Permit C ITY OF TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2001 -00433
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/6/01
SITE ADDRESS: 06855 SW BAYLOR ST PARCEL: 1S136DD-01400
SUBDIVISION: WEST PORTLAND HEIGHTS ZONING: MUE
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 4 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing work associated with new office building.
FEES
Owner:
Type By Date Amount Receipt
ESLINGER BUILDERS PRMT CTR 11/6/01 $166.00 27200100000
11575 SW PACIFIC HWY 5PCT CTR 11/6/01 $13.28 27200100000
TIGARD, OR 97223 PLCK CTR 11/6/01 $41.50 27200100000
Phone 1: 503 - 620 -9515 Total $220.78
Contractor:
ROME PLUMBING INC
17295 SW EDY RD
SHERWOOD, OR 97140 -8709 REQUIRED INSPECTIONS
Phone 1: 625 -1452 Rough -in Insp
Reg #: L IC 96346 Underfloor /Underslab
g Final Inspection
PLM 34 -265PB
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 folloVv rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
( 1,
sued By: A ArApt I / Permittee Signature: A^
Call (503) 639'4175 by 7:00 P.M. for an inspection needed the next business day
- -7 2) 7 T//
,,. Plumbing Permit Application
Allk
Date received: ?AP a/ Permit no.: 1 c9-.0,1 '3= 3
I '' City of Tigard
h ,�� 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.: . 4 rtl
Land use approval: Case file no.: Payment type:
rt.
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory f / Commercial /industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
// Q
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address:6 -s /bf -,-"5:14. Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1 and 2-family dwellings only:
Tax map /tax lot/account no.: /5136 L) b , goo f 40o (includes 100 ft. for each utility connection)
SFR (1) bath
Lot: 13-18 (Block: Z Subdivision:j(f Por tttSu �. - tie SFR (2) bath
Project name: y loaS- ('0 � . C SFR (3) bath .
City /county: ii re f I ZIP: 9'79 ,^ U Each additional bath/kitchen
Description and location of work on premises: ' P" 1t (CFid1C Site utilities:
Catch basin/area drain .
Est. date of contpletion/inspection: ,' ? Drywells /leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft:)
�" Manufactured home utilities
Business name: Rome 1 i)iw t 3_ _, c, • Manholes
Address: f 'Z,„� j ' r . .: Rain drain connector
City: 5V1�:(/'d.C State:J,. ZIP:
7/4.0 Sanitary sewer (no. lin. ft.)
Phone: 60,_c—m 6 2 Fax: • E -mail: Storm sewer (no. lin. ft.)
CCB no.: 9b 3+(. I Plumb. bus. reg. no: 34 — 9.42s PE Water service (no. lin. ft.) .
7 Fixture or item:
City/ tro ic. no.: '7 i ZZ Absorption valve
Contractor's representative signature: X 42 91 Back flow preventer
Print name: ' 1 Date: �. O
. Backwater valve
CONTACT PERSON Basins /lavatory
o l eo VV , ". , Clothes washer
Name: Dishwasher
Address: / I S'7b S'1,I 9 - '� . t, !kw E 1 60 Drinking fountain(s)
City: —7,--;- A Stater I ZIP: q7,9"49-3
Ejectors /sump
Phone: . f5' Fax: 1,0 r, '-"E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): jig Floor drains /floor sinks/hub
Mailing address: / 0 Garbage disposal
L % Hose bibb
City: State: ZIP: Ice maker
Phone: I Fax: E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the Iii t• ce and repair made by my regular Roof drain (commercial) .
employee on the prop , • 4 , ii‘ ti chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: r , � , 1 , " �' Date: i . 97. Sump
ENGINEER Tubs /shower /shower pan
Name: �� .. 1 , .n Urinal
, � t Water closet
Address:
3' .5.1,4_9 s4 t / %,� , Water heater
City: .T St at L ZIP: Other:
Phone:22,6— i 286 Fax: I E-mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Mlnlmum -fee $ �� W " V
permit This pcnn application
❑ Visa O MasterCard Plan review (at ZS %) $ y/. so
expires if a permit is not obtained / 2�
Credit card number: / / within 180 days after it has been State surcharge (8%) $
Expires TOTAL $ ,Zoe' D , 7,
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount
440 -4616 (6 /00 /COM)
t
PLUMBING PERMIT FEES:
PRICE TOTAL New:1 and 2- family dwellings. only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in . PRICE TOTAL
Sink 16.60 the:dwelling and the first100 ft. "QTY, - (ea) AMOUNT
Lavatory 16.60 / d for each utility connection)
�(p 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 L 16.60 %„�-
Y[ 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 '` • Quantity by Work. Performed
Gas piping requires a separate mechanical // / 0 Fixture Type: New Moved Replaced R. emoved/
permit.
/Cot (p Capped
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
Other Fixtures (Specify) 16.60 Urinal
/ Dishwasher
f -term E <c J / / g r (90 Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer- 1st 100' 55.00 3 .,
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st'100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
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 /O . // _ l9 /_ , 0
Quantity Total is > 9 (J�
*SUBTOTAL
8% STATE SURCHARGE
-PLAN REVIEW 25% OF SUBTOTAL l i r .-6
Required only if fixture qty: total is > 9
TOTAL $ 07070 lit
`Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
'"`All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms \plm- fees.doc 10/10/00
Sewer Permit Worksheet Tie/ X 00/ _ 00 « ��
Fixture Unit Ratings
Fixture Value Times (x) # of Fixtures Total Fixture Value
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1
Floor Drain - 2 inch 2
-3inch 5
- 4 inch 6 .
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48
Oil Sep (Gas Station) 6
Shower - Gang 1
- Stall 2
Sink - Bar �j/i/ 2 y t
- Bradley • 5
- Commercial 3
- Service 3
Washer - Clothes 6
Water Extractor 6
Water Closet 6 4 a
Urinal 6
•
TOTALS
Business Total Fixture Value e: 3 -
Address ?S(k�i . divided by 16 = a , EDU
7 % , 4`o Round EDU to nearest whole number and multiply by $2300
is \dsts \forms \swrwkst.doc SP
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested C= ° AM PM BUP
Location lQ q1S S Suite MEC
Contact Person Ph ( ) 376 - G 8'e PLM ( 9040 / U 4 ./9)
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: } J� ` , �- - ' p ELR
Crawl Drain
Slab Inspection Notes: � SIT
Post & Beam v ) ^ l /
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear •
Framing
Insulation
Drywall Nailing fl
Fire wall
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
Storm Drain
Shower Pan
Other:
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: ❑ Unable to inspect — no access
Fire Supply Line iJ
17;
ADA D Ins ector Ext
L �g
Approach/Sidewalk / lJ L' P
Other:
Final DO NOT REMOVE this inspection record from the job. site.
PASS PART FAIL