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Permit
• I CITY OF TIGARD PLUMBING PERMIT IN I COMMUNITY DEVELOPMENT Permit #: PLM2009-00078 T t G ARL7 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/08/2009 Parcel: 2S114AA00200 Jurisdiction: Tigard Site address: 16285 SW 85TH AVE 403 Subdivision: DURHAM HALL BUSINESS PARK Lot: 0 Project: Souper Natural Pepper Heads Project Description: Install (3) 2" floor drains, (1) floor sink, (1) mop sink, (2) 3- compartment sinks, (1) 2- compartment sink, (1) hand sink. Owner: FEES SHIPMAN, W H LIMITED Quantity Description Date Amount BY NORRIS & STEVENS INC, 621 SW 4 ea Floor Drain /Floor Sink/Hub 04 /07/2009 $66.40 MORRISON STE #800 5 ea Sink 04/07/2009 $83.00 PHONE: 1 12% State Surcharge - 04/07/2009 $17.93 Plumbing Contractor: JAK NORTHWEST LLC 17114 NE 20TH ST. VANCOUVER, WA 98684 PHONE: 360 - 772 -0957 FAX: 360- 828 -5988 Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $167.33 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules Issued By: `�„ . � • , _\ = 1 ( - Permi Signature: Q Q Afi: lI \ .,. � Qs� `t } rl �t 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. ' Frurn :Copies & Fax To:15035981960 04/01/2009 13:27 11944 P.001/003 Plumlbin Permit A lic • EIVED Building Fixtures City of Tigard - Received g zoos 7 l D 9 PermitNa.:a��iQ 131 SW Hall Blvd., Tigard, OR 1 1 Phone: 503.639.4171 Fax: 503.598.1960 Pla°Review Other PermitNo. ?© '� l l � Inspection Line: 503.639.4175 CITY GC TIGARD Date/By: C I .. A !: I _ Date Ready/By: Juris ® See Page 2 for Internet: www.tigard- or.gov BUILDING DIVISION Notified/Mcthod: I ` t Supplemental Information TYPE_ OF WORK FEE* SC / HE DULE ❑ New construction ❑ Demolition Forspecial information use checklist Description Addition/ alteration /replacement ❑ Other: New w I - 2 Qty. Ea. Total amily dweltiags (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 24920 ❑ 1- and 2- family dwelling OCommerciallindustrial SFR (2) bath 350.00 0 Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder Each additional bath/kitchen 45.00 ❑ Other: Fire sprinkler l- sq. ft.) Page 2 JOB STTE INFORMATION AND LOCATION Site utilities Job site address: /62g-_ j 5' g'5 Catch basin or area drain 1 16.60 City /State/ZIP: T! g are( ) d /e Drywell, leach line, or trench drain 16.60 Suite/bldg./apt. no.: aj{Rl yp Project name: b 1,1. ;ricer /4 )- /a it. Footing drain (no. linear ft.: _) Page 2 Cross street/directions to job site: Manufactured home utilities 110.00 �� S �' Manholes 16.60 U a1 0 u. rha m rr' - ''° i ' 7. A Rain drain connector 16.60 .547 u 1 cr 2-3- ' - Sanitary sewer (no. linear ft.: ) Page 2 ( S f / it ft, p u . ),( c CC .eSS ( S 4a4ict yr A 4•1 Storm sewer (no. linear ft.: ) Page 2 Subdivision: / v /� 0 Lot no.: Water service (no. linear ft.: ) Page 2 c. Tax map /parcel no.: c. 311 H A A C J O 2 _ Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK Back low preventer Page 2 et Aid: rty CO km u•es/G ;et / , 4", - / e t4 °- ie 6" : ° :' elf- Backwater valve ` mo � 16.60 ( d a, i wy 5 rya a WQ' {+r 4 4 -. s ^S' to S • a H; is Clothes washer 16.60 (.�D �t ®, C 1r� Dishwasher 16.60 ' ❑'; PROPERTY QtNER C tJ� ) ❑ TENANT - Drinking fountain 16.60 ` Ejectors/sump 16.60 Name: Imo. /4 G . A i /o J't ii. L rb 94 / [/' o ii nr,' 1- S re alas. E ton tank 16.60 xpans Address: (:.. f 9 /14C i Sew i ee e V Fixture/sewer cap 16.60 City /State/ZIP: Port/04a / aR 17 a C+,5 Floor drain/floor sink/hub - y 16.60 66,P0, Phone: (03 ) I / ,-3.° Fax: (P3) .1, e A /34 image disposal 16.60 APPLICANT ❑ CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: 3 J ,t/ivr'"1`'k «/ a .c/- L L G l Interceptor /grease trap 16.60 Contact name: �� e �r' / Cd. A.'4 Medical gas (value: $ _ ) Page 2 Address: 1 i f 'k 'l-k- S' f- Primer 16.60 City/State/ZIP: Vi't /tCOA Vt.,' vb.,' 9 to ev 77f7 Roof drain (commercial) I 16.60 Phone: (3 ( ) 7 7Z - et 5 6-7 1 Fax:: ( 03. ) e , f 4- 3 1 0 , - Sink/basin/lavatory S 16.60 gs . Gv Tub /shower /shower pan 16.60 E-mail: J Cc 1 - /l (Qtre (_ c , ,_a 5. e--,. l2 e.t Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: _T e ,,,,n,, y -t ■ W e 5'' f -- Li. G. Water heater 16.60 Address: / )// I f 4/e 141 S r- Other S City/State/ZIP: Vet," CO u V -e..., Wi pee � 9 rv7 i vp a kC Phone: ( ..6O) 7 .. - c9 fi Fax: (51 6 6 5'- a f . p Residential backflow minimum t permi ee: $36.25 CCB Lie.: /ed V 9? II, 6' e l Plumbing L �.�m3` ic. no.: 3'?- S1W �'B Plan review (25% of permit fee) r `X " - " /f f / ! r State surcharge (12 of p ]- f fee) / Authorized signature: ".04.1 FL / 7/ 13 e / / 1 TOTAL PERMIT FEE 167.3,E Print name: 3.s 41 - 4"p ! 4 K 6, Date: Q $0-0/-69 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. I:\ Building \Pmmitn\PLMI+- PennitApp.doc 12/27/16 440.4616T(10/02/COM/WBa) Ertim :Copies & Fax To :15035981960 04/01/2009 13:28 #944 P.002 /003 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 drain - each additional 100' 46,40 2,001 to 3,600 $160.00 Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00 7,20 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 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 - Inspection of existing plumbing or each additional $100.00 or fraction thereof to 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. Commercial Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing futures? 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 Quantity, by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: Replace engineer. 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 Riser 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 re ardnn fixture work: Disposal - Commercial - - S - lndustrial c../^e ea e1: r'.,C+ : 3 /ad0' e�/ Z+ 1r Ice Mach./Refrig. Drains / I Floc," S i A .k Oil Separator (Gas Station) ( a- . 3 ,I3eL , c , 1 H As . Rec. Vehicle Dump Station 1 6 l g1h Shower -Gang -Stan ) aA /urn /: ry ‘,'.. Sink - Bar/Lavatory J lt4,ttd Wig' 4, 5 1/.4- - Bradley *Note: If the future 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: is BuildinpiPenninu .M-Penlimm.doc 12/27/06