Permit CITY OF TIGARD
PLUMBING PERMIT
l DEVELOPMENT SERVICES PERMIT #: PLM2004 -00060
��' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/10/04
SITE ADDRESS: 07204 SW DURHAM RD Q800 PARCEL: 2S113AC-00103
SUBDIVISION: PACTRUST ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B . FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Plumbing TI, resetting (4) lays, (1) sink & (1) dishwasher. No sewer assessment.
FEES
Owner:
Description Date Amount
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WM I [PLUMB] Permit Fee 2/10/04 $99.60
PORTLAND, OR 97224 [TAX] 8% State Surcharp 2/10/04 $7.97
Total $107.57
Phone :
Contractor:
DEAN WARREN PLUMBING & REMODEL
PO BOX 14701
PORTLAND, OR 97293 REQUIRED INSPECTIONS
Top -out Insp
Phone : 503 492 - 9514 Final Inspection
Reg #: L1C 154919
PLM 26 -736PB
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
I sued By: , ,. j_ j!�JA
/
' Permittee Signature:x
Call (51 639 -4175 by 7 :00 P.M. for an inspection needed t next business day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY , '
Received Permit No.:
City of Tigard
Date/By: U7!� d
13125 SW Hall Blvd., Tigard, OR 97223 e Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 u/�ntro��firyui'�i , Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 --Air 07/ 11 Date Ready /By: Juris: 1i1 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: 1 / a, Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
ID Addition/alteration /replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
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�;,� (1) .;,` s ..: :01e ;_� . " 4 w, �OF,wGONS.I3RUCTiIOIY{ 4 F 13 ,kt ;a" ± SFR I bath 249,20
❑ 1- and 2- family dwelling M. Commercial /industrial SFR (2) bath 350.00
SFR (3) bath 399.00
ID Accessory building
I: Multi-family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Page 2
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Fire sprinkler (- sq. ft.)
a , I , ^" ` ;: J OB SITE.nINFORIVIA =
" '" � TIO1V:a AND LOCATION'-; c. .- 4 -,, +° < ..Ei - => Si ut
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Job site address: - 72- 01 / S w i2 h d41 ,d : d° ad Catch basin or area drain 16.60
City/State /ZIP: 7-0 5 ,),-/ On■ Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name:
Manufactured home utilities 1 10.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
Fixture or item
Tax map /parcel no.: � V} „ y_ ,
1N 16.60
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Absorption valve
,, 4711€„ t r DESCRIPTION 0E° WORKt l l st '!1:!4.! i , .t;, Page 2
x� � ���,�,� � .,;:+�.a._v- .�.,_,,.� .�� / ,�. , � ,,- ,,n.,*'xr:�.����, Backflowpreventer
i � �5 4 1 - 1 La.t,'S I l ?r° .)4 / i S�'. % / - /0/1344),-4-4,- Backwater valve 16.60
Clothes washer 16.60
Dishwasher / 16.60 /t'p , lOd
"rn.;ry „x „ , i:i:., ; ;, t -., �k x; � „.;�,.. ,,, a r:... ;,,$ ik -- la` �' . ; Drinking fountain 16.60
�� TENANT � �' ��
. PROPER OW NER i i wk. -4 wv, -., ,x .,." i ,> t
ra?:� ,��� il <., _ �, ��,�_�.,r_ ��,,� d_',.e"�t`�...._� Ejectors /sump 16.60
Name: Pd Expansion tank 16.60
Address: / 57 5-2i 0,,.. 5 1pto,;,) / p /t1./ Fixture /sewer cap 16.60
City/State/ZIP: / J ( C '7 V Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phone: ( ) Fax: ( )
5 ; x �: „ >�. "�:.:�,�<�. s 4 °'r���., = "�'. I >T;i�r� =�'" : , ;�; , . . , �r� , , )��; -1'� Hose bib 16.60
�p " s , : ,, 9PPLICA a , .� s.<' ® PERS Ice maker 16.60
Business name: /� ,, aw, G-a "r, ti. le/Lib,, /,t_S I- / c e,,l ocia/ Interceptor /grease trap 16.60
Contact name: T j'Za�L Medical gas (value: $ ) Page 2
n Primer • 16.60
Address: /"o.. �d� /1�7a/
Ci ty /State/ZIP: o� c ? 14 3 Roof drain (commercial) 16.60
����" ,( Sink/basin /lavatory _C 16.60 3, a)
Phone: (so ) ) N 51- S S/`/ Fax:: (5 - ) - S 6"-.yl/ g
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
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�,r t
t£ � "CO NTRACTORS $ P " �, 4 Water closet 16.60
&mss_ , >s 444 P A - k i, o...,,.' a.,,, a,; ,. ' K 6 -d
Bu siness name:��� l )1 -le (v �( LL1�`( �/ ] p lJ/D t ;i Wa heater 16.60
� t ^ /� Je, Other: .
Address: (� Subtotal
City/State /ZIP: Minimum permit fee: $72.50 09. loo
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
Plumbing Lic. no.: Plan review (25% of permit fee) q
CCB Lic.: j j'y 9/ g 16 ^ 73 ��� 7 ( 7
State surcharge (8% of permit fee)
X Authorized signatur Plbi
��i TOTAL PERMIT FEE 6 � �# 6'7
- / _ (� This if a permit is obtained within
Print name: J�' a Date: c �Cj / �/ permit
180 days application after it expires has been accepted as not complete.
*Fee methodology set by Tri -County Building Industry Service Board.
€:\Building \ Permits \PLMF - PermitApp.doc 12/03 440- 4616T(I0/02/COM /WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information ` .. -
Fee Schedul Residential Fire Suppression Systems:
' ..
� � Tieea'ea "� Tot t ` ` :Fe`e':'
. A, :, ., a: t o a p' 4PerpTi ,
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��S iteU l > � itres � 1 � � ����: ��,.F ��� ... ���:. �:��, ��.�, ��h� �, . �,� .
Footing drain - l 100' 55.00 0 to 2,000 $115.00
46.40 2,001 to 3,600 $160.00
Footing drain - each additional 100' 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:
46.40 :„°, =;r � ;,. ;?r`",:`_"":P�. - , 4
Water Service - each additional 100' ry aluat1O)1, . f � ° .' ,Permit Fee , , ," ,i - - :.v. ,.
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
a ,,, . , .„, e
Y additional $100.00 or fraction thereof, to and
� � ,�a :�,� �.� � �. �s�,��.�a� �.� ��, � { . , ;b'eea � Total � �
_P r l% IMPIOl IP.1ll s,'. - zrgV eQ ' .': T2wflo.: including $10,000.00.
46.40 10 001.00 to $25 000.00 $148.50 for the first $10,000.00 and $1.54 for
Commercial Back Flow Prevention Device $ ,
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 * .
''a ,i , WV/R4.1 Quanttt5 by (Fixture), Work Performedi , •
r Fixture T yp e s ' 4 � - : , , Reptafe .a�1 1, ,
�� , t N ew Mov Exshng capped E Comments regar 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 fees assessed for the sewer increase must be paid before the
• Oil Separator (Gas Station)
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 total is >9.
-Service
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 uilding \Permits\PLM- PermitApp.doc 3/03