Permit • CITY OF TIGARD PLUMBING PERMIT
Ls �� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00054
c + 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/23/04
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE PARCEL: 1S133AD 02200
SUBDIVISION: ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: 2 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 3 GREASE TRAPS:
LAVATORIES: 9 OTHER FIXTURES: 3
TUB /SHOWERS: 4 SEWER LINE: ft
WATER CLOSETS: 4 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: bldg. fixtures for new building.
FEES
Owner:
Description Date Amount
WESTGATE BAPTIST CHURCH
12930 SW SCHOLLS FERRY RD [PLUMB] Permit Fee 2/23/04 $431.60
TIGARD, OR 97223 [PLMPLN] Plan Review 2/23/04 $107.90
[TAX] 8% State 2/23/04 $34.53
Phone : Total $574.03
Contractor:
KEVIN SHARPE PLUMBING
3851 SW CULLEN BLVD
PORTLAND, OR 97221
REQUIRED INSPECTIONS
Phone : Rough -in Insp
Underfloor /Underslab
Reg #: LIC 112898 Top -out Insp
MET 00004632 Final Inspection
PLM 26 -593PB
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.
Issued By: " Gf�f� 4 Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit i e FOR OFFICE USE ONLY
ED R eceived /--�
City of Tigard DateBy:a - 7 -O V /45, Permit No.: t� l y� 2ooL/ -(N
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review e �r I „ 1 v I s cj
Phone: 503.639.4171 Fax: 503.598.1 o DateB � Other Permit No.:
24- Hour Inspection Line: 503.639.417 �B 9 2004 urn ,' hV� (
P �' 6.1 n �rte � Date Ready / � (,Ol/ Juris: m See Page 2 for
Internet www.ci.ttgard.or.us CITY OF Nohfied/Metlto ) £ Supplemental Information
s ' t f � 1 � ° . y M c4 L ni n visroly � ti4(? i u ,.. ,v�i� 1 -A yy! . F o r s r ec aEEt information - ., .› checklist.
t t �PJ�
� � SCHEDUL
'New construction ['Demolition P f ist.
Description Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
r : ±, ?a: f3 . :. :.s.. h�zxk : = :a*a =;ara =:x;�.. .,rre e� m�
�� u,'i ' ' . CATEGORYOFCONSTRUCTION r SFR (1) bath 249.20
❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
; r. 4. .r:s_ , .,., > er ao,x 'n sa sr r :: :r , °ate, =:r..::a„ _ Fire sprinkler ( ft.) Page spri kl r 9 s. ft. a e 2
' R . �T�4 ' :FJOB SITE$l INFO AND h r L ® ATIO L r,
,4.. -, -.- ,Hitt .,.- ,, _ . .t .' Site utilities
Job site address: 07 `.'3Q SLD /00 /Weft. Catch basin or area drain 16.60
City/State /ZIP: --- O e. co 7. z 3 _ Drywell, leach line, or trench drain 16.60
J
Suite/bldg. /apt. no.: 1 Project name: F` . Footing drain (no. linear ft.: ) Page 2
Vv FS� k C f i X51 Manufactured home utilities 110.00
Cross street/directions to job site: 1 . 30 - i - \e‘
Manholes 16.60
Rain drain connector 16.60
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
Fixture or item
Tax map /parcel no
Absorption valve 16.60
, ` ? . DESCR OF WO £ ,{ a : , h ° M - 1 Backflow preventer Page 2
S c - k Q U i CiJ I n Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
gae Drinking fountain / 16.60 6
„ cf . 1 ®��ROPER'O WNER . ,.. I IL -„,,,60 ..s ..,N. .,, , } TENANT . > x = re. 6
Ejectors /sump 16.60
Name: (, 3 F5 C Te 1 C r11) iZ C irk Expansion tank 16.60
Address: k 'z e 30 5 t, S G KeiW c Cs p_t2 )/ R Fixture /sewer cap 16.60
City /State/ZIP: krt t lj,� L" ci 7 z z 3 Floor drain /floor sink /hub a, _ - 16.60 33.70
Phone: (563) S Z y - 3 S 6 Fax: (SD s) $ zzi L s-60 Garbage disposal 16.60
M , Ra Hose bib ., 16.60 3 3_ 2 0
; , ,:-, `�', ; ,t a ® r P .s L � I T a . ,o rt , v j ; ® CO ON . .:.. Ice maker 16.60
Business name: (,� ` . - 1 FT l5 r Ctkt )2 614' Interceptor /grease trap 16.60
Contact name: 1/2,- U 1-1-6 Medical gas (value: $ ) - Page 2
Address: (Z9 - 30 SLJ 5G11d(-LS c1 (1V R1j Primer 16.60
City/State /ZIP: c G - D i d 12 e tJ 7 27- 3 Roof drain (commercial) 16.60
Phone: (,Q3) 5 7 Z - 7 3 S �. Fax: : ( )
Sink/basin/lavatory G) 16.60 y
Tub /shower /shower pan q 16.60 6,6 . CZ
E -mail:
Urinal 3 16.60 riQ 9G
lfa. w q . tV a,,gam 1 1` r c ' ^ � * CONTRAC ' oV . QR � 4 : , , �; Water closet =( - 16.60
Business name: .K cV i►J p Sk_k k.a p . P( t1,n f31 vo G Water heater 1 > 16.60 It , ( Q
Address: 3455 ( 5 to CvLLttJ Other: •
_ Subtotal g3/.6Q
City/State /ZIP:
0 'p , "/- (- to.) iJ 04,6 r 17 Z 1 Minimum permit fee: $72.50
Phone: ( 502) z cj 3 131 L I Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lie.: (, i Z c v/ "(1 ,0 Plumbing Lic. no.: 5 I 9 `1" IP I Plan review (25% of permit fee) / 07.. g permit 3 7 l ) .
�� 1 1 � ' � S tate surcharge (8% of ermit fee /,� �
Authorized signatur < "L 4, S ' i ;5 r �� 7 _
r t� r- 7 / - -5e f TOTAL PERMIT FEE 57(1.
1 Print name: 2 Q / j U .�� Date: 2 _ �� _ O H 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\Permits\PLMF- PermitApp.doc 12/03 440- 46t6T(10/02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
:; ';'i• .sm ti 4ie. • +e C �:fl'; r.t=", �' , ,e ,.' , ti ,'' : . ,
S1te�Ut111125 Qty .' 1 sFee( r T e' S'qp Ore I±ootage „ t Pernnit Fee
w„ 5 3'.. :a%3 h�+s.�. axak rsa., m ,. d e . , - _ » C +, , �, . a
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' 1 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 : ;fit: a i ; Er- .,- r ;' ',:' .? "
Valuation.. f v ,Permit Fee.; `; k
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
* r t F (ea)k �Total� additional $100.00 or fraction thereof to and
`' "Fl%tll)eOIIteII3 �, Q y including $10,000.00.
GYo. aka va �•�+vw.. > € 't f✓ i :�
Commercial Back Flow Prevention Device j 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
��,� Quanta tiy(Ftxture)WorlcPerformed`
4Fiiti re'T}' e °# t �", '�' - �` 'a. Replace -'$ t
� N ew M . k using Pp a Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru \
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain /sink - 2" r
•
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
• -Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice MachtorfG Statio n)
. at
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Oil
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar /Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PernutApp.doc 3/03
,
Accumulative Sewer Tally Parcel # 1S133AD -02200
Tenant Name:p/estg`'ate Babtist Church This SWR# 2004 -00068
Site Address: 10730 SW 130th Ave This PLM# 2004 -00054
•
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 4 16 4 16
Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 2 4 2 4
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drr 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 C 9 18
Sink - Bar /Lavatory 2 0 0 . 4/ ''0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service .3 0 0 0. 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 4 • 24 4 24
Urinal 6 0 0 3 18 3 18
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 0 0 23 81 23 81
Current Fixture Value 81 divided by 16 = 5.1 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU .
Change 81 divided by 16 = 5.1 over (under) $ 12,240.00
Enter EDU Change Here 5.1
Notes:
Signature: st rV ak k.. 4 v gig / Date: / 2
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
is \Building \Sewer Tally \SewerTallySheet.xls 11/19/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7/94-- AM PM BUP
Location 107 30 SC( .3 Suite �j MEC
Contact Person " Fat MO Ph (( ) £5 7z- - 7 3 V `-- PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: /
Ftg Drain ELR
Crawl Drain
Slab • Inspec ion ' otes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler Air
Fire Alarm
Susp'd Ceiling / ��'� `. �'L-
Roof Mr"
Other: (Th4
Finale..-
FAIL
L ING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
. ELECTRICAL
Service
Rough -In
UG /Slab •
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date Tiviop G Inspector Ext
Other:
Final . DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL