Job site address: 13S S W 72 Site Utilities
Suite #: 1 bS 1 Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: 7r SPCC si4,¢.C,c Drywell / leach line /trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2 _
DESCRIPTION OF WORK Fixture or Item
Absorption valve 16.60
r^ Backflow preventer Page 2
- vyS itA,U sill k + f`0 11 qt. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER i 0 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
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
❑ APPLICANT _ ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip:
Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory . 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
Business Name: OP Plu 1,t�, Water closet 16.60
�O � S - C/ 'j " "`( Water heater 16.60
Address: wC k,p� Other:
City /State /Zip: l 1W . 6A. Q7 ( Other:
Phone: s - q q 4 Z Fax: ng 13 6 Plumbing Permit Fees*
CCB Lic. #: ti o d 12, Plumb. Lic. #: ?6 -76 P8 Subtotal $
Minimum Permit Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36.25
Signature: Date: Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $
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 \PlmPermitApp.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 - 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 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
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total 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 550,000.00 $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 Pe rformed 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 P
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 ar vatory /
- Bradley
- Commercial
- Service
Swimming Pool Filter
•
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
•
is \Dsts \Permit Fonns\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
•
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / 6 - AM PM BUP
Location • 1 3 ` � 72 i !'te( Suite / cs/ MEC
Contact Person Ph ( ) PLM — 010 , - 5-6 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: 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
Other:
4 S PART FAIL
HANICAL
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 Dat ! _ Inspector Ext
Other:
Final DO N • REMOVE this Inspection record from the job site.
PASS PART FAIL