Permit CITY TIGARD PLUMBING PERMIT
#: PLM2006-00010
i, DEVELOPMENT SERVICES PE
w. � � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/9/2006
PARCEL: 2S 113B0 -00600
SITE ADDRESS: 16580 SW 85TH AVE ZONING: I -P
SUBDIVISION: SEWER TREATMENT PLANT LOT: JURISDICTION: TIG
Project Description: Pipe replacement, vents and drains.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: H7 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: 200 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CLEAN WATER SERVICES Description Date Amount
2550 SW HILLSBORO HWY
HILLSBORO, OR 97123 - 9379 [PLUMB] Permit Fee 1/9/2006 $101.40
[TAX] 8% State Surchart 1/9/2006 $8.11
Phone : 503 - 681 - 3600 Total $109.51
Contractor:
CASCADE MECHANICAL SYSTEMS INC
PO BOX 399 REQUIRED ITEMS AND REPORTS
ESTACADA, OR 97023
Contact # : PRI 630 - 4492
Reg #: LIC 127012
PLM 3 -324PB
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 to OUNC by
calling 503 - 246 -669• or 1 • • . / / /
Issued By: Permittee Si nature: . 14
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that bus Rs 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 - 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
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 55 7,201 and greater _ $309.00
Sewer - each additional 100' 46.40 1,[ fib
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 Back flow 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: 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 buildin •
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 the food service area
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
-Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor p
Water Closet - Toilet 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- PennitApp.doc 07/06/05
Building Fixtures ' ^ •
Plumbing Permit Application ON1011f18
JO AIIO
City of Tigard t j Received D 3 U 2LZ , _ b0
n 7 Date/By ' Permit No. (� /a
13125 SW Hall Blvd., Tigard, OR 97223 9002 NF\I Plan Revie
Phone: 503.639.4171 Fax: 503.598.1960 DateBy Other Remit No.:
24- Hour Inspection Line: 503.639.4175 .a_1a 'L I Date Ready/By: run' 65 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I 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
❑ I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: ( <. $' 8 O 5 (c..„; g ,s ' Catch basin or area drain 16.60
City /State /ZIP: Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Cezae Gt/Cik Jam✓ /t Footing drain (no. linear ft.: ) Page 2
` Manufactured home utilities 110.00
Cross street /directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.:Z, ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK 1-40114. Backflow preventer Page 2 121) f � riLt P «Je' 7-lah ?, , 4 Backwater valve 16.60 -
121) t Ve� �� a''t /iS Clothes washer 16.60
-
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
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: ( ) p er:: ( ) Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60 -
Business name: CiGf.SGelc2 7)2edi.GLL/i/ s 4 K /S S Water heater 1660
.
Address: �o tL 3 �9 Other:
City /State /ZIP: ": „e „ cv ` ' 7e' 3 Subtotal
Minimum permit fee: $72.50
Phone: (, 53) 630 - ,'%4 Fax: (. 3) 6 30 . - S ei Residential backflow minimum permit fee: $36.25 (0 • 9
CCB Lie.: ! as? 62(,, Plumbing Lic. no.: 3 - 3 2 Y! v Plan review (25% of permit fee)
State surcharge (8% of permit fee) may.
Authorized signature: TOTAL PERMIT FEE a /
Print name:: ey Al 6,-y Date : /_ r _05 1 This permit application expires if a permit is not obtained within
6 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Permita\PLMF- PermitApp.doc 06/05 440.4616T(10/02/COM/WEB)
CITY OF TIGARD ■
BUILDING DIVISION PERMIT #: PLM200( -00010
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1 /9/2!10t?
Phone: (503) 639 -4171 A llit
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' ' I �..
INSPECTION WORKSHEET FOR DATE: 6/5/2006 TIME: 1:02AM PAGE: 74
SITE ADDRESS: 16580 SW 85TH AVE CLASS OF WORK:
SUBDIVISION: SEWER TREATMENT PLANT LOT #: TYPE OF USE:
PROJECT NAME: CLEAN WATER SERVI(MS
DESCRIPTION: Pipe replacement, vents and drains.
OWNER: CLEAN WATER SERVICES, PHONE #: 503-
CONTRACTOR: CASCADE MECHANICAL SYSTEMS INC PHONE #: 630.4492
Inspection Request Scheduled For: Date: 6/5/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Pluinhinq final 03104401 3- 1.1 8221 Y
Corrections /Comments/ Instructions:
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` PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / 7'??) -e- Date: / Phone #: (503) 718-
CITY OF TIGARD
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BUILDING DIVISION
Alio PERMIT #:14-12D(76'*-- 0 0 0 / 0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639-4171 .tlipivilllilil‘\
Inspection Requests (24 Hrs.): (503) 639-4175 ,--'-gfr --.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / 475V7 g-51 1- \ Ave_ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: „---- PHONE #: ) 222-1
CONTRACTOR: J CLS- PHONE #:
Inspection Request reduled5or: Date: q 7- oco Pour Time:
Code # Inspeen Description Confirm # Contact # Message
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Corrections /Comments/ Instructions:
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S OASS PARTIAL APPROVAL fl CANCEL 0 NO ACCESS
n FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: i T / ) I 4 Date: 11 / VI Phone #: (503) 718-
CITY OF TI ARD
C G • BUILDING DIVISION
_ PERMIT #: 01^ > 013 4 0 -000 D
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 / �wh/ /1 lhl I �A
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Inspection Requests (24 Hrs.): (503) 639 -4175 ' 6 ''
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: j (o5 g, /AN' e- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:"? )) S ?)- -2
CONTRACTOR: S ke PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections /Comments /Instructions:
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❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ntlie) Date. v 1 / Phone #: (503) 718-
CITY OF TIGARD , ` , •
BUILDING DIVISION PERMIT #: PrV2DO(o DO /0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 4, 1 19� �i
Inspection Requests (24 Hrs.): (503) 639 -4175 .....,4-
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS:. b O J M.__ _ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: -- -.
DESCRIPTION: f
e OWNER: --e" ' c ,� PHONE #: Sb3 -5 V
CONTRACTOR: a7�J`evt PHONE #:
Inspection Request Scheduled For: Date: j — ��.-- 0 co Pour Time:
Code # Inspection Description y. Confirm # Contact # Message
3D ; 33-O � ` �` ---`
C orrections /Comments / Instructiopps:
P+ -ASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
Li FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: n) Date: - A Phone #: (503) 718-
CITY OF TIGARD ' • , •
BUILDING DIVISION 7 PERMIT #: PL +M2006 -00010
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/9.0.006 ����
Phone: (503) 639 -4171 i 4 , ^,u,,, ,,
Inspection Requests (24 Hrs.): (503) 639 -4175 - ' �!,
INSPECTION WORKSHEET FOR DATE: 2121/200£ TIME: 7 :02AM PAGE: 76
SITE ADDRESS: 16580 SW B TH AVE CLASS OF WORK:
SUBDIVISION: SEWER LOT #: TYPE OF USE:
,�f_'W"f.:R TREATMEN r PLANT
PROJECT NAME: CLEAN WATER SERVICES
DESCRIPTION: Pipe replacement, vents and drains
OWNER: CLFAN WATER SERVICES, PHONE #: 503 6t31 - :i >t Cl!
CONTRACTOR: CASCADE MECHANICAL SYSTEMS INC PHONE #: 630 -4492
Inspection Request Scheduled For: Date: 2/21 /2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
20 Plumbing rough•in 027216.01 503.572.8221 I
Corrections /Comments/ Instructions:
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V PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: 4 f✓ Date: / Phone #: (503) 718 -
CITY OF TIGARD .
BUILDING DIVISION • 4 PERMIT #: ; I_K ('):!!;?; i •' t' ±0 A
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ! z �';,;�;
Phone: (503) 639 -4171 f� I `
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 2/14201 ,, TIME: 0'2,44 PAGE: ii
SITE ADDRESS: T(;;- 0 SW 16TH AVK CLASS OF WORK:
SUBDIVISION: ;;I ' JF _I PL . A TM .NT,' PLAN 1 LOT #: TYPE OF USE:
PROJECT NAME: CLEAN WAFER SERVICES
DESCRIPTION: Pipio rephdti:::>st eiit, 'icnk ;A ;?1 + i<:zii) .
OWNER: (1, F . ik.N WA LJF , :3,I , It I `:, PHONE #: !1O k .
CONTRACTOR: A` *.. Ivril CI Ik:'AI_',; {1,d I: .Wt ` INC PHONE #: (, q) 'f
Inspection Request Scheduled For: Date: 2J4.000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
30',) : a 1.iiii :irvj Exndosl.ab 02( :ti 3 01 ::,4'13 0/! U2.>1 N
Corrections /Comments /Instructions:
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.1 ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
(l FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: Date: '! /� Phone #: (503) 718 -
/
CITY OF TIGARD P[-n1
BUILDING DIVISION - PERMIT #:ata2 -d06' d 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 „� 1 pmyp,q \p� I s i
Inspection Requests (24 Hrs.): (503) 639-4175 _W. •
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / 6._s 3S 4-4 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: `l A
DESCRIPTION: 1"
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OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
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Corrections /Comments /Instructions:
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- PASS El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION [ ADDITIONAL FEES ASSESSED
Inspector: (/ Date: I ( I, L2 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION '�" - • ,,, PERMIT #: 1 1 tv1:)00: (? ;'s 1(l
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: },cli . ( );a(,
Phone: (503) 639- 4171vdgpNU
Inspection Requests (24 Hrs.): (503) 639 -4175 _. �,� __..
INSPECTION WORKSHEET FOR . DATE: 1/11/2006 TIME: 7:01AM PAGE: /2
SITE ApDRESS: 16680 SW 86TH AVE CLASS OF WORK:
SUBDIVISION: SEWER TREATMENT PLANT LOT #: TYPE OF USE:
PROJECT NAME: CLEAN WATER SERVICES
DESCRIPTION: Pipe replacement, vent: and drains.
OWNER: CLEAN WATER SERVICES, PHONE #: f5O3681- 4,01)
CONTRACTOR: CASCADE MECHANICAL SYSTEMS INC PHONE #: 630-4492
Inspection Request Scheduled For: Date: 1/1112006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing undeislab 024746 -01 603-572-8221 Y
Corrections /Comments /Instructions:
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❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: v �j
pector: D ate: 1/ l / ✓ Phone #: (503) 718 -
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