Permit CITY TIGARD PLUMBING PERMIT
16' DEVELOPMENT SERVICES PERMIT #: PLM2001 -00234
' �' I- � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/7/01
SITE ADDRESS: 06855 SW BAYLOR ST PARCEL: 1S136DD-01300
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: ?
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: B 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: 100 ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: 300 ft
Remarks: Site utilities for new commercial building. Other fixtures are (2) manholes.
FEES
Owner:
Type By Date Amount Receipt
ESLINGER BUILDERS PRMT CTR 8/7/01 $400.40 27200100000
11575 SW PACIFIC HWY PLCK CTR 8/7/01 $100.10 27200100000
TIGARD, OR 97223 5PCT CTR 8/7/01 $32.04 27200100000
Phone 1: 503 - 245 -9773 Total $532.54
Contractor:
ROME PLUMBING INC
17295 SW EDY RD
SHERWOOD, OR 97140 -8709 REQUIRED INSPECTIONS
Sewer Inspection
Phone 1: 625 -1452
Reg #: LIC 96346 Water Service Insp
PLM 34 -265PB Storm 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 Utility
Notification enter. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You :y obtain c• •ies of th- - rules or direct questions to OUNC by calling (503) 246 -1987.
•
Iss ed By • IfM �l PermitteeSignature: AS
Call (503) 6 • -4175 by 7:00 P.M. for an inspection needed the next business day
05/22/01 TUE 09:38 FAX 503 598 1960 CITY OF TIGARD l�juub
�- L AI-) c, i -- S) -9e i Wfr
•
Plumbing Permit Application
Date received: / ) 7 Permit no .0 `11 2 / -DOM ( k
• te ; ' ' City of Tigard ` �
ty Sewer permit no.: Building permit no.:
` ' , - Address: 13125 SW Hall Blvd, TigarI, OR 97223
Ciry ofTigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: ��
a
Fax: (503) 598 -1960 Date issued: B I Receipt no.:
Land use approval: SD 20c.) -coo ,..1.-1- Case file no.: Payment type: _
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 14Commt:rcial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Additicn/alteration/replacement ❑ Food service 0 Other:
1011 SI fE INFORMATION FETE SCI1EUhI:1 (fur special information use checklist)
Job address: Alba Go2/V /.9 E2 4y/:0/2 Sr 3- 68 7 r Description Qty. Fee (ea.) Total
'kR�� New 1 -and 2- family dwellings only:
Bldg. no.: (D ?6 5 Suite no.: ('includes 100 ft. for each utilityconoection)
Tax map /tax lot/account no.. /5/ 360/) /3o0 f /yo o SFR (1) bath
• Lot: IB1ock: Subdivision: SFR (2) bath
Project name: 5/•IY1.0F eexiA r ofRCF /3 v /1?2 /J6r SFR (3) bath
—Description 776 ZIP: 9 72 2-3 Each additional bath/kitchen
Description and location of work on premises: 5/T /c/r /. 5 Siteatilities:
. Catch basin/area drain / / ( • ( Q o
• Est, daft. of completion/inspection: SGT 2 / Drywells/leach line/trench drain
• Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: Manholes .4 3' �
Address: Rain drain connector •
City: I State: PIP: Sanitary sewer (no. lin. ft.) /pp i 55;
Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.) , 3jjp 1 / rD
CCB no.: Plumb. bus. reg. no: Water service (no. lin. ft.) /06 / S-
Fixture or item:
City /metro Ilea no.: Absorption valve
Contractor's representative signature: Back flow preventer eon Hat., , y • to
Print name: D1,te: Backwater valve
CONTACT PERSON Basins/lavatory
Clothes washer •
_
Name: Dishwasher .
Address: Drinking fountain(s) •
City: State: 2 IP: Ejectors/sump
Phone: Fax: E -mail: Ex ansion tank
OWNER . Fixture/sewer cap
Name (print): (56.14/ /e &u /GDE/S /NC. /7,9`1-60(4 ESmrGrd2
Floor drains/floor sinks/hub
Garbage disposal
Mailing address: /6 L) #4C/F /G 'y /Wig /60...___ Hose bibb
_City: 776-41-40 State:D/2 23P: 97223 Ice maker
Phone: 620- 95 I Fax: X20 -y + E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair matte by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: D<te: Sump
ENG NLFR Tubs/shower /shower pan
Name: /9/6 �•�/a /rr.rG £ , sT/tY- /f=GX //v/t ' Water Water closet
Address: /39/Q St-) GA -L13/L W/J/1 / SQ /7/5 /00 Water heater
City: ��,4,✓00.O I State: O2 ::IP: 9 7/ 5 - Other.
Phone: 925 -2799 I Fax:925_g91i9 E -mail: Total ..
Minimum fee $ /DO r VD
Not all jurisdcrions accept cleat cards, please call jurisdiction for mote in& rmatio Notice: This permit application Od , /�
❑ Asa MasterCard ex if a permit is not obtained Plan review (at-4._?,..: $ /
credit card lumber: ,_L 1_ S tate surcharge (8%) "" $ ,
Exp, res within 180 days after it has been TOTAL $ , '- • S - /
Name of cardholder as shown on credit card accepted as complete.
$
Arne 7nt 440.4616 (6/O0/COM)
s_ Cardholder Moat= J
TZ j 7 On i -
'PLUMBING PERMIT FEES:
pwp,. -.070.1-p.; ft•lelieta0 ,,,,: :,, :,:- i• , '.-,: : , 4 -. , , :
FIXTURES (individual) ;,.' `, = „- QTY. ' - (ea) - AMOUNT, ',(itiOlpitIfis'afilllyfittbitkifiiCP4*`In -,'''' - ° PRICE' : :'1 •.'
Sink 16.60 ,the41Wellititfaii**IffrObOIL CITY*, (0a) : '-=:AMODNT
Lavato 16.60 'fol'i4-Pff4ltilitiddiiriiaibre
ry
One (1) bath $249.20
Tub or Tub/Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60
SUBTOTAL ' • -
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 \ TOTAL
. .
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 '' , ' 'T '* ' . ■ , ' ' ' Quantity brWdrkTeifiormed ..%
Gas piping requires a separate mechanical - L''F0iiiire,TjiPp:' s ''';' -,'''' °:Neve,'-'1, ,-,.MoVOI,.1 ?Retilac6d,r . °Werri,oVe'd/
permit. _ ,,„;.: : . f .:.,,.,?, ,- , . .,. , -',': -: ..), ..,- - l '''' . -,'
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16.60 Dishwasher
&4b 0 6. 14-N .2 / 6 , 0:- - - - S 3 tY Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2"
Sewer - 1st 100' / 55.00 cS" ' 3"
Sewer - each additional 100' 46.40 4"
. Water Service - 1st 100' / 55.00 c5 ---- Water Heater
•
Water Service - each additional 200' 46.40 Other Fixtures (Specify)
Storm & Rain Drain - 1st 100'
/ 55.00 S r•-•'
Storm & Rain Drain - each additional 100' , z 46.40 0 4,0
-, '
Commercial Back Flow Prevention Device a 46.40 9 --L .Y0
Residential Backflow Prevention Device* 27.55
Catch Basin / 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if 10 .. ': ,',
Quantity Total is >9
* SUBTOTAL
900-9
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL ::; t ,
Required only if fixture qty. total is >9 ,.', ' , : A:, , , i. ' : : 1 v V ' Iv
TOTAL , ,,, : i! ,:-' $ -
. ,' ' e'"::' "- 3 7 , $3
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backfiow '
Prevention Device, which is $36.25 + 8% state.surcharge. .
*I,
All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i:\dstsVorms\plm-fees.doc 10/10/00
• Plumbing Application
Date received: P ermitno.:
x 1 City of Tigard � "`� � , `J y g Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date:
Fax: (503) 598 - 1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family U Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: SFR (3) bath '
City /county: I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: Manholes
Address: Rain drain connector
City: I State: I ZIP: Sanitary sewer (no. lin. ft.)
Phone: I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.)
_ City /metro lic. no.: Fixture or item:
Contractor's representative signature: Bac flow valve
Absorption
Back flow preventer
Print name: Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
Address: Dishwasher •
Drinking fountain(s)
City: I State: . I ZIP: Ejectors/sump
Phone: Fax: E -mail: _ Expansion tank
OWNER Fixture/sewer cap
Name (print): Floor drains/floor sinks/hub
Mailing address: Garbage disposal
Hose bibb
City: I State: . I ZIP: Ice maker
Phone: I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at _ %) $
❑ Visa ❑ MasterCard if a permit is not obtained
Credit card number: / / State surcharge (8 %) .... $
Expires within 180 days after it has been
TOTAL $
Name of cardholder as shown on credit card
accepted as complete.
$
Cardholder signature Amount • 440 -4616 (6/00 /COM)