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Permit a CITY TIGARD PLUMBING PERMIT l ll`� DEVELOPMENT SERVICES PERMIT #: PLM2006 -00077 DATE ISSUED: 6/28/2006 - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 113AD - 01700 SITE ADDRESS: 16940 SW 72ND AVE ZONING: C - SUBDIVISION: ROSEWOOD ACRE TRACTS LOT: 030 JURISDICTION: TIG Project Description: Other fixtures: (3) primers. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: M FLOOR DRAINS; 3 TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: 3 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 2 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES BRIDGEPORT LAND LLC 3939 NW ST HELENS RD Description Date Amount PORTLAND, OR 97210 [PLUMB] Permit Fee 6/28/2006 $245.60 [PLMPLN] Plan Review 6/28/2006 • $61.40 Phone : 503-241-2875 [TAX] 8% State Surcha 6/28/2006 $19.65 Total $326.65 Contractor: GRIDLINE PLUMBING + HEATING 4343 SE 37TH AVE PORTLAND, OR 97202 REQUIRED ITEMS AND REPORTS Contact # : PRI 503 -771 -8790 FAX 503- 771 -1083 Reg #: LIC 74105 PLM 26 -449PB 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 the ules or directluestions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. sued B 41.1 4.16W, Permittee Signature: _ 0" --\----- Call 503 - 639 -4175 by 7:00 a.m. for an inspectio ' at 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. `Building Fixtures r _ Plumbing Permit App ica ion a V E roR, off Fi USE: ONLY or ��r Received n \�,� City of Tigard FEB 13 2007 /3 Daze /Bye 6 'P,)''--- PennN ` IY ` 4 011 K 7 ( 13125 SW Hall Blvd., Tigard, OR 97223 / Plan Review Phone: 503.639.4171 Fax: 503.598.1960 //gt/ilt 1 1 .' Date/By. r,/ eti /y ",'4 Other Permit Noi j) 4 '''''/M 24- Hour Inspection Line: 503.639.417 ti �. ' '_ I , Date Ready /By: ..../ / twig 'i , ® See Page 2 for Internet: www.ci.tigard.or.us ��� '' Notified/Method:,/ rF' �� f Supplemental Information P ;� .� IS1 q_ h uJ V 0/ � i A f . FEE* SCHEDULE ❑ New construction ❑ Demolition / u L For special information use checklist. Description 1 Qty. 1 Ea. 1 Total 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 glommercial /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 Site utilities Job site address: Wit' VI Lj St `7 2 AA' NC' Catch basin or area drain 16.60 City /State /ZIP: 11 q AA () r. Drywell, leach line, or trench drain 16.60 Stiite/bldg. /apt. no.: ( I Project name: ` \C ?S 'ljt"...(}LuSt, Footing drain (no. linear ft.: ) Page 2 • Manufactured home utilities 110.00 Cross street /directions to job site: Manholes 16.60 a ,TZt ew • Rain drain connector 16.60 ,L'l) £ l.AQ { k kScouc5. Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: 015/ f ? F 'D O /70 U Fixture or item Absorption valve 16.60 • DESCRIPTION OF WORK Back flow preventer ( Page 2 y6r ye Backwater valve 16.60 l • Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 4 16.60 • ❑ PROPERTY OWNER • 'iTENANT WC�Z Ejectors /sump 16.60 Name: Expansion tank 16.60 Address: L(( 'yVC,` L(ppcJ * Fixture /sewer cap 16.60 City /State /ZIP: MC. O t40 ,. t CA- ot L44 e Floor drain /floor sink/hub v7 / / p �, 26 16.60 1/9, O0 Phone: ea)) X1 "C s-eo Fax: ( ) Garbage disposal CCCJJJ 16.60 0 Hose bib 16.60 ' (APPLICANT DeCONTACT PERSON ' Ice maker 16.60 Business name: CCOVA - C.CUN,SC �s UL. - , Interceptor/grease trap 16.60 Contact name: V \ c l!N 'll okki Medical gas (value: $ ) • Page 2 Address: ta L(i S' m(�t 1� Primer 3 16.60 ug, 80 • a /� Roof drain (commercial) 16.60 f City /State /ZIP: 1 { �itV C �� 2 r // ) �p � `r i l ( [ 'te r ) �j r _ �! Sink /basin /lavato �j 3 16.60 Phone: I� T�1 5G I Fax:: 0S 6 `{ is J ry 6i���„ o. Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CON "TRACTOR Water closet Z 16.603, Za Business name: a - I ,� ' ri . IL. „Ai V j , l4_ �;e Water he ( 16.60 ! 6 �D ._ r Address: - Other: i City /State /ZIP: S ©�, �.. 97�j Z S u$72.50 btotal \''.. i.. . `\ T�� � N Minimum permit fee: �V Phone: 5 7� `79p Fax: (53) 77/. f 3 Residential backflow minimum permit fee: $36.25 . CCB Lic. :11 /© Plumbing Lic. no.: �_ 4 '-17 `�73 Plan review (25% of permit fee) /pi ,' `� Authorized signature: G' State surcharge (8% of permit fee) /7 � r (k l �j 1j u Print name: jo #/i/ po Date: _ .20 =,k This permit application expires if a permit is not obta........ _- 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i:\ Building \Permits \PLMF- PemiitApp.doc 06/05 440.4616T( I0 /02/COM/WEB) r.- y 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 0 to 2,000 $115.00 Footing dram - 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 'Fixture or Item A Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and Commercial Back Flow Prevention Device t 46.40 including for the first $ �,�i� $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 Inspection of existing plumbing or each,additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. 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. Fixture Work: - Plan Review for Complex Structures ; .- Are you capping, adding or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing . please indicate work performed by fixture. Failure to system that meets any of the following criteria. accurately report fixtures could result in increased sewer fees *. Please check all that apply. Quantity by (Fixture) Work Performed ❑ Any new commercial building. Fixture Type:, . Replace ❑ Any new exterior plumbing site utilities. Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ,. ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi /Whirlpool` • providing services to human beings. Car Wash -Each Stall ❑ Plumbing installations alterations or additions to food service -Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor/Water Aspirator are being installed•for thefood service area. Dishwasher - Commercial • ❑ . Any new residential building containing three (3) or more - Domestic - dwelling units. Drinking Fountain ❑ Any NFPA 13 - multipurpose fire sprinkler system. Eye Wash Floor Drain /sink 2" • Submit 2 sets of plans with any of the above. -4" Car Wash Drain Isometric or Riser Diagram, Garbage. - Domestic ❑ Isometric or riser diagram'isrequired for newIbuildings Di - Commercial: three (3) or more stories in height. - Industrial '- \, lce,Mach. /Refrig. Drains , - . . : - • • Oil Separator (Gas Station) Comments 'regarding fixture work: Rec. Vehicle Dump Station • Shower,. -Gang t. ' -Stall Sink - Bar /Lavatory - Bradley - Commercial 1 ' - Service Swimming Pool Filter Waslyer - Clothes *Note: If the fixture work under this permit results in an ' Water - Extractor er p , Water Closet - Toilet h increase of sewer EDUs, a sewer permit will be issued and . . Urinal fees assessed for the sewer increase must be paid before the ..' Other Fixtures: - plumbing permit can be issued. i:\ Building \Permits \PLM- PernitApp.doc 07/06/05 1 CITY OF TIGARD o. BUILDING DIVISION PERMIT #: PLM2006-00077 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/28/2006 Phone: (503) 639 -4171 ��i0�4� p il I Requests (24 Hrs.): (503) 639-4175 _ __.. INSPECTION WORKSHEET FOR DATE: 8/311006 TIME: 7:05Am PAGE: 43 SITE ADDRESS: 16940 SW 72ND AVE CLASS OF WORK: SUBDIVISION: ROSEWOOD ACRE TRACTS LOT #: 830 TYPE OF USE: PROJECT NAME: MENS WEARHOUSE DESCRIPTION: Other fixtures: (3) primers. OWNER: BRIDGEPORT LAND LLC, PHONE #: 503.241 -2875 CONTRACTOR: GRIDLINE PLUMBING & HEATING PHONE #: 503 - 771 -1790 Inspection Request Scheduled For: Date: 8/312006 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 034303 -01 503- 771.8790 N Corrections /Comments/ Instructions: / ' /4 I I I I 97, ,ffr 4 1Y - ■le../. e -- a2 ir ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL 1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED L . Inspector: k1 b ` ej 7 Date: 1 ' A Phone #: (503) 718- ) ` CITY OF TIGARD _ _ BUILDING DIVISION c PERMIT #: PLM2006.00077 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/28/2006 Phone: (503) 639 -4171 /amwdplo ' Inspection Requests (24 Hrs.): (503) 639 -4175 °`__ INSPECTION WORKSHEET FOR DATE: 711012006 TIME: 7:06AM PAGE: 15 SITE ADDRESS: 16940 SW 72ND AVE CLASS OF WORK: SUBDIVISION: ROSEWOOD ACRE TRACTS LOT #: 030 TYPE OF USE: PROJECT NAME: MEIN WEARHOUSE DESCRIPTION: Other fixtures: (3) pruners. OWNER: BRIDGEPORT LAND LLC PHONE #: 503 - 241.287 CONTRACTOR: GRIDLINE PLUMBING & HEATING PHONE #: 503 "771 -8790 Inspection Request Scheduled For: Date: 71/0/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 032863 -01 503 -771 -8790 Y Corrections /Comments/ Instructions: • I El 'ASS U PARTIAL APPROVAL ❑ CANCEL n NO ACCESS • FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: pi ]1".T' Date: �Q Phone #: (503) 718 - -3/