Permit CITY OF TIGARD
PLUMBING PERMIT
,.I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00176
�'� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 4/28/2005
PARCEL: 2S113AC -00103
SITE ADDRESS: 07216 SW DURHAM RD P100 ZONING: I -P
SUBDIVISION: PACTRUST LOT: JURISDICTION: TIG
Project Description: Replace (1) sink, install (1) dishwasher.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [PLUMB] Permit Fee 4/28/2005 $72.50
[TAX] 8% State Surcharl 4/28/2005 $5.80
Phone : Total $78.30
Contractor:
ADDISON PLUMBING
17506 SE RIVER RD. REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97267
Phone : 503- 785 -1840
Reg #: LIC 151754
PLM 3 -449PB
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 - 2 or 1- 800 - 332 -2344.
�(
Issued By:j" , 7eW__ Permittee Signature:
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.
Plumbing Permit AnREti IVED FOR OFFICE LiSE ONLY,
City of Tigard Received �-,� _ permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 APR 2 8 2005 Plan Re . /Z' -(73--- y �1_ ���er2�� (/() 7
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 . /��ar�, � \ Date/BY Other Permit N �
��ey
24- Hour Inspection Line: 503.639.4175 CITY OF TIGA Date Re�y/By: ° ° g ® See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVI' J Notified/Method: � 1�r Supplemental Information
TYPE OF WORK FEE* SCHEDULE
El New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
"El Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2 -family dwelling Commercial /industrial SFR (2) bath 350.00
I:1 Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
•
• JOB SITE INFORMATION AND LOCATION ' Site utilities
Job site address:.7Ztt Sw 5 ,,.,,A,,,o.N.,- Catch basin or area drain 16.60
City /State /ZIP: partic+.>� a.te Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt.no.: (oo I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
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
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
d2.�w..otse.
o..&. lc B�-ajr._,clay.� 5:%-..k. Backwater valve 16.60
Clothes washer 16.60
Dishwasher i 16.60 lb -4.
❑ PROPERTY OWNER 0 TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: (535 Sia3 �, ke..,, 5.. -∎k, 36o Fixture /sewer cap 16.60
City /State /ZIP: QpA ,,)_, pq._ Floor drain/floor sink/hub 16.60
Phone: (s 0-3 ) ‘zc‘ _ 68oa Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: a ,asin/la I 16.60 lb . bc7
( ) Fax: ( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name:�� Sow 1 (L Water heater 16.60
Address: 1- �b se (Zivp.r s Other:
City /State /ZIP:IN., o,- 11 2,ceT Subtotal 33.2a
Minimum permit fee: $72.50
Phone: (se - S )7 srr (it U.o Fax: (t e ) Residential backflow minimum permit fee: $36.25
Lic. no.: Plan review (25% of permit fee)
Plumbing CCB Lic.: is - il -4 -F g ?' elF? e
Authorized signature: State surcharge (8% of permit fee)
(,�
1 TOTAL PERMIT FEE i x , J v
Print name: ,Sc,_y il,.„o,;v t Date: 4-2 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 \Permits\PLM- PennitApp.doc 12/03 440.4616T(10/02/COM/WPB)
Plumbing Permit Application - City of Tigard .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Feelea) Total. _ Square .Foot age: . 'Permit Fee:
Footing drain - l 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' 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
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
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
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 * .
.Quantity by (Fixture) Work Performed.
Fixture Type: Replace
New Moved Existing 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"
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
- Bridle Quantity Total
ommercia i 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 Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200 00176
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/20/2005
Phone: (503) 639 -4171 irtiliii Inspection Requests (24 Hrs.): (503) 639 -4175 __
INSPECTION WORKSHEET FOR DATE: 4/29/2005 TIME: 7:11AM PAGE: 103
SITE ADDRESS: 07216 SW DURHAM RD P100 CLASS OF WORK:
SUBDIVISION: PACTRUST LOT #: TYPE OF USE:
PROJECT NAME: NEWKIRK
DESCRIPTION: Replace (1) sink, install (1) dishwasher.
OWNER: PACIFIC REALTY ASSOCIATES, 0 PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 503-78&1840
1840
Inspection Request Scheduled For: Date: 4/29/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 005615.01 603 -740 -8116 Y
f 1 0 D i Corrections/Comments/Instructions: v
!-. --
(--.' ,
.
I
c413' SS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 91 ! , Date: 0 // 6 — "Phone #: (503) 718-