Permit s
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2009 -00031
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/18/2009
PARCEL: 25101 CB -00400
SITE ADDRESS: 42700 SW NALL_BLVD ZONING: I -L
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TIGARD INDUSTRIAL PARK
Project Description: Installation of commercial backflow preventer for irrigation system.
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
GAZELEY, HARRY W
PO BOX 230414 Description Date Amount
TIGARD, OR 97281 [PLUMB] Permit Fee 2/18/2009 $72.50
[TAX] 12% State Surch 2/18/2009 $8.70
Phone : Total $81.20
Contractor:
MICHAEL A. WARFORD
171 LILNN AVE
OREGON CITY, OR 97045 REQUIRED ITEMS AND REPORTS
Contact # : PRI 971 -221 -5334
Reg #: LIC 8004
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 • - •uestions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu: d By: . Liii.4 Permittee Signature: . 6 .•;;;,. /
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.
Plumbing Permit Application ,
Buildin g Fixtures . ; FOR OFFICE USE ONLY
City of Tigard Received P I I , 6? Permit No.. , 9 -QvO /I
14 - V 13125 SW Hall Blvd., Tigard, OR 97223 Date/By:
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Review Other Permit No.:
DateBy:
Inspection Line: 503.639.4175 D ate Read /B Puri
®
TIGARD Y Y
Internet: www.tigard or.gov Notified/Method: 416 Supplemental SeePage2 for Information
TYPE. OF'. WORK FEE *. SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. 1 Ea. Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY. OF CONSTRUCTION ' 3 . . SFR (1) bath 249.20
1:1 1- and 2- family dwelling �"c;ommercial /industrial SFR (2) bath 350.00
ID Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
y ':
- JOB'SITE'INFORMATION AND LOCATION, _ Site utilities
Job site address: / 17e 5'42 44 G, Catch basin or area drain 16.60
�fi /State /ZIP: �
Cit y Drywell, leach line, or trench drain 16.60
-, , �i � 2 �
Suite/bldg. /apt. no.: I Project name:
Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: /4, !/ de,,,./„...".v
t Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: l Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
. - DESCRIPTION' OF WORK .. - Backflow preventer ( Page 2 5/6
l _ St / <fr "... 4 - , �4 r�Siri' Backwater valve 16.60
��� ' /�`? 6` n 4 1:_ `� 40 A Clothes washer 16.60
/ �7 (� �v� -[lam Dishwasher 16.60
v - �.2.-1 ‘) Drinking fountain 16.60
,Cl PROPERTY OWNER ❑ 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
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
Phone: ( ) Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
. CONTRACTOR Water closet 16.60
Business name: �::;. 6,,Z,..-772.„,, Water heater 16.60
•
Address: /2/ Gi, M a,....9 Other:
Subtotal
Cit /State /ZIP:
y .� 0/7 / j a, 9 7 25 Minimum permit fee: $72.50
Phone: (�� ) i9?/ i9?/ , �c5 3 e/ .p Fax: ( ) Residential backflow minimum permit fee: $36.25 ��'
C ,: 8'2,4 441 t Plumbing Lic. no.: Plan review (25% of permit fee) -0-
�� State surcharge (12% of permit fee) _
TOTAL PERMIT FEE c 70
Authorized signature: b ( go
Print name: /7 e� �J Date: ,7 2, /, ..,,, , :? 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.
1 \Building\Permits\PLMF- PermitApp.doc 12/27/06 440- 46t6T(t0/02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities' Qty Fee (ea T otal_ Square F iotage r Pe>rmit.Fee w ,y
f
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 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 a . °
Storm & Rain Drain - 1st 100' 55.00 Valuation:.: , _ • Perthit 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
e( ea Total additional $100.00 or fraction thereof, to and
Fhtti1C0 ",Oi' ItCitl �_"t Q F e ( ).° 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
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work: ;. °� `Plan Review for Plumbing`Iristallations"
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
QnantitZ "by (Fixture) Work "Pe'rformed greater, except systems designed and stamped by licensed
, :. ' engineer.
''Fixture Type: Replace . .'Previous Capped Added _ :_'Existing. ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
-Domestic , „
Drinking Fountain ;' . '.Isometric or Risei,'" Diagram °
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
- 4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
•
Sink - Bar/Lavatory •
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
•
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i•\Building\Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
�•
BUILDING DIVISION PERMIT #: PLM2009- 00031
13125 SW Hall Blvd., Tigard, OR 97223 Q' �U DATE ISSUED: 2/1812009
Phone: (503) 639 -4171
A gh " °° ` 9 60w 1 �f
Inspection Requests (24 Hrs.): (503) 639 -4175 ' 1 / -2-
INSPECTION WORKSHEET FOR DATE: 2/23/2009 TIME: 7 :00AM PAGE: 1
SITE ADDRESS: 12700 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD INDUSTRIAL PARK
DESCRIPTION: Installation of :ornmerdal I:�ack3�low preven a jfor irrigation system.
OWNER: G AZELEY, HARRY W, PHONE #:
CONTRACTOR: WARFORD, MICHAEL PHONE #: 971 -221 -5334
Inspection Request Scheduled For: Date: 2/23/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 080754 -01 971- 221 -5334 N
Corrections /Comments/ nstructions: _
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: VZ Date: 9 Phone #: (503) 718-69
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