Permit C ITY O F TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00083
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/8/04
SITE ADDRESS: 09000 SW DURHAM RD PARCEL: 2S114AA 00100
SUBDIVISION: ZONING: R - 4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT 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: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: 206 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 36 ft
Remarks: Science remodel, site utilities. Other fixtures are (3) rain drain connectors.
FEES
Owner:
Description Date Amount
SCHOOL DISTRICT 23J
13137 SW PACIFIC HWY [PLMPLN] Plan Review 2/25/04 $51.80
TIGARD, OR 97223 [PLUMB] Permit Fee 4/8/04 $206.20
[TAX] 8% State Surcharl 4/8/04 $16.50
Phone : Total $274.50
Contractor:
ROBINSON CONSTRUCTION
21360 NW AMBERWOOD
HILLSBORO, OR 97214 REQUIRED INSPECTIONS
Phone : 503 Sewer Inspection
Storm Drain Insp
Reg #: PLM 63147 Rain Drain Insp
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
+ I
Issued By: `!J /� / 1■_ ,, Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Site Utilitie Cl `�C o J
. lei rl . ,i �trr il,m.'4 e x fm #-m��t, , ��i r" z r
Plumbing Permit ApplicatioE t / oeoFFicus Y,de.�49�M�eam
Receiv}d / �/ �j �
City of Tigard Date/B ' �� 5 Penult No in jay �000
13125 SW Hall Blvd , Tigard, OR 97223 _ (� Plan Review t
Phone 503.6394171 Fax 503.598 1960 FEB [D tau i�� '�jtf y 5� �oe� Other Permit •.., ,.4 4,1,175 GG
Date B 7
24- Hour Inspection Line: 503 639 4175 • - Noti r F mo . Date Ready .. / 9 es f f V F s � � ® See Page 2 for
Internet www ci tigard or us ., CITY � fied , ; / ff/ . Supplemental lntormation
: ' g '' -' ' ' '' LU —1-4`.=r- ' I,ON ," - , ` ' '�_ ,, ., FE SC HEDiJLE -
. p ?: x T Y P E «OF' _ -
..:� , _ •�'��s'"i: ='fit_ ,., x .,x ��";�i. .� ., . -r.�-; " . .. ..,.� , -.
For special information use checklist.
❑ New construction ❑ Demolition
Description I Qty I Ea I Total
st Addition /alteration/replacement ® Other Drum/. 1 mu... New 1- 2- family dwellings (includes 100 ft for each utility connection)
) i .,i.1' `` w- -,' E , -`;h = CATEGORY OF CONSTRUCTION; ; - - ` SFR I bath 249 20 •
❑ I- and 2- family dwelling N. Coi'mnercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399 00
Each additional bath /kitchen 45 00
❑ Master builder ❑ Other.
Fire sprinkler ( sq ft ) Page 2
kr4: , -4;S ;. V . :JOB''SITE IN4F,ORMATION;. .ND 'L• OCATI0- -• ;; . Site utilities
Job site address: gDoa L J(j Ipty .A+j pg. Catch basin or area drain 16 60
City/State /ZIP. — 1 1 & P 4 2 . - 1 9 (JVe. 11 ?,Z,4, Drywell, leach line, or trench drain 0 16 60
Suite/bldg. /apt. no.: 1....) A i Project name 1i&N,C) \24}ct Z Footing drain (no linear ft.. ) p Page 2
Manufactured home utilities 0 110.00
Cross street/directions to job site
Manholes 0 16 60
S L 'pill_, Y5(.\) b . tb SU 1 0 U1/4 Rain drain connector '5 16.60 ff
Sanitary sewer (no linear ft.. ZOfe) Page 2 '4),
7/. 7 1
Storm sewer (no linear ft 3 (0 ) Page 2 56,616
Subdivision: Lot no.' Water service (no linear ft D ) 0 Page 2
Fixture or item
no.: s t`4 A.A., Qp l'pp
Tax map/parcel 2
Absorption valve 16 60
p: '" =g % - ', /, `= D E SCRIP TI O N'-OF=WORK` : ,• Backflow Page 2
�`e, . _ ,,A �« .� , �:� .� .. ,. , acow preventer age
Backwater valve 16.60
! k) lb el Ot. PCM t1 -i- 4Z- rtinhra- t, O C' VA. KT! /.. Z-ST01€1 Clothes washer 16 60
`6U0G . flAt tJE.btJ SC L G--)Lt C..14 SS 1 M4 Dishwasher 16 60
9 ` ` ":r f, Dnnkmg fountain 16 60
;, w' PROPERTY $I) ; ' ®4TENANT - w : " . ,y ;,,",' .
°� ...... -` ar I� " �.. Ejectors /sump 16 60
Name: -1 j( - _ TWN.L,ecrim SCdkODL ryj,(•ViatCT Expansion tank 16 60
Address: 616 p SL ) S Ap n w_-& Fixture /sewer cap 16 60
City/State /ZIP: Tc - at 9 "1 Zz3 Floor drain /floor sink/hub 16 60
1.
Phone: (5012)431 ,4,o oo Fax- (l ;b3 ) 43% .. 412.4.-7 Garbage disposal 16 60
„f• ,),: ;® `�`APICANT • PL, '"r• , ` $'� 16 60
` ' ``; ' ,: ",' r7T r "' CONTACT= 'PE
Ice maker 16 60
Business name: CULL OL..4 0 1 . ) 1 C t t 2 . C4 ' ("c Interceptor /grease trap 16 60
Contact name. Vt'r14 1 b j.So*-3 Medical gas (value $ ) Page 2
Address: '31 S (J A I (.( - : #3 Z.00 Primer 16 60
City/State /ZIP: 10(x11,,,64N) t OW C-7 Zn 4 Roof drain (commercial) �r 16 60
C Sink/basin /lavatory 16 60
Phone: (S-j b-27) Z Z b — �'j 'i 5o w I Fax: • (S'p't 2,75 .. C (y 2, Tublshower /shower pan 16 60
E -mail gi ti. 0 e d,1' Wa /
,• W Unnal 16 60
/, ` I: °
, ' 0*it A,CTOR:%'�;. y Water closet 16 60
Business name , , ( ,ti " ` u� tI\, r juh C, V\ �V 0. Water heater ' 16 60
I Address: 2 \3(e f (Arco \ Other.
��WVW`Q9 r1
Subtotal
City/State /ZIP: VT ILI U.ro 0 `7 l ( Z �
Minimum permit fee $72 50
Phone. <3) (2 Fax 5 - 531
Fax (503) t S — � � Residential backflow minimum pe m rit fee $36 25 j,p�
CCB Lic.: W ' lumbmg Lie. no.: Plan review (25% of permit fee) 67
State surcharge (8% of permit fee) . V &,,j'O
Authorized signature: c c A. a -(0 r TOTAL PERMIT FEE ,
Print name ($•'S Date. 2 - J/0 9 this permit application expires if a permit is not obtained within
71 180 days after it has been accepted as complete.
U *Fee methodology set by Tn- County Building Industry Service Board
r \Bmldmg\Permns\PLMU- Permithpp doe 12/03 440- 4616T(i0102 /COM/WE13)
a
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
5; ,, ' ' 4F,ee -To :.
;Q �r� .- (?� ' "S` "ware Footae: ' �� ` - ��Per.mi
S'ite�,T7tiltie ;s . >.a . � � ...:� : �* ��: ; ��. ;x�'.: ;a . �..:z, ; A. ",.,4- �.. .., g a =�` r �, . .,..s. .. ,
Footing drain - 1' 100' o 55.00 0 to 2,000 $115 00
•
Footing drain - each additional 100' • o 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220 00
Sewer - 1st 100' i 55 00 SS eV
7,201 and greater $309.00
-
Sewer - each additional 100' f 46 40 Li 4 4
Water Service - 1st 100' e, 55 00 Medical Gas Systems: '
Water Service - each additional 100' O 46.40 '. Va1uat101h� Pe'r,m1t.Fee: ' ' o
Storm & Rain Drain - 1st 100' %I 55.00 5 0- - "
$1.00 to $5,000 00 Minimum fee $72 50
Storm & Rain Drain - each additional 100' O 46 40 0 $5,001 00 to $10,000.00 $72 50 for the first $5,000 00 and $1 52 for each
;,,, ,} ;. „, additional $100 00 or fraction thereof, to and
1XtII3'e -Or )(t ni ' ' " d .- , ; ='QtY• ,Fee,(ea), '
.. ,_»w, „„��.,_ ~ „„i! .. ., ; ;g , ..„."„: ; °;51,-,, , � a, c c, . ._ , , ,,.,.. _ ,A.... ,u ■ including $10,000.00.
Commercial Back Flow Prevention Device o 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) 0 27 55 and including $25,000 00.
Rain Drain, single family dwelling 0 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 $100 00 or fraction thereof
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
„i,4 i�`�5�i`.;' "` ''�^fr`' ". "z , .;,Q ti %.iby(Ftxiiii. ':W.Nriere "rmed''`�.
YF'ix -,r ,t tM { *T,, . a ;" z k' e - % 'VF(. 14ce'F Z' F'' _
ture:Type.�.iz „.• �` _:�.�� `� �� _ _, P , . . .t
r,: -w— - -- - - t:z.ow,, , ° 4 44.--1 h ; `, s . v. , 7- - 6 Comments regarding fixture work:
;,,ny 4 m ,,,. s, ,, a,,, „ ; _ , N o ed:.d„ . og q F .:._, a, C 0 g g
mss.. :yNew ;' - , , , , , 2:- om ;.
Baptistry/Font wai EX t v I iJ ( SS • • N% .4l-$
Bath - Tub /Shower
Jacuzzi/Whirlpool .)( i � �� Cti �
N4 IV
Car Wash -Each Stall r �'� 4 �17• _
-Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial
- Domestic ` ` )
Drinking Fountain
Eye Wash — tt,1ilia 4 ,vet,,
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
Et-ittf-G. ,sita# 1.1 .
Sink - Bar /Lavatory _ 0 Quantity Total
(SG/Ghtt - Bradley
(4 ti ) - Commercial L Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Falter
Washer - Clothes ®'"
Water Extractor Plan Review .
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
•
Unnal
Other Fixtures' .
•
■ YButldmgtPemuts\PLM- PermtApp 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 7 L C AM PM BUP
Location 7W6 . 1 Suite MEC
Contact Person Ph ( ) PLM _700y CDC)
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 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 J
Susp'd Ceiling -- — —
Roof
Other:
Final
S PART FAIL
PU M
Post & Beam
Under Slab �,�� Z2
Rough -In ��
a • -ns
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
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 Date III c Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL