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Permit
CIT OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00501 DATE ISSUED: 10/7/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 25111 BA -00107 SITE ADDRESS: 14200 SW 97TH AVE ZONING: R -4.5 SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 028 JURISDICTION: TIG Project Description: Site Utilities: storm drain lines. Other items: (2) manholes. CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: 1 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 2 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: 286 ft Owner: FEES MBM HOLDING CO LLC PO BOX 120 Description Date Amount NEWBERG, OR 97132 -0120 [PLUMB] Permit Fee 10/7/2005 $197.60 [TAX] 8% State Sureha 10/7/2005 $15.81 [PLMPLN] Plan Review 10/7/2005 $49.40 Phone: 503 - 502 -7954 Total $262.81 Contractor: REQUIRED ITEMS AND REPORTS Phone : Reg #: 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 -6699 or 1- 800 - 332 -2344. Issued By: l r L � Permittee Signature: p < c-, c 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. i Site Utilities , Plumbing Permit AroigtieF IV ED City of Tigard Rece - ! Permit No.: � \ 13125 SW Hall Blvd., Tigard, OR 97223 c 2 Dat:BvY n t DD `�" a)5O5o / 8 Phone: 503.639.4171 Fax: 503.598.1960 5EF 2 t n Plan Re view Other Permit No.: 24 Hour Inspection Line: 503.639.4175 i Date /B 91 2 910 c ?w Internet: www.ci Lin 5 TY pF T1t. a I , ,,, .� I Date Ready y: JuJ C ©t � t, Notifed/Method1a ) QY�� 'ris1 la SeePage2 for r Supplemental Information TYPE VII WORK' FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total ❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ID 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: /4 2_[J - S ci 7 if £ Catch basin or area drain i 16.60 /6 , 6 0 City /State /ZIP: T 4,4 fi D 2_ ct 1 21 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: „ ,2,z,-1 pc...Ts Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street /directions to job site: 1 .- 13‘.....04.14 S 54.2 711 b f Manholes . 16.60 31 Zo f 4l/ .. r.. 4... Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: 266) Page 2 /17. 80 Subdivision: 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 S I 1 57 i.. (L( Li N ES Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 91 PROPERTY OWNER ❑ TENANT Drinking fountain 16.60 Ejectors/sump 16.60 Name: 1,,,, B Yt ulll 1 h) E a L' -0 L L C._ Expansion tank 16.60 - Address: ? Q i3 k 12.0 Fixture /sewer cap 16.60 City /State/ZIP: N 5 'F. pity + OIL. q 7 13 Z_ 0 i 2 o Floor drain/floor sink/hub 16.60 Phone: (5C'3) VS 2_. 79 S4 Fax: ( ) Garbage disposal 16.60 APPLICANT ❑ CONTACT PERSON Hose bib 16.60 s E_ t 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 Sink/basin/lavatory 16.60 Phone: ( ) Fax:: ( ) - Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: 5,4,„„f_._ A 4- L . Water heater 16.60 Address: Other: City /State /ZIP: Subtotal / 9760 Minimum permit fee: $72.50 Phone: ( ) / Fax: ( ) Residential backflow minimum permit fee: $36.25 / CCB Lic.: . Plumbing Lic. no.: Plan review (25% of permit fee) 4 9. 4-v State surcharge (8% of permit fee) / S. 91 _ Authorized signature: it/ 1 4/ / j TOTAL PERMIT FEE Z 6 2. 1 Print name: Date: 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 \Pennits\PLMU- PermitApp.doc 06/05 440-4616T(10/02/COM/WEB) t 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 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 g5. dt, $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 c r2. 8Q $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 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 f . 1.Bt� 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 1:1 Any new commercial building. Fixture Type: Replace ❑ Any new exterior plumbing site utilities. Previous Capped Added Existing El 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 - multipurpose fire sprinkler system. Eye Wash Floor Drain /sink - 2" Submit 2 sets of plans with any of the above. -3" -4" 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 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- PermitApp 07/06/05 r P • I I I TL 11300 ill • 112G0 \TL 11100 I • � 'I= ' •-; n t N 1 TL ? 1 5 /It ID' - STERY MANAGE LAMENT I ' r .2 , I o to T I . • I I '3 1 I r %' Spent LO75 1 -7 I I '' ..--,.-...4/1 �� - _- �-- . - - S TREET NOTES OFFICE N i I I jt: G 'I Co GG i ❑1 swam axe Q WATCH USING PAMENr FI u V PI a6 J /�/,,yl�� \� I lyj Si I Ii I 4 - WS ''� m 5T U +70.71 tHaVATE r I I I ❑3 STANDARD tLFB RAMS • 'L I:O' . CO TL . (f) 1 r.'_ r.'_ JJGG I I a • • 1 Cr 1 � W 2S7 ( - . ` 90 2,r 00 , m Z17.79 1 sik 1+6/.E4 1Y Rr 1101, 1101, (£pl' \\ "YYl/ U � II _ i EWR 71100 • TE U7FRLL E OUi: 9.7 /• PK 0 � 1Qt �1RB IRAN9TIOM. - • • 202 ICE 1 ' - -J 7.7.1" ((PRIVAT 5 STk 7 71.76 It RT YM 0L' ED 1 3 s LF 4 P1t R ill 6D " DETEN 71 0 • 'IPE I R -7 I ❑ IQl USING TRANSOM. BATCH �� ' 3 J 0 b / 4._ 2.. 'N i �� Or 60• DA' M/ 2 i USING C CURB 0 30' 60' .. •-1 • f ` � l5 YATE STOW/ . R � • YEXi�. �� 1 EACH ENO O SL.a +• 1 S TORY ORANAEE LAMBENT 1 I 3 �� 2 I I ❑ R6. 1Y nu m . YM BEPI .. W Q x - w m - ^_ __ __ -_ 6 STk OIIS = i--o I T :[111111 ...L /, fir - .Ti . BC BEN37T O' LOT 7 I I sTAIO.V✓0 Cllr$ NLL 91ED 13Tr I I TC Olt 77010 f ^ l i I " w 1p1 I I �� L I ❑7 FUTURE 5[ERAU! BY BLIDER fV/ LOW Z 11 I •'hi I 1. I PWVAIE UIERAL I F • r ' ^ �1 = 17 UIU1T EA3]ENi 10' UIl1T EASEMENT' m siStk. 01813.1 ,1 , m STA: 0+81.24 �1 81] EfeSRNE POE VA4T 10 FE ili07EC..71 INA+NG S 'ORM:IKN "1 6 M a I I I r0R 7lIE BF7E}]i Or rm THE 6ENEf1T CE I� nsm _ R6VATE UIERAL �� I ' L 8500 LOTS 2 3 1 LOT 1 E N I Ek 717.OD I ��B 1 I 9 813101E E7�iNE CL1.96 co t 3 I E N 1r7S1 SR.S4 750.17 � � r m STA: 0+817{ ! .1 I . ❑ � . Ti_ - x'•90• ' I G 1 i 1 i E OJT II } L � � PPVC i _¢ m NEW 5' w.w TO uA Tw E K EASING d I I P18YA1E LITERAL I PRIVATE UIERAL 3 O I S ' 11 cA 6081£ STk 2131.% YIN NEW S te \ I I 3 I KEEP t1OE m STA: 0.61.1 m STk 0+81.24 I 7 I Z y I ❑ R15LL 15' m1+ERau O6YC1YAr APPROACH & o tV II I E 76a0 '.• Px .: (LTg) I I 2 7 STk 1101.37. 11 ENO VALE ? -- " • u _ I C .I 0 PAC I U . 10 6 STk 4 +8128. 1B' L7 TIN i ~ IN6IE T/AT COVSigI Z�'o p ,_ • f- g V I I c 550ENA11( I SG 1125 ' �Of � ( ENO CURB YATCN E105TING. I� �+/ Fak CC I :ID) O6 I .1. �4 X I CB 11 =1 I Lr YIN 6" PVC ! Sik 1 +62.16 II' LT Y1N .� 9 ^� I w ! ' �j ! PoY; 261 I Stk. CLRB RA L b{3 6' NNE (T1P,) I 7 O II.7 Io 7 P�1c 6' PIIE ( T1P. I l0 t + .Yf a � es -as: I -- - � o I 8400 01 ® 1 0 0 x 995T13'E I 2 +00 3 +00 ©4 + DO © � _� _ __ -- • __ TL S GO I + 7, , - - I T Z 1 al CAI 0.• Z Oa c -E _ T ,� SW MOUNT VI EW -�� ®�� Stk. o.mm S 9701 CW I I Iy TL 11800 U m w (08 IDs) TL 11800 L 1200 I o Gt. Q ig cr I P © TL 11966 Sik 1{71.65 ,I O I 3 I OE5107 PNi I PoMi E YA/Ol 3 CJ 1-1-1 Q Z W I = I i 4 Z. ar W N o Li PVI STA = 0 +67 G. 8 .C� Q 3 p o PVI ELEV - 268.71 CO ¢ AC A.D. = -2.25 8 ? o K =2219 PM STA = 1 +65 8 � Q PVI ELEV - 263.07 ~ m © / O I A.O. 2.83 V� 2-C 76•Zo Z M 'd' L I ; - 50.00' VC - E s K =31.77 13g I Q I 61E DISTANCE STANrI PONE AT y S R 90.00' VC I J 97M 4.15 AImow STITFFi.� E 8 R v p N n PVI STA = 3 +32 •� �� m 9 47 j } W q N 900 900 INSTANCE PONE AT PVI ELEV = 258.19 ! O ib .. > U °+ N h AO NTF)L4CM!N F1 VAil01 A.D. = - 1.44 m m N m IS' TROY RTAV41 LAZE I K 69.50 272 I I^ -- ' I I I > L, a .0 1 • E I I I 100.00' VC -1 I I I I I • I ! I i N i 268 .. N I - ,,, W L. 1 J EC •C l ii �X m i j rcaC/L j • IA N -,.-11111111/4, W I., N 264 U U m illin iii i m _ _ I 1 a 260 __- M� OFFICE COPY CI 256 1 ' • • I INSTANCE PONT AT � - � - . 75U' 175 KIM STREET. 252 I ���0- II~ , � y op T!VARQ • • 248 � `��� • �n� �.�.., �L proved ��; F o W I � ( - - _ For onf t e wo k as described in -- • suit r . a' Nat I -_ ' r °' M ' a 244 _T. �.. }`) c - IVld i- � .", - - _ _ T'f -� .�.Q tW� '� t �� - 1 a C Lai ti Se: Lett -rto: F•tlo . ........ ....[ j. DATE I 8/15/05 OA TN/ EL I I I I I I I I I i _ A tar l :. 10111111111111 .1 '[ ENOINEERI S ROPER 2400° Job address m ,_N 1 `m °^o co. 1 p rO1 .- o n � " ,y • ° N� �� �� �� o o Nm �^ ° o n ® s' s xY a . �4 �i ' I SHEET 11ThE o n R F •_� • > rr �S t,6 I � -1 Date: /V . ' / /ry B E � C • HE p CKED p,I H N � N H IV H IV. �N NN N N N N N �.•��. `%� II�'6 � ` .' -..._ VC3te: / / % /! .]7117 /STI M 0 +00 1 +00 2 +00 3 +00 4 +00 5 +00 6 +00 SHEET HUMBER C100 CITY OF TIGARD _ .. I- / /�1 BUILDING DIVISION E PERMIT #: w S"" /9 e"r` l 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 // nir��Nhuyp; %hihi\ Inspection Requests (24 Hrs.): (503) 639 -4175 .. ' __.. INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: / - 4 / 23 0 0 kV 14 ? t � � CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Des ' • n Confirm Contact Message ,:10 5o2f pit Corrections /Co ents In ructions: 4....e_____ •.,7•7, 0..) k ASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS I I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED r L �,�6� 1 Inspector: i "\I( l '��,/ Date: !J v Phone #: (503) 718- 131 • Inspections Required for: PLM 12005- OO,SOJ .. Code Inspection Description I PASS Date I By I ✓ Code Llnspection Description I PASS Date I By BUP - Building Permit ELC - Electrical Permit 405 Excavation 105 Underground/slab cover 410 Fill 110 Temporary electrical service 415 Grading 115 Electrical service 205 Footing - 120 Electrical rough -in 805 MFG - Structure grading/footing 125 Wall cover 210 Foundation walls 130 Ceiling cover 215 Footing drain 135 Low voltage 220 Slab _ 140 Sign installation 3 10 Crawl drain 145 A/C or heating unit circuit 225 Post/beam structural 150 Hot tub /spa/pool 230 Underfloor insulation 195 Misc. inspection: 235 Shear walls /anchors 199 Electrical final 240 Exterior sheathing 245 Firewall 250 Roof nailing _ ELR - Restricted Energy Permit 255 Wtr proofmg basement walls 135 Low voltage 260 Tilt -up panel 195 Misc. inspection: 265 Masonry 199 Electrical final 270 Reinforcing steel (rebar) 275 Framing MEC - Mechanical Permit 810 MFG- Structure set -up 280 Insulation 605 Post/beam mechanical 285 Drywall nailing 610 Gas line 287 Suspended ceiling 615 Mechanical rough -in 295 Misc. inspection: _ 1 620 Hydronic piping 899 MFG- Structure final 625 Duct work 498 Grading final _ 630 Fire damper 299 Final inspection 635 Smoke detector shutdown — 640 Exhaust hood J 695 Misc. inspection: 699 Mechanical final BUP - Fire Protection System Permit 905 Sprinlder underfloor /slab PLM - Plumbing Permit 910 Sprinkler rough -in 305 Plumbing underslab 915 Fire alarm rough -in . 310 Crawl drain • 920 Suppression trip test 315 Post/beam plumbing 995 Misc. inspection: 320 Plumbing rough -in 998 Alarm final 325 RP/backflow preventer 999 Sprinkler final . 330 Water service 335 Rain drain 340 Storm drain SIT - Site Work Permit 505 Sanitary sewer 405 Excavation _ 345 Culvert/catch basin 410 Fill 350 Septic tank 415 Grading 395 Misc. inspection: 205 Footing 399 Plumbing final • 210 Foundation walls 215 Footing drain 420 Sprinlder supply lines SWR - Sewer Permit 495 Misc. inspection: 505 Sanitary sewer 498 Grading final 595 Misc. inspection: 499 Final inspection 599 Final inspection I : \Building\IVR\InspCard- BUP.doc 04 /06/04 CITY TIGARD PLUMBING PERMIT 4 . 4 i DEVELOPMENT SERVICES PERMIT #: PLM2005 - 00501 '•, DATE ISSUED: 10/7/2005 13125 SW Ha+l Blvd., Tigard, OR 97223 503 -639 -4171 PARCEL: 25111 BA -00107 SITE ADDRESS: 14200 SW 97TH AVE ZONING: R -4.5 SUBDIVISION: TIGARDVILLE HEIGHTS LOT: 028 JURISDICTION: TIG Project Description: Site Utilities: storm drain lines. Other items: (2) manholes. CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: 1 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: - URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 2 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: 286 ft Owner: ` r LA FEES MBM HOLDING CO LLC V t � 6, (p/&6e scriPtion PO BOX 120 ). , Date Amount NEWBERG, OR 97132 -0120 / [PLUMB] Permit Fee 10/7/2005 $197.60 .A/,' � [TAX] 8% State Surcha 10/7/2005 $15.81 r [PLMPLN] Plan Review 10/7/2005 $49.40 Phone : 503 - 502 -7951 r ' 0 v, / �Iu Total $262.81 Contractor: ` � ' 111 ./'r c)o W REQUIRED ITEMS AND R - • 0 ok tp.,......, 71)2 „, ) , . , I 0 fib l eg #: • 01. a ir . of ,, • /� � it f , , , 0 • ,52pic ei m.„, . i 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 -6699 or 1- 800 - 332 -2344. issued By: "� � ; r" � 4. Permittee Signature: e p ,c f c3 1 .0 A 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.