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Permit
CITY OF TIGARD PLUMBING PERMIT 1 DEVELOPMENT SERVICES PERMIT #: PLM2003 -00326 'VIII DATE ISSUED: 12/15/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15750 SW 98TH AVE ADM. BLDG. PARCEL: 2S111 CD -00300 SUBDIVISION: ALDERBROOK FARM ZONING: R -7 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2 OCCUPANCY GRP: A2 FLOOR DRAINS: 1 TRAPS: STORIES: WATER HEATERS: 2 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: 9 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 2 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing for new administration building. Other fixtures: 2 hose bibbs, 6 roof drains, 1 primer. FEES Owner: Description Date Amount TIGARD CHURCH OF GOD 15670 SW 98TH AVENUE [PLUMB] Permit Fee 12/15/03 $390.60 TIGARD, OR 97223 [PLMPLN] Plan Review 12/15/03 $97.65 [TAX] 8% State Tax 12/15/03 $31.25 Phone : Total $519.50 Contractor: WESTERN PLUMBING 9460 SW TIGARD STREET TIGARD, OR 97223 REQUIRED INSPECTIONS Phone : 503 Sewer Inspection Water Service Insp Reg #: LIC 2439 Top -out Insp PLM 34 - 29PB Storm Drain Insp Storm Drain Insp Rain Drain Insp RP /Backflow Preventer Final Inspection 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 / C{ ale...#(14 Issu By: � (� Permittee Signature: x/ Z4/1 i Call (503) 39 -4175 by 7:00 P.M. for an inspection needed the next business day Accumulative Sewer Tally Tenant Name Tigard Church of God This SWRta 2003 -00301 Site Address: 15 98th Ave. This PLM# 2003 -00326 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 0 0 0 - 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 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain /Sink - 2 inch 2 0 0 0 0 0 - 3 inch 5 0 0 1 5 1 5 - 4 inch 6 0 0 0 0 0 - Car Wash Drn 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 0 0 0 Sink - Bar /Lavatory 2 0 0 2 4 2 4 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 1 3 1 3 - 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 2 12 2 12 Urinal 6 0 0 0 0 0 Previous EDU Count 5 80 80 Capped EDU Credit 0 TOTALS 0 80 0 0 6 24 6 104 Current Fixture Value 104 divided by 16 = 6.5 Current EDU 1 EDU = $ 2,400 Previous Fixture Value 80 divided by 16 = 5.0 Previous EDU Change 24 divided by 16 = 1.5 over (under) $ 3,600.00 Enter EDU Change Here 1.5 HISTORY Previous EDU ct. from water PLM# EDU# SWR# department/Jaime PLM# EDU# SWR# PLM# EDU# SWR# Name: ‘,/ � // j A dt _ , /�L Date: –.:9 —& , Signature of person that calculated this tally sheet and date perfromed is required Building Fixtures )1I) f fr ` S 6 e_e h 4 - '7 --.22/e2 Plumbing Permit Application Received Plumbing �, Date/By: 7 7 0 7 Permit No.: r !a/ p 5O'3 3 Planning Approval Sewer City of Tigard p 2403 DatDate/By: Permit No.S •002.0 / J UL 13125 SW Hall Blvd. Plan Review Other r �D� -cle,307 - Tigard, Oregon 97223 ` 0 y of Date/By: : Permit No.. Land Use r'IT $ 9 1GAR� Post - Review /� n Phone: 503- 639 -4171 Fat 196( 110; //,, r - GbS� , � ( � i \ Date/By: Case No .: Internet: www.ci.tigard.or.us ' .' Contact J� .: ® See Page 2 for P Request: V - 24 - hour Inspection Re uest: 503 - 639 - 4175 Name /Method: / l6. Supplemental Information. ` TYPE OF WORK. '` , FEE* SCHEDULE (for special information use checklist) ❑ New construction ❑ Demolition Description I Qty. I Fee(ea) I Total ❑ Addition /alteration/replacement 0 Other: . New 1 - & 2 - family dwellings . netudes 100 ft for each utility connectio f lk.V. :, CATEGORY OFCONSTRUC� :, , .` _�! SFR (1) bath 249.20 ❑ 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 ['Accessory Building ❑ Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Fire sprinkler • ft Pare 2 Job site address: i 571C i4'l/Z✓l1 / 7764-/Q, , , . , ' ,.. . ` . : ,-. ' ° _ s's ' 71' „ 1 : Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: 4 /w /i(/ /,pJ,� Q�t/ ,80/40/A0 DrywelUleach line /trench drain 16.60 Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: 774,rd C ! Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: Water service (no. linear ft.) Page 2 ' - Fixture or Item DESCRIPTION OF WORK .` Absorpt valve 16.60 A 2 NOW AVM/AlaTA/E774A Backflow preventer _, , /(,, , /U A.XO Page 2 2. 9V / /17( nb/t ► ci/)Xfz// Qi Backwater valve 16.60 Clothes washer 16.60 0 �� Dishwasher 16.60 a Drinking fountain 16.60 PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60 Name: 77134-N otagem Of s 29 Expansion tank 16.60 Address: /6,7B 51,) feaw #l/GN(/o F ewer cap 16.60 - Amy . City /State /Zip: niv DIe 97 _ ( loor dr floor sink/hub 0" / /(e. 6,0 16.60 l / / e disposal 16.60 h Phone: Fax: Hose bib 2 ,,f), ,4^ 16.60 it APPLICANT "_.c - ' . ": 1, 0 ,u - `" 5 ` Ice maker 16.60 Q Name: Interceptor /grease trap 16.60 0 Address: Medical gas - value: $ Page 2 0 Primer ✓ &.Zw 16.60 p City /State /Zip: Roof drain (co rcial) _ 1 / q9 60 16.60 G Phone: ,2-2,9- -915T I Fax: Sink/basirQlavatory 3 / ??, 16.60 2 E -mail: Tub /shower /shower pan 16.60 0 1 ,t . . o2 i . i. :Mr . - Urinal -16.60 0 P l q Water closet /33.2o 16.60 Business Name: t �i�r,Qi1, � Ltt//�fJ�,(�' Water heater Address: 9yl o ate, 1 � - at - /a / ,/3,2O 16.60 A Other: City /State /Zip. 42a Dd- 9 72 - 2 - 3 Other: pl P F ee s Phone: x7 - lv3`j• - 6 5 Fax: (08 q/ - 9e/ Subtotal $ 39 D, In0 CCB Lic. #: 0 1437 Plumb. Lic. #: 5y , Aq�$ Minimum Permit Fee $72.50 $ Authorized # Residential Backflow Minimum Fee $36.25 Signature: / 1 . / Date: 7 u 6 _) Plan Review (25% of Permit Fee) $ Ql•evS State Surcharge (8% of Permit Fee) $ a1, (Please print name) TOTAL PERMIT FEE $ 5/ 9, Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri- County Building Industry Service Board. i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 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' 4 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' I 55 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 additional $100.00 or fraction thereof, to and Fixture or Item Qty. Fee (ea) Total 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 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 accuratel re 1 ort fixtures could result in increased sewer fees *. ?. 1 "(0.: " •■■ Comments regarding fixture work: a m . fi e ; v5 . N f„,- 6,„-,..,. LI: f., ■. `. 11 Ba.tis /Font - - -- Bath - Tub /Shower - - -- - Jacuzzi/Whirl...l - - -- Car Wash -Each Stall - -IMMIMK_ -Drive Thru - - --_ Cus.idor/Water As.irator _ - -IM_ Dishwasher - Commercial -' =MI - Domestic -_m/M7NENO-ME Drinkin: Fountain __III___ E e Wash __MIEW__ Floor Drain/sink - 2" _-IMMINIEW-4- - 3 MMINNINI MIMI - _111-111__ Car Wash Drain ∎_ /- Garbage - Domestic -_ rF- *Note: If the fixture work under this permit results in an _ Disposal - Commercial - 11W_ 4 increase of sewer EDUs, a sewer permit will be issued and - Industrial . - _MICA fees assessed for the sewer increase must be paid before the Ice Mach. /Refri:. Drains �__N -M plumbing permit can be issued. Oil Se.arator Gas Station ,- -- Rec. Vehicle Du . Station -_ - - - Shower -Gang /BEM -Stall Mill Sink - Bar/Lavatory _- - - Bradley - -A - Commercial - WIWI - Service -_ I Swimmin: Pool Filter - - -- Washer - Clothes - - -- Water Extractor - - -- Water Closet - Toilet _ - -- Urinal - - -- Other Fixtures: - - -- . iADsts\Permit Fon s\PlmPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP c9,Oo3 - 663K' 7 Received Date Requested /1 AM PM BUP Location 4.0L-e. _Suite MEC Contact Person Ph ( ) �d � f ` c C Q" Contractor 4.1-V Ph ( ) SWR BUILDING Tenant/Owner ./ -1 A ` ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Ailif Storm Drain Shower Pan / — / Other: ma PART FAIL CHANICAL 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: 111 Unable to inspect – no access Fire Supply Line ADA Approach/Sidewalk Date 1 Inspector © � /% 7 i� Ext Other: Final DO NOT REMOVE this inspection record from the Job site. P 1 PASS PART FAIL