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Permit
• , F L �4 F9 d ITY OF TIGARD PLUMBING PERMIT �& DEVELOPMENT SERVICES PERMIT #: PLM2005 -00225 I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/1/2005 PARCEL: 2S 101 AB -02201 SITE ADDRESS: 07117 SW BEVELAND RD 200 ZONING: MUE SUBDIVISION: BEVELAND LOT: 2 -3 JURISDICTION: TIG Project Description: Building fixtures transferred transferred from PLM2005- 00019. Other fixture: expansion tank. CLASS OF WORK: ADD 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: 1 URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: 1 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 2 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES ZIMMLER DEVELOPMENT LLC Description Date Amount 7165 SW FIR LOOP SUITE 100 /PO BOX 230698 [PLUMB] Permit Fee 6/1/2005 $116.20 TIGARD, OR 97223 [TAX] 8% State Surchari 6/1/2005 $9.25 Phone : 503 - 598 - 3440 Total $125.45 Contractor: CH KRUSE PLUMBING 5802 A NE 88TH ST REQUIRED ITEMS AND REPORTS VANCOUVER, WA 98665 Phone : 360 -573 -4337 Reg #: LIC 111654 PLM 37 -296PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -669 • or 1- 800 -332 -2 4. Issued By: / , Permittee Signature: ern . ,- . ,-,% / 9 7 ,24:(>2.4,---■._ Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. �E IVE® Plumbing Permit Appl FOR OFFICE USE ONLY City of Tigard 'JAN 18 2005 Date/By 1---/17 or -71- Permit No.? �- t 'r � i-70,1 I ! 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 '- ,;;., \ Other Permit No.: 11 24- Hour Inspection Line: 503.639.4175 CITY OF TI ,'-,?_ i�� ; i Date/By. JI g 2 S for G I3 Internet: www.ci.tigard.or.us BUILDING DI , Date Ready/By: t ° "$ See Page 2 for Notifieed/Metd/Met hod --fur S supplemental Information TYPE OF WORK FEE* SCHEDULE ea 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 I Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 ❑ Master builder ..--106 Each additional bath/kitchen 45.00 0 Other: Fire sprinkler ( , sq. ft.) Page 2 I L- �• - .,, iit INFORMATION AND LOCATION I _ _ Site utilities Job site address:' 7/ _ ./ 6 - 6.W. eo le ,7 c , -. Catch basin or area drain 16.60 City /State /ZIP: 7i �c Q� i�� j Drywell, leach line, or trench drain 16.60 � Suite/bldg. /apt. no.: /00 Project / name: 2 l Footing drain (no. linear ft.: ) Page 2 �P(� �� / t S Manufactured home utilities 1 10.00 Cross street /directions to job site: 7 ,'/e' /i V Manholes 16.60 (C' czt. led .171n !/] or -41ct S / C,.Q Rain drain connector 16.60 ./ pule l:6- 5- 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 DESCRIPTION OF WORK Backflow preventer Page 2 r !/f i L✓G/ - G,4 71-----, ,, _-,-,-,,,91,,/, Backwater valve 16.60 / ,h/c/. Clothes washer 16.60 Dishwasher 16.60 ,PROPERTY OWNER I " 0 TENANT Drinking fountain 16.60 Ejectors sump 16.60 Name: `Z i ✓44 dam/ ii ,--- o-e / .-P, L , L C Expansion tank 16.60 Address: 7 J6 5, W - F� tar 5 / i / Go/- Fixture /sewer cap 16.60 /) City /State /ZIP: 'D , .BMX o 2 3o 6190 5, ,,t/. Pt / / �f/� S74 /oo Floor drain/floor sink/hub 16.60 ( ) 5 yl - 3 (i ( ) Garbage disposal 16.60 Phone: Fax: Hose bib t / `d, 16.60 .91) '0 , APPLICANT ❑ CONTACT PERSON • . H y d Ice maker 16.60 Business name: G t ! l� ✓ /..\ Pl,, z , / k, Interceptor/grease trap 16.60 Contact name: /.(,1I e c<__ Medical gas (value: $ ) Page 2 Address: 510 % 11 eg- fi Primer 16.60 City /State /ZIP: � C&(, frt ,z � �O s CS -- Roof drain (commercial) t15 v� 16.60 Phone: (3tl )S `J 3 - y'; 3 7 Fax: : �f0f1 ) f -5 3 6-6 Sink/basin/lavatory Zi a S � 3 16.60 7, ) Tub /shower /shower pan 16.60 E -mail: Cell - 36 o- s.- g ../ 375 Urinal 16.60 • CONTRAC�TORO Water closet t 16.60 .55, Business name: (4 C� <� �"" Water heater 16.60 Address: Other: City /State /ZIP: Subtotal . ! 16.20 Minimum permit fee: $72.50 Phone: (Q3) S' 3 .- 4331 Fax: ( ) Residential backflow minimum permit fee: $36.25 CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) State surcharge (8% of permit fee) 1 q,-,2,4f 7 , Authorized signature: TOTAL PERMIT FEE ` 6 c- Print name: r 6, / ' 1/15R---- Date: /..,) - (,. j ..---- This permit application expires if a permit is not obtaiueu win.. 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i:\ Building \Pennits\PLM- PermitApp.doc 12103 440- 4616T(10102/COM/WEB) a - 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 - l 100' 55.00 0 to 2,000 r. $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 Storm &Rain Drain - 1st 100' 55.00 Valuation: Permit; Fee:, $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 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 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof to and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for 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 * . Quantity by. (Fixture) Work Performed `Fixture Type: Replace New . Moved Ems' ting Capped 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" -3" -4 „ 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 Mach.Refrig. Drains Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar /Lavatory 7 '7 Quantity Total - Bradley Commercial ? , Isometric or riser diagram is required if fixture quantity Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet y Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i:\ Building \Permits\PLM- PermitApp.doc 3/03 Plumb Permit Appl A , • l FOR OFFICE ; l!51 o • ' o.: City of Tigard ► R ece i v ed Date/By. ` 'P Permit N ? (.� .�_oo 5 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.639.4171 Fax: 503.598.1960 dl7o- hfii• I Date/By: view Other Permit No.: 24 -Hour Inspection Line: 503.639.4175 CITY OF TIGA L� ,, , I x `� G L. Internet: www.ci.tigard.or.us BUILDING ®1 - Date Notifiee d/ d/Met y: Ju it S See Page 2 for Method: Tl Supplemental Information TYPE;,OF WORK FEE *. SCHEDULE For special information use checklist g New construction ❑ Demolition Description I Qty. I Ea. I Total ❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) a:, -'- CATEGORY:` OF�'CONSTRUCTION .; „; % - �• ' `- `" SFR (1) b ath ''- ..�. -. -_.. . ............. CONSTRUCTION ... �:��: O 249.20 ❑ 1- and 2 -family dwelling 14 Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building El Multi-family SFR (3) bath 399.00 [3 Master builder _ Each additional bath/kitchen 45.00 ., M er.._ ❑ Other: Fire sprinkler ( sq. ft.) Page 2 .., Art�K INFORMATION AND, LO ` . > _.. ......: : _ .. 9 . CI . Site utilities Job site adds ° l / / 133' .5 .ti. 6e. & 'e1 l'tv1 d /( 2 v Catch basin or area drain 16.60 City /State /ZIP: /" cvd (/62, / .- J Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: o d I Project name: ,�7Ge/cvi c� i g �, n i 1 /' ti, Footing drain (no. linear ft.: ) Page 2 / / / Manufactured home utilities 110.00 Cross street /directions to job site: 7 7 ie/e /' „____-/ L / �, p Manholes 16.60 (6e 26. . r T/el �ln %/l /J . 4 �j /, ..e Rain drain connector 16.60 Df'be & > 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 'DESCRIPTION OF> "WORK; ' w: .. ....;`,. -:. Backflow preventer Page 2 y - 0/i( 4 i / ✓ o . 4 / 7 p0 6 A t . - _ j, ,i 1 /I Backwater valve 16.60 I/ / / Clothes washer 1 6.60 ,/ Dishwasher 16.60 ;:....: ... ,.,.... Drinking fountain :' ing f • .:, EROPERTY:; O_ WNE13, :: -..:• , _ 1 = ', ; : ®TENANT -' `. k_ ° 16 60 ' ' Ejectors/sump 16.60 Name: `Z / 121 /J'! 42 tt / ,` G't-Cirn` - G t C / 0 Expansion tank / 16.60 / Address: 7/ ‘ 5. L F/r ,6 $ L5 . /&(2. Fixture /sewer cap 16.60 City /State /ZIP: . j c 0 6/9 // 5 , l , ( /- F t 4 / 5//7. Floor drain/floor sink/hub 16.60 Phone: (� S: y ) / Fax: ( ) Garbage disposal 16.60 s AN �' D Hose bib 16 ❑ APPLICT <: Y ®::CONTACT< °PERSON `: . - :, " Ice maker 16.60 . Business name: G H 4- A Ply t , z, 7 6 Interceptor /grease trap 16.60 Contact name: , r kw � Medical gas (value: $ ) Page 2 Address: 5 ©% el ci Primer 16.60 City /State /ZIP: ��NIi (i6' C (-c �itI �S" ‘‘S Roof drain (commercial) 16.60 / /, „J 7 Sink/basin/lavatory jA. f l i tv , ` 16.60 i,1 S0 Phone: (342)5- 3' r _ I 3 -7 F ax:: (• - , 0 ) `5 3 63 l Tub /shower /shower pan 16.60 E -mail: Ce61 - 3i g _ s -/375 Urinal 16.60 CONTRACTOR,:- . Water closet :,2. , 16.60 33,Ec, Business name: Ci n Water heater /' / . 16.60 f b , Address: ` Other: / City /State /ZIP: Subtotal, / Minimum permit fee: $72.50 Phone:.( ) 5- 3 L4 31 Fax: ( ) Residential backflow minimum permit fee: $36.25 ii &, CCB Lic.: Plumbing Lic. no.: Plan review (25 %'of permit fee) Authorized signature: State surcharge (8% of permit fee) . /`/!tom • TOTAL PERMIT FEE /;? 6',5 Print name: 6 6,,,,, v . /A ! '� Date: i.--A 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\PLM- PermitApp.doc 12/03 440- 4616T(10/02 /COM/WEB)