Permit CITY TIGARD PLUMBING PERMIT
44 DEVELOPMENT SERVICES PERMIT #: PLM2005 -00382
+L II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/12/2005
PARCEL: 2S112DD -00300
SITE ADDRESS: 15900 SW 72ND AVE ZONING: I -L
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Commercial irrigation backflow.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
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
Owner: FEES
TIME OIL CO Description Date Amount
P O BOX 24447
SEATTLE, WA 98124 [PLUMB] Permit Fee 8/12/2005 $72.50
[TAX] 8% State Surchari 8/12/2005 $5.80
Phone : Total $78.30
Contractor:
TRUSCAPES INC
21600 NW ANBERWOOD DR. REQUIRED ITEMS AND REPORTS
HILLSBORO, OR 97124
Phone : 503 -531 -9216
Reg #: PLM 7962
LIC PLUS BACKFLOW
•
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 -0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions ,• OUNC by
calling 503 -246 699 or 1- 800 - 332 -2344
Issued By. r
Permittee SignatursNr / / ,
Cali 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.
Plumbing Permit Ap ' on I V t I) , , ,,; (,,, , (, 1.1 , ,,, )
City of Tigard ,s !3 i. 2. 2005 V ia/os 66 , 1 N0.: �l,f'� 5
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 ,� • , DaulBy: Other Permit No.:
24_ Hoff Inspection Line: 503.639.417/; ITY O F TI GA R D . ' J i:. Dale Ready/By: ■ See Page 2 ter
hamlet www.a.tigatd.or.us BUILDING niV1SInni Netifed/Metiod: "i! SappimeamInformation
TYPE 01? WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For spedal bffoneaatlon use atoll&
onlalt raliadreplacement ❑ Other: 1- Description -h Qv. I Ea. 1 Total
New 1- 2-faaily dwellings fmcludes 1001. for each utility connection)
CATEGORY 01? CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling j<Commercialrmdustrial SFR (2) bath 350.00
❑ Accessory building ❑ Muati- family SFR (3) bath 399.00
❑ Master builder ❑ Other:
Fire 45.00
Fire (_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION utilities -
Job site address: 15 0 S W 7 Z NO Ave Catch basin or area dram _ 16.60
CitylState2IP: r Ti G pt-f,0 0 g Drywell, (each line, or f drain 16.60
SuitolbldgJapt. no.: 1 Pr name: S w ELL S'n4 7) 0 IV Footing dram (m. linear ft.: _J Page 2
Cross /directions to job site: Man 110.00
-? 2 ND + eA po E [l Dg. Rai drat _ 16so
Rain drain connector 16.60
Sanitary sewn (no. linear It: __) Page 2
Storm sewer (no. linear ft: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft: ._J . _ Page 2
Tax map/parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
NGOST (LAD of O gA C.VFl o) O (V1 Backwa�� 1 16.60
1 g I a'i (i,/l 1) S r1M . Clothes washer 16.60
Dishwasher . 16.60
❑ PROPERTY OWilER 1 0 MANI' _ • Drinking fountain 16.60
Ejectors/sump 16.60 •
Name: •
Expansion tank 16.60
Address: Fixtnrlsewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone: f .6 - g cO Fax: ( ) Garbage disposal 16.60
_ . . _, . ..❑ APPLICANT ...❑..CONTACT_PERSON.. _ .. Hose bib 16.60
Business Truscapes, LLC lcemaker 16
hm sceptor/grease trap 16.60
caatactname: Terry Peniuk Medical gas (value:5 ) Page2
Ate: 21600 NW Amberwood Dr. lamer 16.60
City /StateiZI: Hillsboro, OR 97124 Roof drain (commercial) 16.60
Thaw: ( ) 503 - 531 -9216 I Fax: : ( ) Same siSink/basin/lavatory _ 16.60
Ph
Tub/shower/shower pan 16.60
Urinal 16.60
CONTRACTOR L. Water closet 16.60
Business name: Water heater 16.60
Address: Other
City/Staoer P: Subtotal
Minimum permit fee: 572.50
Phone: ( ) �- ? 7 \--- 67 J Fax: ( ) Residential backflow mi�um permit fee: 53625 • SZ
CCB lac.: 7962 LCC 4 - Pl unbin8 Lac. u.: Plan review (25% ofpermit fee) _ .
State sardine (896 of permit foe)
Authorized Fa TOTAL PERMIT FEE -1 V .
Prim I P r name: I 1 f f 1V t K D a t e : g ) L o s This permit application apires if'a permit b not obtained within
180 days alter it has been accepted as complete.
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (en) Total Square Footage: Permit Fee:
Footing drain - I" 100' 55.0(1 0 to 2,000 $115.00
Footine drain - each additional 10(1' 46.40 2.0(11 to 3.6110 $160.00
3.61)1 10 7.200 $220.00
Sewer - 1st 100' 55.00 72(11 and greater $309.00
Sewer - each additional 100' • 46.40
Water Service - 1st 100' 55'(10 Medical Gas Systems:
Water Service - each additional 101)' 46.40 -
Valuation: Permit Fee:
Storm & Rain Drain - 1st 1011' 55.00 $1.00 to $5.000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 101)' 46.40 $5.001.00 to $10.000.00 $7230 for the first $5.000.00 and $1.52 for each
Fixture or Item Qty. Fee (en) Total additional $100.00 or fraction thereof to and -
including $ 10.000.00.
Commercial Back Flow Prevention Device 46.40 $10.001.110 to $25.000.00 $148.50 for the first $I0 .000.00 and $I.54 for
Residential Backflow Prevention Device each additional $I00.00 or fraction thereof, to
i minimum permit tee $36.251 27.55 and including $25,000.00.
Rain Drain. single family dwelling 65."5 $25.00I.00 to $50.000.011 $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. and including $50,000.00.
s
p i 4 p � p 50 $50.001.0(1 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
Fixture Type: Replace .
.\s Moved Existing Capped Comments regarding fixture work:
Baptistry /Font
Bath -Ft h /Shower
- Jacuzzi/Whirlpool .
Car Nash - Each Stall •
- Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink - 2'
•
•
4 ..
Car Wash Drain
(Jarhage -- - Domestic
- 1
Dispgsal__ -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 Nlach. /Refrig. Drains
p
Oil Separator Kits Station) fees assessed for the sewer increase must be paid before the
Rec. vehicle Dump Station plumbing permit can be issued.
Shower -Gans
-Stall
Sink - Bar /Lavatory
Quantity Total
- 13radle}
Commercial Isometric or riser diagram is required if fixture quantity
• - Sery ice total is >9.
Swimming Pool Filter
(Washer - Clothes
Water Extractor Plan Review
Water Closet - Toile( Plan review is required if fixture quantity total is >9.
Urinal • • -
Clthrr Firhvr <'
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PI- ivl2O05.00M2
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 0/12/2 006
Phone: (503) 639 -4171 404001,f), Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/31/200 TIME: 7 :01AM PAGE: 66
SITE ADDRESS: 15900 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: SHELL STATION
DESCRIPTION: Commercial irrigation.
OWNER: TIME OIL CO, PHONE #:
CONTRACTOR: TRUSCAPES INC PHONE #: 503-531 -9216
Inspection Request Scheduled For: Date: 1/31/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 02699t103 111 - 111 -1111 `r
Corrections /Comments/ Instructions:
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IA -, SS G 'ARTIAL APPROVAL Ill CANCEL 111 NO ACCESS
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❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: )Y\ 6& Date: //2/76‘ Phone #: (503) 718-