Permit CITY TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00222
�- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/16/2004
SITE ADDRESS: 09000 SW DURHAM RD PARCEL: 2S114AA 00100
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: 2 MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: El FLOOR DRAINS; 14 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 49 URINALS: 4 GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 16 WATER LINE: ft
DISHWASHERS: 6 RAIN DRAIN: ft
Remarks: Phase 2, other fixtures are: (8) drinking fountains, (5) primers, (16) roof drains & (16) overflows.
FEES
Owner:
Description Date Amount
SCHOOL DISTRICT 23J
13137 SW PACIFIC HWY [PLUMB] Permit Fee 6/16/2004 $2,290.80
TIGARD, OR 97223 [PLMPLN] Plan Review 6/16/2004 $572.70
[TAX] 8% State Surchar; 6/16/2004 $183.27
Phone : Total $3,046.77
Contractor:
OREGON CASCADE PLUMBING
PO BOX 12127
SALEM, OR 97309 REQUIRED INSPECTIONS
Phone : Rough -in Insp
Rough -in Insp
Reg #: LIC 127 Underfloor /Underslab
PLM 24 - 33PB Underfloor /Underslab
Top -out Insp
Top -out Insp
Top -out Insp
Rain Drain Insp
Rain Drain Insp
Final Inspection
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 -0100. You may obtain copies of these rules or direct questions o OUNC by calling (503)
246 -66•'.
Issue. By: , � � ` ,� , Permittee Signature: A ,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Cw-
1 7
Plumbiri Permit , II °i' ��' F .. -
1 i . .;
FOR OF ICE, USE ONLY
City of Tigard 4 2004 DateBy,,� A al Permit No
c I onr9eD e
13125 SW Hall Blvd., Tigard, OR 97223 MAN Plan Revied+
Phone. 503 639 4171 Fax 503.598.1960 y IJIt r i Date/By Other Permit No .
ITY O
24- Hour Inspection Line 503 639 4175 OF TIGARC 2L2r 6 I 11 Ready/By Date Ready /B iw I ( Page is p See Pe 2 for
C
Internet: www.ct.tigard.or us Ig1141 P1It j(' DIVISI Notified/Method ' Supplemental Information
;; 4,;, ; 31 4;` #` , . FEE -t,
° a' : .ys, t �� TY
P E� " > V1'OR „r ,. . ' ": ,„ .0 : - , , SCH E DULE
❑ New construction ❑ Demolition For special information use checklist.
Description f Qty. I Ea. .1 Total
Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
j ''r '�r Alf' V ;m. ;, 1 , I s ": ,max• -, NSTRUGTION°�`x
- °f ',:;, , ' '., '` f 3;; SFR 1
- CA'TEGORY 'OF,'CONS , , : r ( ) bath 249.20
,.� ,u��s "'�t,�. .� "r�r�. _, ,� > „3. stir ` °rs..` .,: ., ,,-. ' mot':, ,��5`�� _. - �,�.,,
❑ 1- and 2- family dwelling X Commercial /industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45 00
❑ Master builder ❑ Other:
i t,.,;_, ' ::w ,b' -, ., -. `, .:; > , *,; <a ...,, .1. x , ,,x Fire spnnkler ( sq. ft.) Page 2
w ' ,, JOBSITEtINF TION -r ,.:” Si u tili t i es
Job site address: el 000 NO 17L) . A4 Rk7 • Catch basin or area drain 16 60
City /State /ZIP: TrG,Att D1Q • r-j ZZ3 Drywell, leach line, or trench drain 16.60
1
Suite/bldg. /apt. no.: Project name: TNAK0 44, roa Z Footing drain (no. linear ft • ) Page 2
V Manufactured home utilities 110.00
Cross street/directions to job site: S W PIAL Y3(,V Y2 -
Manholes 16 60
5k) OV PrT-k 1 4(0 Rain drain connector 16 60
Sanitary sewer (no linear ft. ) Page 2
Storm sewer (no linear ft ) Page 2
Subdivision:
Lot no.: Water service (no. linear ft ) Page 2
Fixture or item
Tax map /parcel no.: 2 5 i 1 AA. pQL 0 D 1
Absorption valve 6 60
i '``x- ,-,,,;,::r" ° ,' ` , D E S C RIP TI ONO Y, WORKt «_ ;� , - "
= , - :)` =<3 , a € _ , _ '� cc , -� , , , 5 ; :,. -.-t , , ,.= _ _..;,, _ AU., :> ,:'..'W, ). _ -. , Backflow preven Page 2
e t.tt0 0Q (-i q50 's 1 ” � 4 �,u1 lG S.vr.Ct I ( Backwater valve 16.60
La/ (A.O -LO � ' I► "1 GI.4.4SVDU �ldS • 14.144.1.3 di..¢H. Clothes washer 1660 I f
it 1 Dishwasher 16.60
1.4 S kCkv 001..,s tic •
t`,` g
. , , ;'. '- .,, :r , ..:;,;r.: s ,; ..:, ° . .6_ ,: • Drinking fountain 16.60 .4
=` PROPER OWNE ,i , . -,
, Z ,i t T ; "'i,, " -',': E
> :�t �` - c � � q : -, r - :: .� v .. � ar, nr „� `.+(�> ., �.,, Ejectors /Sump 16
Name: -I-
1611,40 _ TihaLAtii(J .M * L , . T Expansion tank 16.60
Address: 9 b 0 SW : SR . ' 7 3u1, . Sr. Fixture /sewer cap 16 60
- r
City/State /ZIP: ” &Any7 • b ¶-7 21-3 Floor drain /floor sink/hub 16 60 1 L( V
Phone: (S6 °j) 9 31— 1- 1 DO3 Fax: (ci o 2 ( y 04`1 Garbage disposal 16.60 2
+ , 3 '; � i ., ris.r.,. Hose bib 16 60
=re ?:' : ": W i1 APPLICANT kv `� , :` yy ti.
i°� _,�rx., ice maker 16.60
Business name: D` )1L OL 0 1..i W ELM AtizeriTerS Interceptor /grease trap 16.60
Contact name: tTI•k t77)11fll.ISaA.) Medical gas (value• $ ) Page 2
Address: 315 5w 1-0A-514 ( - Mu ST • * Zoo Primer 16 60 .5 /
City/State /ZIP: me .b7 a2, I/ '2.D 4 Roof dram (commercial) 16.60 (P
(6n) sz 675 n (c�p-5) 2 5 ( 2 Sink /basin/lavatory 16.60 ��
Phone: Fax:
Tub /shower /shower pan 16.60 ( /
E -mail: ebiv1 ) c ctDt Urinal 16 60 L.f /
- ;"5 t. - " ..s„ 'ONT
_
,CRACTOR` - , =yz' �`_ :);.` , Water closet 16 ( /
:�.z,� r,t ,,�. fY _ ,. Wi � . . ;�,�
—
Business name: /� N'� Water heater 16.60
Address: V Other: Q(e.Y46w ( (p
Subtotal
City/State /ZIP: ��
Minimum permit fee. $72 50 / 99 60
Phone' ( ) Fax: ( ) Residential backflow minimum permit fee $36.25 /
CCB Lie.: \ Plumbing Lic. no.: Plan review (25% of permit fee) 512 70
' "' ` State surcharge (8% of permit fee) / g 3, A 7
Authorized signature: q V I✓ TOTAL PERMIT FEE 3 o y�
Print name: (- XKuS Date: S 1pill 6 L1 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board
I \Bud ding\Permtts \PLMF- PermiiApp doc 12/03 440- 4616T(10/02/COM /WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information `
' • Fee Schedule: ' tf SITE. UlluliitE.S / 1 • Residential Fire Suppression Systems:
�i, - . ., c" -•1"- ;sl `»'v - 4 °., -- x':3,•'. 'f�'«°A$'�'.:F`:.�� ° %�,�.' :.�'�.s ^ ;.�..r . .;�;t�: ^� ;1: ' "4 ;'� >p � , � ' _ , `�', .,
3 < <• it �3: -,., ; +'s': ^.:., • , t> pifee'fea To'tiiiI e ,
'; ;.. ;.� k -e� � ..,: „, . (.., , , c o 3: ware oota e s 0, .1 P,er `
Al _: a :, ,
��t� Sltez1., u �� ,��'���'�s��n���„- w��`r'.�a,' � ",riSt�r4��a���9�'aa1u����ad xi ,��"n. -:��: iz ..� � _ .�� �, ���, .>�_ .,. ®b_.,, a._ e� _v�1 > � � ... ..� ss _ ,
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' 4640 ,m4 " ';, - :a , w "i ,,' � ; ; �;i `, F
. 'Valu S " ,- ; ,':: • t P :1 e rmi t• t F ee :: - >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
. „ ssr<,•.,%1 ri ,,;.a =..., ,. gt,-'e additional $100.00 or fraction thereof, to and
” , "% ;# 'x Q't`y- s , -, , ,-,'. ,,,,
- F o r3Item g - 5 ::: t -& _ i ,y:,.,
_�` s � '� � r:' ' ' 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 $3,79.50 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 * .
_;, v '; ems. ; Quaritityb `y(Fixture)WorkPerforiiied:i '
ture'•E e :ASR' ":1v �F:.'� §, iu '; eplace��, . i g
e.z` yp • z ° r. }�,'` ,;,, .i 4 ) n . ?'4,- ;.` R r' ::: ^ " °�:'u'_
:,, �: , "" �� , a �=; lvzoved isnag om = ca p ped,. ' . , Come• • nts,regarding'fixture work: •
• Baptistry/Font A GD '(.l<, US OF "riff, ' - ou69/
Bath -Tub/Shower zzi /Wh r f %X.N IGE5 to -
-Jacuzzi/Whirlpool 5tAti,rTCY2
Car Wash -Each Stall • • ■ NO P / _ _
-Drive Thru
Cuspidor/Water Aspirator '� � a 1 ` b G i " L '�
Dishwasher - Commercial f04 enr !!L [ �' - 1 1 �/� S I i- kli
- Domestic
Drinking Fountain
Eye Wash 1' 1rq. 4, To • • uSI
Floor Drain /sink - 2" f?: d� � 1 A —r
3"
i " mss ' N L' MrrVCt'7
Car Wash Drain
Garbage - Domestic •
Disposal - Commercial *■ Ite: If the fixture work under this permit res Its 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 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 \Budding\PermIts\PLM- PermiiApp doc 3/03
■
I 1 k
• •
. . /
Site Utilities ,..__ . . , ..
. . .,
Plignibing Perniit r.X.11@liatiiik IR
. Tog .OFFICE, usE',ONLY,
. .7.• . . ,,; • .„..._
City of Tigard Received
q 1 I.A1 . 66
13125 SW Hall Blvd., Tigard, OR )97213
1 - , 1 4 20 Date/By 04 Plan Review Permit No17
Phone: 503.639.4171 Fax: 503.598.1960 gisTyl/h , v Date/By Other Permit No •
24- Flour Inspection Line: 503.6 ,31,41150 F TIGARD .41
1 uns 0 See Page 2 for
Internet vvww.ci.tigard.or us - - • 4, 1:II- Date Ready/By
E
fied/Method / 6. Supplemental Information '
r' rNINs,r1V0.1591\1 Noti
- - -.,,,,, ,.- ,, . ,,, , .,,,, ,, „,,, 7T , , ._ „ ,
, ;:S',10:g:IMTyilt b
t..,owlsiik :444,0,,,t?„,A,.:A1,. ''''N'M A 'Atli', :V: %' '5K:' ;.;`:,, ' - ',',1-'' ', - tE §6
, HDijEE
1. :`*'';, '„, .,,,,
D New construction 0 Demolition For special information use checklist.
Description Qty Ea. Total
tgAddition/alteration/replacement D Other: .,. New 1- 2-family dwellings (includes 100 ft for each utility connection)
'4 `
• S FR (1 ) bath 249.20
D 1- and 2-family dwelling 1 Commercial/industrial SFR (2) bath , 350.00
SFR (3) bath . , 399.00
D Accessory building D Multi-family .
Each additional bath/kitchen 45 00
D Master builder D Other:
Fire sprinkler ( sq ft ) Page 2
F'
!'''aiiikaijiitii■aratticelffiWTv'if'-z
tO1 1- ‘ ' , ,,, aw,,.,„:,,,!: ;,:,:„ - d'r , ■• ,r,;, ; .-'' `. !''''', 7 ', -' `- S i te utilities
Job site address: Dm 'L) 0021+Afri le() . Catch basin or area drain 16 60
City/State/ZIP: IT&Aleto ble 17 z-z,--3 Drywell, leach line, or trench drain 16.60
Suite/bldg/apt. no.: Project name: -ter ) As l a. t kost z Footing drain (no. linear ft . On ) Page 2 i 9f4.21
Manufactured home utilities 110 00
Cross street/directions to job site: 6( 4.k i s w 19 T
Manholes 16.60
S U) 0 Ma (*AM ga Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no linear ft.. £)) Page 2 /4(7.• te
Subdivision: Lot no.: Water service (no, linear ft.;') 3415 Page 2 / ill sAa
Fixture or item
Tax map/parcel no.: zs 1( 9 Ap opt bo
,. Absorption valve 16 60
11:Wsgaggliiiiii::1,-,t-SAigf6 .%.,i,t
' .........4..... ..,...kul....--, , 0,..2:1.3' 4.-0-.:7 -;7". - ;''z , ,7 , ', , > ,, ,ft., , S.:17;.: Backflow preventer / Page 2
02-M V t)t i4Ca's rblenD N OF 1%511)('7. 11t,Put, Backwater valve 16.60
Gorti•I• Oglo --z-s ciLisAsg,00ti K6Lay - Clothes washer 16.60
Dishwasher 16 60
141N.114/41. it, /004 -. ONCE iwt 6AST FActice (4, .
At itAwv wo ,, t!tol ,,,,, i ,,,,, w , , , 1 ,,, Dnnlang fountain 16 60
1:1!"'L•o, Y7';e3".• L:'nf-'14 ...1.•••,';',,3w.-,'W '''...I
Ejectors/sump ,
16.60
Name: - 11C.,Aier) - -rvAd-lbrrItO e- IA DR, VLSI . Expansion tank
16 60
1 - Address: t i ( 94 6/ cr. . Fixture/sewer cap 16.60
1 City/State/ZIP: --I(.44 (- 1 "7 - Z - 2 "3 Floor drain/floor sink/hub 16 60
.. Z Phone: (S-0)) -f' 1 - Li D D '3 Fax: ( 957) q3 - Li Di{ 1 Garbage disposal 16 60
.. 5) i ...-.1„:•....--, ! , , i ,..,,. 9 ,,r4i,„
I PT
,:- , .■":' , ',„,f, 4 7 oiCa , Wit, , ,„ - ,4 f°NIZIT: Hose bib 16 60
tX,24.7.1: , 'Vr, - Vg eli S.,.9,. ,••.':•:. Ice maker 16 60
----,.. Business name: OUU., DL' DP WELV-£.5 ,2lAlliCrS Interceptor/grease trap 16 60
Lf 'Contact name: 1 1'1'1k obiA4440k) Medical gas (value' $ ) Page 2
Address: -.2 )1C S1 /4)61 A , ,,—re) 4 3r . 41* 2ADD Primer 16.60
City/State/ZIP: oy z-r G b/00 02 c-ito 4, Roof drain (commercial) 16.60
Sink/basin/lavatory pan 16.60
Phone: 6b3) 2,f, - 1,,, 550 I Fax: : (997 ) Z - q i q 7 .... .
Tub/shower/shower 16.60
E-mail: f , i 44,3- c, 8 hi, 4.. .c044... •,,_ Urinal 16 60
Wi itril 1.4110.'ofh)..rr,...'
. i':;,:7411 1 ,5;..,••:;0•Aat441•11 , :thl:':',.1;,A. 'A-,..c, „ "tf ',U 0,-, "e- Water closet 16 60
Business name: C _
Water heater 16 60
■. Address: Other:
Subtotal
City/State/ZIP: , Minimum permit fee. $72 50 5 sg, 110
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee $36 25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) 1 /45,4T
(f. 7 1_____ ,...„4„..5 -6. Tab State surcharge (8% of permit fee) Liep.4)/
n
I Authozed,signature:
‘. —..., TOTAL PERMIT FEE 774, g4,
‘"-- Print name: 71 CAr2X; ,.. NeiCVS Date: , ,// 1.116 IT 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 SI3LuldingTermus \ PLMU-PermitApp cloc 12/03 440-4616T(10/02/COM/WEB)
1
■ . , 1
s .
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information "' . * ,
Fee Schedule: Residential Fire Suppression Systems:
sr . °,t�;� r�;�._�_,: t� - .:x ��.� � ;�, , �,�� _.« at.� =���.4�,: , •��.��- a �: a.�,� ' 1:
4 ,,. , I, °,.: „rt� i i . , - t' Ree,(e a)',` „. T Total .,,, ..,
. ` Fri. _ .•. '�,��., ''q r ” e :: S ua re Foota ' ' e;:J ` .: ,d . Pe'rrimit' Fee' n , .
S ' ter' �IItiltaes,:.���, ..a�,��� � „ � � � .. q�R ..�. � �.._,. �,..�, .. ,� ,. .
Footing drain - 1 100' i 55 00 55 0 to 2,000 $115.00
Footing drain - each additional 100' 3 46.40 1 301 • 2,001 to 3,600 $160 00
1 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' 1 55.00 S $. Medical Gas Systems:
Water Service - each additional 100' 3 46.40 /3 9, „� . ., °,, { , . , .
Va u v atmww;' , ', ,
Sto & Rain Drain - I st 100' I 55.00 SS _ x $1.00 to $5,000.00 Y Minimum fee $72.50
Storm & Rain Drain - each additional 100' 2 46.40 92. �0 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1 52 for each
• - —
, .;. <3 ;y - .:_ additional $100.00 or fraction thereof, to and
i ». `, ''' W ” ,W ._ Q` i • ;1 ;61( T y
k. 1., .. - U r. &o t eTTl'4 „,',, to ;Wig ;,, Including $10,000.00
Commercial Back Flow Prevention Device 1 46.40 94,.11„ 1„ $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 foi
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
t 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 * .
'' s Quantitytiy ;(Fizture)WorkyPerforined
YP
B, ' F "`'' "'` " '. 3" ' `- `'` ' ' • • ' " d Comments regarding fixture work:
. _ -: >: ' < 1: - Mo'v 1 Exrshngn 42Cappe g g
Baptistry/Font A Gbt-i tt LISTIt46- VF TIM. RgMDVE-0/
Bath -Tub/Show zzi /Whr ga , ,9 FI- t -roktS L)M 5 01?w-ri e('
- Jacuzzi /Whirlpool
Car Wash -Each Stall TD - 1 - 4t cvr ' e/4"6P Z. totheK.
Drive Toro ST 1pV fC. r7 M. 1 i11ei.. WD12 foe,
Cuspidor /Water Aspirator
Dishwasher - Commercial p+ s E 'S, pig 2 .
- Domestic }� L ��.�p --�-,) -NIA- (�N u
Drinking Fountain "`� ' 1 � ` �/�, �� ""`.154-2,1
Eye Wash foie. Ti r SIE. Zr 1442410
Floor Drain/sink - 2" L' �` n - Mt TIRE
Car Wash Drain 1 Mt �1' ► , `0S ✓x'Atl (�+f,L Y�
Garbage - Domestic .L IN 1LF� l 6 tLl ✓
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 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: '
1 \nuddmg\Penmis \PLM- PermIApp doe 3/03
06/22/04 08:47 FAX 503 364 2276 ORE CASCADE INC. Ej001
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
OREGON CASCADE PLUMBING
PO BOX 12127
SALEM, OR 97309
Plumbing Signature Form
Permit #: PLM2004 -00222
Date Issued: 6/16/2004
Parcel: 2S114AA -00100
Site Address: 09000 SW DURHAM RD
Subdivision:
Block: Lot:
Jurisdiction: R -4.5
Zoning: T1G
Remarks: Phase 2, other fixtures are: (8) drinking fountains, (5) primers, (16) roof drains &
(16) overflows.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for
the plumbing permit to be valid, please have the appropriate individual from your company sign below and
return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building
Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
SCHOOL DISTRICT 23J OREGON CASCADE PLUMBING
13137 SW PACIFIC HWY PO BOX 12127
TIGARD, OR 97223 SALEM, OR 97309
Phone #: Phone #:
Reg #: LIC 127
PLM 24 -33PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Authorized Plumber
If you have any questions, please call 503.718.2433.
AL- 7 : 5 -624- 36
. mr
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: PLM2004-00222
13125 SW Hall Blvd., Tigard, OR 97223 , DATE ISSUED: 6/16/2084
Phone: (503) 639-4171 .. awdolgihtiTi
Inspection Requests (24 Hrs.): (503) 639-4175 ..,-44 'I-.
INSPECTION WORKSHEET FOR DATE: 802005 TIME: 7:07AM PAGE: 92
SITE ADDRESS: 09000 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD HIGH SCHOOL
DESCRIPTION: Phase 2, other fixtures are: (8) drinking fountains, (5) primers, (16) roof drains & (16) overflows.
1/25/05 Revised to Phase II A and Phase 11B
OWNER: SCHOOL DISTRICT 23J, PHONE #:
CONTRACTOR: OREGON CASCADE PLUMBING PHONE #:
Inspection Request Scheduled For: Date: 8/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 012997-01 503-932-2156 N
Corrections/Comments/Instructions:
•
OF -
('°/ d ,
4 • .
PASS pi PARTIAL APPROVAL [11 CANCEL El NO ACCESS
0 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: -
/7', D
ate: b il - Phone #: (503) 718-