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Permit
• CV_ .4. CITY OF TIGARD PLUMBING PERMIT r� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00567 " ' I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 05 2511 PARCEL: 2S 112DD -00300 SITE ADDRESS: 15900 SW 72ND AVE ZONING: I -L SUBDIVISION: LOT: JURISDICTION: TIG Project Description: Site Utilities Other fixture: 4 rain drain connectors, 6 hose bibbs. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: 5 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: 1 LAVATORIES: OTHER FIXTURES: 0 TUB /SHOWERS: SEWER LINE: 140 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: 130 ft Owner: FEES TIME OIL CO Description Date Amount P O BOX 24447 SEATTLE, WA 98124 [PLUMB] Permit Fee 6/6/2005 $468.40 [TAX] 8% State Surcharl 6/6/2005 $37.47 Phone : 206 - 285 -2400 [PLMPLN] Plan Review 6/6/2005 $117.10 Total $622.97 Contractor: EAGLE PLUMBING 13801 S FORSYTHE RD REQUIRED ITEMS AND REPORTS OREGON CITY, OR 97008 Phone : 503- 650 -8703 Reg #: LIC 47914 PLM 3 -154PB 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 952-001 : i • • ugh OAR 952 -0001 -0100. You may obtain copies of these rules or direct questions OUNC by calli • 503 - 246 -669 • • -8 • Issu • d By: 1 11 ' ■ :j Permittee Signature: K CaII 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. Site Utilities pi- -I', 3D NM p • Plumbing Permit Application CIT Or i ILI FOR OFFICE USE ONLY � i City of Tigard BUI D Date/By: • 3 °� Permit No.: / / � ��j _ ��j7 13125 SW Hall Blvd., Tigard, OR 97223 y' / v7 vt /' • g Plan Review Phone: 503.639.4171 Fax: 503.598.1960 y'� I Date/By: / al O � �/ Other Permit No.: 24- Hour Inspection Line: 503.639.4175 ! e` Date Ready By: / °', See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: 1 / Supplemental Information TYPE OF WORK FEE* SCHEDULE Q-' ❑ New construction ❑ Demolition For special information use checklist. Description 1 Qty. 1 Ea. I Total LA (, 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 Iiii Commercial/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 `c Job site address: I.51 0 a > w ,��,s/D 47 Catch basin or area drain S 16.60 City/ State/ZIP: T I L erizo L 0 Ez. c 223 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: Project name: 5 H E L STP� ri p N Footing drain (no. linear ft.: ) Page 2 F Manufactured home utilities 110.00 Cross street/directions to job site: $ F co ft t E P - -7 2. ,,I,� Manholes 16.60 5, A l l 1 i.t P P L12.. O O N ES PERM t b - Rain drain connector 11 16.60 N , y is Sanitary sewer (no. linear ft.: 14 0 ) Page 2 /0/, '/0 Storm sew. (no. linear ft.: 13 0) Page 2 / 01 , c/U Subdivision: I Lot no.: 00 300 Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: 2 S' i 1 2 D D Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 RE 13 ulti.b aX I S I 1 N U & AS S r AM ON Backwater valve 16.60 I S L A N 0 s 414 4> C /1'N o p y Clothes washer 16.60 Dishwasher 16.60 A PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: 'rI11I ©I L co • \ Expansion tank 16.60 Address: Q, o x 2 q « - 7 Fixture/sewer cap 16.60 City/State/Z1P: S E y(,E , w(4. q ys 12,1{ - 0 ii 4 -7 i Floor drain /floor sink /hub 16.60 Phone: (201 zgs- Zii oU jr 326 Fax: (2a p) 2g b - L . (1 4, Garbage disposal 16.60 lA APPLICANT ❑ CONTACT PERSON Hose bib 16.60 ei ( Ice maker 16.60 Business name: A RcIiI r Noi rH 'WES i V>_ c. Interceptor /grease trap i 16.60 / (o Zoo Contact name: t ErE2 km EPA -TZ Medical gas (value: $ ) Page 2 Address: 11 a 3 0 SG 2 1 o N HILL C R Primer 16.60 City/State/ZIP: &RES HAILA ®R Ci 7 0 g 0 Roof drain (commercial) 16.60 Phone: ( li ) 55s. 214 1 (503) 6 y2.7,_ Sink basin /lavatory 16.60 Fax: Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: 7 RP tJa�rtA Water heater 16.60 Address: I 38 0 ( ,� Fer.t.e Other: City/State/ZIP: C- 01_ 4 i _ Subtotal 49,4o _ l� ,\ Minimum permit fee: $72.50 Phone: ( 6.j ��p 3 v Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) p/ ./Q State surcharge (8% of permit fee) 3.7 t IQ Authorized signature: TOTAL PERMIT FEE , 9� Print name: V i i R F P� Date: 7 0 1 T his 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 \Pemtits\PLMU- PernitApp.doc 12/03 440- 4616T(10/02/COM/WEB) Plumbing Permit Applica - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qtr. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1" 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 4/6 ( 7,201 and greater $309.00 Sewer - each additional 100' 46.40 55 Ott 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 #6 ,4 0 $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: 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 : Replace FiztureT YP a New 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 increase of sewer EDUs, a sewer permit will be issued and Ice Machg. Drains Oil Separator ator (Gas Station) paid assessed for the sewer increase must be aid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory Quantity Total - Bradley Isometric or riser diagram is required if fixture quantity - Commercial 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: i:\ Building \Pemtits\PLM- PermitApp.doc 3/03 r CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2004- 00667 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/6/2005 Phone: (503) 639 -4171 At Inspection Requests (24 Hrs.): (503) 639 -4175 1 INSPECTION WORKSHEET FOR DATE: 8/26/2005 TIME: 7:06AM PAGE: 96 SITE ADDRESS: 15900 SW 72ND AVE CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: JACKPOT FOOD MART DESCRIPTION: S11 Utilities Other fixture: 4 rain drain connectors, 6 hose bibbs. OWNER: TIME OIL co, PHONE #: 206 -285 -2400 CONTRACTOR: EAGLE PLUMBING PHONE #: 503- 650 -8703 Inspection Request Scheduled For: Date: 8/26/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 pie_ Plumbing final 014308 -01 503-519 -8788 Y Corrections /Comments /Instructions: `t. ` ` 1 - 1b . - ) f l.x,„ n L , . . 1 \ 8'1Il kc MS Dow114 CL. v A, - S'w,r 'lv S r-k,-, 1 Q " - I mss--, vet e. C -filt 9t" [Nt PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FA IL ❑ CAL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Q��r�- .I� { �^�'' Date:71./l4b r1 Phone #: (503) 718- 1