Permit CITY TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00084
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/10/2004
SITE ADDRESS: 09000 SW DURHAM RD PARCEL: 2S114AA -00100
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: El FLOOR DRAINS: 7 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 60 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 12
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 2 RAIN DRAIN: ft
Remarks: Science remodel, building fixtures. Other fixures: (2) ice makers, (7) primers and (3) roof drains.
3 eo- c..Z��'-w' FEES
Owner:
Description Date Amount
SCHOOL DISTRICT 23J
13137 SW PACIFIC HWY [PLUMB] Permit Fee 5/10/2004 $1,344.60
TIGARD, OR 97223 [PLMPLN] Plan Review 5/10/2004 $336.15
[TAX] 8% State Surcharl 5/10/2004 $107.59
Phone : Total $1,788.34
Contractor:
OREGON CASCADE PLUMBING
PO BOX 12127
SALEM, OR 97309 REQUIRED INSPECTIONS
Phone : Underfloor /Underslab
Underfloor /Underslab
Reg #: LIC 127 Underfloor /Underslab
PLM 24 - 33PB Underfloor /Underslab
Top -out Insp
Top -out Insp
Top -out Insp
Top -out 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 ■ �f
Iss ed By: &-#& -k)' Permittee Signature: L
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next b iness day 0
Building Fixtures RECEIVED _ x . P.ety0�ge.
w ' 2 � U4 t � TA t a., � s' i"' i t i a::Ta'ap._ � r 3 9,, ,. ,1T,,, "`.�5 . +) �, " rr #' ,,� . '
Plumbinz Permit Applicaf +�,i 2 5 ."'i';' , m3^,hv'OR OF v'USE. L yf'• v v v ` o' * °<' sr�oak
City of Tigard CITY OF TIGAR t n ii�y /a .� Lt/ j Penntt No I2 rs.",..7 ot4 • ow y
13125 SW Han Blvd , Tigard, OR 97223 BUILDING DIVIS • Plan Revie [�
Phone. 503 639.4171 Fax 503 598 1960 at ,+�i Other Permit No 1/1 ''tT� C.tS�
24- Hour Inspection Line 503.639 4175 � D ateBy
r Date Ready/By i " 0 Sec Page 2 for
Internet www ci tigard or us Notified/Method - r 14 Supplemental Information
�, .: ' �.. .:f, ,. "TYPEtiOF °WORK' . , , FEE *, SCHEDULE ,, - .'
For special information use checklist.
111 New construction M Demolition
Description j Qty I Ea I Total
.Addition /alteration /replacement S1 Other. (UTgol,1 m {R4 New 1- 2- family dwellings (includes 100 ft for each utility connection)
-- , :I -,, 'r -,_ .. `,CATEGORYs` SFR (I) bath it 249 20
❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath t} 350.00
SFR (3) bath ; 399 00
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 45 00
❑ Master builder ❑ Other:
Fire sprinkler ( ',sq ft) Page 2
•'• , JOB , SITE -INFORMATION;ANDr`LOCATION, S ut
Job site address: 9 0 00 S 00 Neu i (2 p/M7 Catch basin or area drain 16 60
Ci ty /State /ZIP' TG P2,1/, , 0 1• ZL4 Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no. J�] {�. ' Project name: TL4'r 4 H �I4pSr Footing drain (no linear ft ) Page 2
Manufactured home utilities 110 00
Cross street/directions to job site
Manholes 16.60
d ?tA) NriArL- . ¶L\) VD TO !j () pOKNrP -M ve-b. 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 l 1, Li AA 001 D O
Absorption valve 16 60
.4?'a' : F ..!• IPTION'.OF . , , ,_ Backflow preventer Page 2
1 N11.4.t bIA, YJ'tt t o 4. iett.loy .L OF.- S7u5Tllj lz Backwater valve 16 60
z - rD I .Y vj(7IL- V 1104 VW. J.-)IE J SC-I G�1C.t. Clothes washei 16 60
C(.444€7 PUMA, '" G1 A CdJ, UTIL:tC•IES WWI A.lS I era. Dishwasher i f Z 1660 3,a�
, Drinking fountain 16 60
;', •.: O
OPEWNER' yl` K ... ECtiENANT - , .
•- �• _ Ejectors /sump 16 60
Name: T(.., 10 , ' 13 X 1.- 0111,.) SC1k D0L. 1'21cr.1L — r Expansion tank 16 60
Address: 4,1 Go SW SpcNr2 r02& Fixture /sewer cap 16 60
City/State /ZIP: Tvp i2J7 DK., 1 "j Z23 Floor drain/floor smk/hub4 , "7 1660 Os
Phone: (S'O') 4. I - 400 0 Fax. ( 43 ( _ 4041 Garbage dispos 16 60
't:,®. APPLI - - - Hose bib 16 60
-� . =," ' ' .' n= L:',,: a =., y r „',,*,' GONT,ACT PER
; r ; _ �.; , .: , Ice maker 'l, 16 60 3 3 if
Business name:
OU L.l. 0 L4 OP 14.A.E.4.5 POP-G14'ITEGTs Interceptor /grease nap 16 60
Contact name: itcurt.4 4.1.44ew Medical gas (value $ ) Page 2 /
Address' 3(A 6/.4 l.JA�Sbtim Si', #t Zoo Pnmer — I 1660 / I6,AD
City /State /ZIP p ({/1. I:174 4
Roof drain (commercial) 16 60 / , 1 0
(6 Z / Fax: V M.asm /lavatory Cia-Ditt tAh 1 Cob 16 60 tg,ab
Phone: (
!/b - J� 1 Sb (� Dl3 lei 2- ub /shower / showet pan 16 60 �_CU�
E -mail' n l (Z Ow O\_ • e Urinal 16 60
. fit„ CONTRACTORt.. �, _
Business name v. Water closet 16 60
Water heater 16 60
Address: Other
Subtotal /3 3 a %,
Minimum permit fee $72 50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee• $36 25
CCB Lie.. Plumbing Lie no.: Plan review (25% of permit fee) ✓, o fj
CIA‘vr----'. State surcharge (8% of p ermit fee /P1
Authonzed signature: IT-Elo
6 TOTAL PERMIT FEE {{,7 d r
Print name: � X'� 'tf; Date: a/ 2 L This permit application expires if a permit is not obtained i Wit iin
1 180 days after it has been accepted as complete.
*Fee methodology set by Tn County Building Industry Service Boaid
I \ Building \Perrm¢\PLMF- PermtApp doe 12/03 440- 4616T(10/02/COM /WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: -- Tiftts 010 S IT* V'(11- -1'C (-S Residential Fire Suppression Systems:
t ea " : Total ;
Q r' y Feel ( ) ;S ware °, Ftiota e., Permit Fee:
... ,... q., . � . 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 - l st_l00' 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 '•
tValu'atinan`a P.er ° mit'.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
•� ° :',s "i <y : .s ;t :Q't'y , Fee° ea Total! additional $100.00 or fraction thereof, to and
NF;<xture;orltm. '; ( „ >Py , _ „v
s "': .. - .,...,�. , �T x„ �k...: ,- „;.. 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 * .
y � t ,. ;f °, 1 �, „' ,�,',; _ � Quantity;, liy (Eiztui•e)Work�Perforiiied „--
N`gnx ,
°� ;Tr=,v. ,� r:�.',f.r t;„ < <�` "';,�,;.•: 'Moved�;v �- Eaistiu s ',,Capped „ °`
Comments regarding fixture work:
N w� -�.- - _,_,i. ,. -_ �s s�:.:”- .,.,�•.`s g 'st _, .,
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi /Whirlpool ciA &t -- S444 Wr'rz /lEY( W/4 (4 l !- Ntt k
Car Wash -Each Stall 1L.lJCC.. G(,AVSSi2 k/M S
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial l T W'b E' rs Jc - CLA riVtoop-t
- Domestic Z (,I t Kt 1CM0 Aro
Dnnking Fountain
Eye Wash —1E,Mt 6 /L) ail =OA . { I
Floor Drain /sink - 2" — 1
-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. /Refng Drains Z
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
�- - S,tail uk"SS �]
Sink - Bar /Lavatory ( Quantity Total
(SGI Nit, - 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.
Unnal
Other Fixtures
\Bwidmg\Pertmts\PLM- Pevm0App doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
dd BUP
Received Date Requested — 0 AM PM BUP
Location 9 2O 6 , 1� 1 t J Suite c-� MEC
Contact Person 2� Ph ( ) ' 3 Z - 3 u ( PLM .:2 q-97
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
Susp'd Ceiling
Roof
Other:
Final
.77 -71.."".(77
PASS PART FAIL
PLUMBING ,
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other: "
41 PART FAIL
V HANICAL ",
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 fi Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
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'4"71.11TIV- wow $yktien.t140 9 0K ' 4 1P01 1 16$PPY ,' Y.5
t.• ,
CITY OF TIGARD
13125 S.W. HALL BLVD. RECEIVED
TIGARD, OR 97223
MAY 1 1 2004
IMPORTANT PERMIT NOTICE
OREGON CASCADE PLUMBING
PO BOX 12127
SALEM, OR 97309
Plumbing Signature Form
Permit #: PLM2004 -00084
Date Issued: 5/10/2004
Parcel: 2S114AA -00100
Site Address: 09000 SW DURHAM RD
Subdivision:
Block: Lot:
Jurisdiction: R -4.5
Zoning: TIG
Remarks: Science remodel, building fixtures. Other fixures: (2) ice makers, (7) primers and
(3) roof drains.
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 -33P13
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X 1 #Jn �
r r
Signature of A uthorized Plumber
If you have any questions, please call 503.718.2433.