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Permit CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2004 -00414 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/9/2004 SITE ADDRESS: 08680 SW DURHAM RD SCHL. SWIM CTR. PARCEL: 2S114AA 00100 SUBDIVISION: ZONING: R -4.5 BLOCK: LOT: JURISDICTION: TIG 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: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Replace (1) water heater. FEES Owner: Description Date Amount SCHOOL DISTRICT 23J 6900 SW SANDBURG RD [PLUMB] Permit Fee 9/9/2004 $72.50 TIGARD, OR 97223 [TAX] 8% State Surcharp 9/9/2004 $5.80 Total $78.30 Phone : 503- 431 -4000 Contractor: L D PLUMBING 3472 MATHENY RD GERVAIS, OR 97026 REQUIRED INSPECTIONS Phone : 503 Rough - in lnsp Rough - in lnsp Reg #: LIC 56430 Final Inspection PLM 24 -404PB Final Inspection 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 -S 100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-6639. Issued = : Permittee Signature: Ar Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next-.. siness day - Building Fixtures Plumbing Permit Application ";'FOR OFFICE USE ONLY a ' City of Tigard Received 9 �v G�A �d.'�y� , 13125 SW Hall Blvd., Tigard, OR 97223 Plan Re i • t Permit No 5j Plan Review Phone 503.639.4171 Fax: 503.598.1960 / ��,�uNit,�l� � �'t I , Date/By. Other Permit No 24- Hour Inspection Line 503.639 4175 �a ._ `' I " :� Date Ready/By J ur's p See Page 2 for Internet. www.ci.tigard.or us " 8 Notified/Method: Supplemental Information -:�r� - i �?:.,�-'�"���...�..• ��;`��„�. . .: .:s�;,a,„,sz.. _ F�tt:.s.�,€;� V� t aw, - - - - %� °.�T' .� :.�:. �•,.�nc. 'fir :",;,•.r€.a. ;>s= ��.'�, , ., > -.. ° r s '`air's; ,¢ ';.. ' •-#'u, ;,,�j,� ;.., >* ; r . ;?' =T =%'g _ � :fl� °?:• =! �z. °�- - Mix `' � %�:..,:- ' -.�.," �. ... ° °�;vw ", ;r. -, _ - , - .• ;zip , :. `, _.1., N TYRE , IT OR1{ ".:,e .. °: t ` ` P ,.IN.Z7 : r . EEE -~ SC "HEDULE' ;�`.,,:; �`�"z�,;�, °- �.. a.- �, �� _., „�,a�?<:�:.n >:�ru�.e�.r - °� „�g�. "na:'rr� =r, `a�,�:�.::- : :. ... ... .:..... :a�,;.e.�- ., - ❑ New construction ❑ Demolition For special information use checklist. Descnption Qty Ea Total ' Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection) ,: i°% , .. � ; `'` �- ;.;; ua.,: „gin = aa ,.� - � .; <:� iii ; --` ; � :, , ' ` ildg O i@, "C , STRt1 T1 01,i,U w r , �`°'' s... 7 t' `''',�: k. SFR (1) bath 249.20 ' :': .=: ,Asa• .k. -3i1 AI ..wii l .. -r . , .2 - a4: ' ,w.t «rr t,� .O.All ,, Grp. ❑ 1- and 2- family dwelling �[•Cormnercial /rndustnal SFR (2) bath 350.00 ❑ Accessory building L ❑ Multi- family SFR (3) bath 399 00 Each additional bath/kitchen 45 00 ❑ Master builder ❑ Other: , g E y c. ;< ._. - •{ i' ' ,.h..N ., Fire spnnkler ( sq. ft.) Page 2 • JUB"SP iftfti I'FORiVIATION'1`AN IiO 6V � ., °- ; 1 ` 2 s -.. " , � : .r ,- ".1.t - : , ;, .., -.. ,v.,4.. :::T Sr. _ ; L,AL. Site utilities Job site address: • bg0 $ It) t d Catch basin or area drain 16 60 City/State /ZIP: I .3CL • • Or 9 10 a 4 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: J Project name ' Footing drain (no linear ft ) Page 2 3 r l f t 4 /-'e/6 nt ° r 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.: ,• _ '- .; , r: .. g Absorption valve 16 60 ,, ;.r�.,'�,xr D :, WORK •• �; mod`= ^ ' '- ` . , +;I:1 , ''ii, tPx; ` '' , `LULL. ..A'> , . ' ,r1.,.- ^ ' - 44tg ` ` ^i '` .- ;, ,, a ^ - iL ,;, " Backflow preventer Page 2 r_ i r4�.. ( t: 3 f .__i Backwater valve 16.60 Clothes washer 16 60 Dishwasher 16 60 .a_ _,. ;., -� . »,• t Drinking fountain 61 RROPERTY , ©W1 ^ERd'`3 t 7 : ' .). f. TI N° ,. ,�•_ 1 ; , y . • . s '�; 4 z ax „?'z.T:4 - - :�rr.�*.r �; ? r� .,..�.- - a� .�,,`,'�. i a, .:'?' , ...<. ;�. _ ,@ av ¢„ "r.i��;��'.e �: m..r3 — / E /sump .1 Name: / „ `���� �� Expansion tank 661 Address: G - r ■ SAX .� - ` g' Fixture /sewer cap ..1 City/State /ZIP 4,... .. „ ,$) n a_ . 7 Floor drain /floor sink /hub • • 1 Phone: ( 4 7 ‘,/,„1 D Fax: ( ) Garbage disposal 16.60 , ,, fee- r - r;, ° , ;, ' ; : °.� ,,:_ e -. ,,, Hose bib 16.60 , "< , .APRLIGAIVT = fl;-.o..;:`,.:&, : � ;` '' :`ia. . V CO PER =` `''il :lt � .. �-.: .: -, :�,� :, �. `ice„ �..' �� "`'�� °��,� �,r 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: ( ) I Fax:: ( ) Sink/basin /lavatory 16 60 Tub /shower /shower pan 16.60 E -mail: s ° e: ' ez <s :; U rinal 16 60 :. ' 1 °' Awe, < 1 ' — , VTRAG3 , OR : _5 `l ;= ; i'ti L "" Water closet 16 60 Business name l P I ,,, ,,4i. Water heater , 16.60 /j0.4o Address: 3 C 07 � a 1-- U J /Vt-� Other (JI /� City/State /ZrP: 6 e rvx •, ? t) r ! 7' t Subtotal Minimum permit fee. $72.50 Phone: (5 ?eq 4/e/ Fax: (5- 03 370 ,- G C [ q a. Residential backflow minimum permit fee $36 25 ' CCB Lic.. SZ, C( 3 0 Plumbing Lic no,. a y- ye Plan review (25% of permit fee) � State surcharge (8% of permit fee) .6".i Authonzed signatur `i► TOTAL PERMIT FEE -7 cr , Print name: el 1,e L h Date' 9-- 7 — 0 y This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tn-County Building Industry Service Board i.\Btulding\Pemuts\PLMF- PemutApp doe 12/03 440- 4616T(10 /02/COM/WEB) Plumbing Permit Application - City of Tigard t • Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: ' �::r :; ;. :. t F ee' ea -' `>`Iofal "`a = t S fe� ift t><es :. Q *`A ° ,;° (> Square` ootage, ` r. Permit Fee:.:x Footing drain - 1s 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 : .��,�Y, - ' Storm &Ram Drain - 1st 100' 55.00 Val uatio n ::yw „ , : 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 ° a ° additional $100 00 or fraction thereof, to and Fixtufe�orTtem a Qi ' e;(eaj:.F::Igtat., , �%f` 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 e first rst $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 * . Fi�tieYP�' ' "; ,4� �'4 .' : ", .a °Repliee ;,. �,.,- n,v < ` 1::i .. � i! e1 ,' ;1Mtaoea xis * ' =>> „c od, 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 t Sink - Bar /Lavatory Quantity Total -Bradley Isometric or riser diagram is required if fixture quantity - Commercial - 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 \Bu,Idtng\Pernuts\PLM- PernutApp doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested ) AM PM BUP Location ?(.0 ' -/0 Suite � MEC Contact Person ,ten Ph ( ) ( 3 , c 1' / 7 T PLM • �U� Contractor Ph ( ) SWR BUILDING Tenant/Owner /� ri - ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam 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 PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: V 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 ADA Approach /Sidewalk Dat Inspector 7 Ext Other: Final DO NOT RE OVE this inspection record from the Job site. • PASS PART FAIL •