Permit Ak CITY OF TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2004 -00368
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/13/2004
SITE ADDRESS: 07358 SW DURHAM RD BLDG G PARCEL: 2S113AB-01400
SUBDIVISION: FANNO CREEK ACRE TRACTS 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: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Bldg. fixtures: 1 sink reset, 1 New sink in kit., replace dishwaher.
FEES
Owner:
Description Date Amount
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 8/13/2004 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surcharl 8/13/2004 $5.80
Total $78.30
Phone:
Contractor:
DEAN WARREN PLUMBING & REMODEL
PO BOX 14701
PORTLAND, OR 97293 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Top -out Insp
Reg #: LIC 154919 Final Inspection
PLM 26 -736PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: 41111 �GijCJ Permittee Signature: : �
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed next business day
Building Fixtures � �4$�O 40 a
g RECEIVED a� �
Plumbing Permit Application FOR O rr MM,,11 ii 7
OFFICE USE ONLY : • <
City of Tigard AUG 1 04 DateByd y/ Ore/ SA Permit No. l 97V i q_ e473 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi
Phone: 503.639.4171 Fax: 503.598.1960 CITY O F#u+th 7041'/1 Date/By: Other Permit No5CdR 2, s f ,QQ��
24- Hour Inspection Line: 503.639.4175 BUILDI_ 0 . al. N J uris:
www.ci.tigard.or.us --. Date edlMeth S See Pen l for
Internet: www.ci.ti
g Notified/Method: 7�� Supplemental Information
e .�. x, ; »r.. ,. c r . ;.°t .v,s a.�-' is ^a'a:.�asre. ; e -. t`"F ..,. -s : :,r, . r _,'R,. -a ^w�� `^.,,: r,,,,,,,e`; ^ ,.. • P , yt - , #' ; Pat 3 t M g 4 k•�" ' ' S' o` .'E�'"' t ip 4 V S r ,., r n '; `t I; y'_`.-. •!;:, �
e 'I; YPE OFf WORK g =.. t a '4 1 F -EE S.CHE ` ,' ` + •
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❑ New construction El Demolition For special information u, a checklist
Description I Qty. Ea. I Total
[a Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
, may ; .' ",. �. , n2 , ;:a.v.m. ;-ic er ;;, :., s etr.�j
g `Wigti =M ' ` A: j GOli GO - §JLW TOI�FA'` `:k ''` * ll t SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bathflcitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
�' mss. , area ff
j OB S1T'E It fgk IATIQ) Ai TD)riLOCAT ON. _ , , P
�. S ut
Job site address: - 23 )~3- s 4., /9,-,--14)4., /l J Catch basin or area drain 16.60
City/State /ZIP: f'e -1 6 "--- 9 ?�yy Drywell, leach line, or trench drain 16.60
Sui/bldg./ t. no.: F- Project name: __. yr1k Footing drain (no. linear ft.: ) Page 2 •
CC 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.:
¢.,a.. , , ..., ,� ::.2 :':x 1 r:_ : •. „., Absorption valve 16.60
111 ,� :117111,,:. �DES'GRTPTION OFWORK t _ rt,
" �f � „: ` , .. y 1 .� < �: , . Backflow preventer Page 2
- Ae- p� / JY 4 S /kJ, Backwater valve 16.60
( _. _E"'sr PI t 4.i S r 'tM - _, Clothes washer 16.60
( ` t J n 51 h- v � Dishwasher / 16.60
� /� c , Drinking fountain 16.60
n i ROPER WNE M <. � tf RV - _ g
Ejectors /sump 16.60
Name: ,4,_/.v1,57 Expansion tank 16.60
Address: / ) S /,., S el oc, rzt ,,),-/, ,, c Fixture /sewer cap 16.60
City/State /ZIP: ,(D,...-1-- a fi _ 1 >22t) Floor drain /floor sink/hub 16.60
Phone: (,rrr7 C 2 y, 6 3 00 Fax: ( )
Garbage disposal 16.60
a t ,. >.. xr.iiw..:. #.. < : . ' at ., -, „.,.. ,µ. .z::. i a ,. fit Hose bib 16.60
_AP LIC '� r s a. OI AG�T �RSO
f��s :. , r. c a .. ..n�'; u4 y 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: ( ) Fax:: ( ) Sink/basin /lavatory -2 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CON7 RAC�;®Ri ,, : „} .<,, l ; ,
�i� tr .:.4M.,v "���:a� AR_ w r�.��r,. tea.,.= :.� <ai"'?- :"�`�..� ��44'��,,:b�•A-^� ��4�� Water closet 16.60
Business name: 0e -- 4 ft s,t) t A&.ed./ Water heater 16.60
Address: P. C.j A304- /.t /mil Other:
City/State /ZIP: e lf - 1 S ) '. S 3 Subtotal
Minimum permit fee: $72.50
Phone: (6 ) 2 )G - ty/ ) Fax: ( ) ) 2q (- 22/ 6 Residential backflow minimum permit fee: $36.25 7 ,c 5
CCB Lie.: ) - y Si 9 Plumbing Lic. no.: 2,g__ 736 P/3 Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5 .8
/
Authorized signature: TOTAL PERMIT FEE
Print name: ,,e Date: 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.
1:\ Building \ Permits\PLMF- PermitApp.doc 12/03 440- 4616T(10/02/COM/WE13)
•
Plumbing Permit Application - City of Tigard .
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
" ` :' 5 �. °s ' "1; f ': ; 'd � c; 1 r r. R.
S1tEUtltles 4, Q Square Footage Perms Fee ;
Footing drain - 1" 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 - Ist 100' 55.00
Medical Gas Systems:
Water Service - each additional 100' 46.40 a uatlan " " Prmlt I1 eC i
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
_ °: ,ia :: 3 a- o,E eOr _•' - Q additional $100.00 or fraction thereof, to and
r fi Xt'Y 1C121� " ee (ea)Tota1
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
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
[ r , " r , Qu iitrtyyb ( Ftxtare) �'o k Perfa
A4A ' Ftxtore�Ty t e j �'�' i.a.s� "� %Re h a ce
VA '� ��' s
m ^� e � ��' Mop a �it� " ca ed 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
Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
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
- Bradley l Quantity Total
-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 Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
t: \Building\Permits\PLM- PermitApp doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 3 Date Requested r rt � AM PM BUP
Location � I 7 9' / Suite MEC
Contact Person Ph ( .n ) 7 q VAT to PLM O' G ov .3log
Contractor Ph ( ) SWR
BUILDING Tenant/Owner COt G� ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam �r J/L / Du/
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
-U1a INi3
O t &Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
dr i
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 E Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: E Unable to inspect — no access
Fire Supply Line f f
ADA
Approach/Sidewalk Date Inspector 7 7 , ,o( Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL