Permit 1
CITY TIGARD PLUMBING PERMIT
I4 DEVELOPMENT SERVICES PERMIT #: PLM2005 -00623
„ -.1 4 '�' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/10/2005
PARCEL: 2S 110 DC -02300
SITE ADDRESS: 11545 SW DURHAM RD B -6 ZONING: C -G
SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT: JURISDICTION: TIG
Project Description: TI with vacuum & air system for dental office. Medical Gas Value: $1,800
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 4 URINALS: GREASE TRAPS:
LAVATORIES: 3 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 • WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
DURHAM /99 ASSOCIATES LTD PTNSH Description Date Amount
BY CRIIMI MAE SERVICES LP
ATTN: LOAN SERVICING [PLUMB] Permit Fee 11/10/200E $301.50
ROCKVILLE, MD 20852 [PLMPLN] Plan Review 11/10/200E $75.38
Phone : [TAX] 8% State Surcharl 11/10/200` $24.12
Total $401.00
Contractor:
D P PLUMBING /DARREN T PLACEK
15825 NE SPRINGBROOK RD REQUIRED ITEMS AND REPORTS
NEWBERG, OR 97132
Phone : 537 - 9492
Reg #: LIC 110612
PLM 36 -70PB
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 start- • in 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requ -s you to fo rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 0001 -0010 throu, h O A R 952 - 0001 -0100. You may obtain copies of these rules or irect questions to OUNC by
cal i ng 50 - 246 -6699 • 140 ed 332 -2344. /_
Iss By'- / e a� Permittee Signature:) ( vn
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Building Fi ures Paa05 453
Plumbing Permit Application. , .
- :, - _ . FOR OFFICE USE ONLY
City of Tigard i u ic L t il V E® R eceived permit No..
13125 SW Hall Blvd., Tigard, OR 97223 Date/By. y 6S (.1-1 .,i A* l '.
2005 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960N / /yr�,rm r . ;' tit /0)6(1-W Permit No.: 1,,
24- Hour Inspection Line: 503.639.4175 l � " Date/ ��I �U Jv�T+� r �
Date Ready/By: / ® See Page 2 for
Internet: www.ci.tigard.or.us (ITY r1F 71(: � N n otified/M d:11M /, 5- - � (a, Supplementa In
11 ( izEm QRmnsio" , ' . V/r't �/ ft i�C % ((( FEE* SCHEDULE
❑ New construction ❑ Demolit / JC For special information use checklist
Description I Qty. I Ea. I Total
- TA ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
'CATEGORY OF CONSTRUCTION - SFR (1) bath 249.20
El 1- and 2- family dwelling OA Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
• JOB SITE' INFORMATION AND LOCATION' Site utilities
Job site address: 1/'/S" 5 w 1) 111 1 - ti.o... /" A-6 Catch basin or area drain 16.60
City /State /ZIP: i e J> QL.- 4' 7 may • Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: b L, I Project name: b2 IAN ,,, X Footing drain (no. linear ft.: ) Page 2
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: Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: aj• l 0-De -0a...300 Fixture or item
Absorption valve 16.60
DESCRIPTION •OF WORK Backflow preventer / Page 2 4& r , t(]
f I Backwater valve 16.60
Clothes washer / 16.60 16 .
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER I ❑ TENANT -
Ejectors/sump 16.60
Name` , I q 1 P, 1� ,, 0,/ i T r ! 1 ST Expansion tank 16.60
Address: 1 � i T� '� Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub / 16.60 Ii-, 626 •
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT Igii CONTACT PERSON Ice maker 16.60
Business name: L) p p &)J,,,! t.H
Interceptor /grease trap 16.60
Contact name: _9 gy p. -1 Medical gas (value: $ 'f ° Page 2 72,50
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: Sink/basin/lavatory 7 16.60 deo,
( ) Fax::( )
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR _ Water closet 1 16.60 1 6240
•
Business name: - b P 4 2,,„,, y , Q f 1 ,4) ( , Water heater I 16.60 (Q
Address: /581,5 N i, Q 1,,, , Q, k, b Other:
City /State /ZIP:
�ati4) c2-. 4 713 Subtotal
` � . � l 2 Minimum permit fee: $72.50 Q
Phone: (�..L.C_5l 7J, - 9,4 ei Fax: ( ) Residential backflow minimum permit fee: $36.25 Q030 !•
CCB Lie.: /1 6 & ( `)-- Plumbing Lic. no.: 15.6 '70P15 Plan review (25% of permit fee) 75, 3 tr
State surcharge (8% of permit fee) A / 9
Authorized signal L
°�� �� "`•'« TOTAL PERMIT FEE "7/ /)/r )c
Print name: /J 2 y � u Date: / o S This permit application expires if a permit is not obtained within
r, /� 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\ Building \Pennits\PLMF- PermitApp.doc 06/05 440-4616T(10 /02JCOM/WEB)
6 - -x >>
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information •
• Fee Schedule: 0 Residential Fire Suppression Systems:
•.Sit Utilities • , -,Qty., ' Fee (ea)' Total = ' Square, Foota • e: ge: Permit 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 - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 , .
Storm & Rain Drain - 1st 100' 55.00 Valuation: 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
Fixture or Item ' Qty. Fee (ea) .Total additional $100.00 or fraction thereof to and
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 Back flow 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50 and up - , $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Complex. Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees*. Please check all that apply.
- Quantity by (Fixture) Work'Performed ❑ Any new commercial building.
Fixture Type Replace Any new exterior plumbing site utilities.
Previous Capped ' Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whiripool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial El Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 - multipurpose fire sprinkler system.
Eye Wash 1 Floor Drain /sink - 2" 1 Submit 2 sets of plans with any of the above.
-3"
4" ,
` Car Wash Drain Isometric or Riser Diagram .
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture•work:
Rec. Vehicle Dump Station
Shower -Gang ■
-Stall
Sink - Bar/Lavatory 3 • , ' - -
- Bradley
- Commercial 0 '
- Service y r
Swimming Pool Filter -,
. Washer - Clothes / *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet / . increase of sewer EDUs, a sewer permit will be issued and
Urinal , fees assessed for the sewer increase must be paid before the
Other Fixtures: . plumbing permit can be issued.
i:\ Building \Permits\PLM- PermitApp.doc 07/06/05
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CITY OF ��w n m n=�m TIGARD
BUILDING DIVISION PERMIT #: PUN20O5,00623
13125 Hall Bkd.. Tigard, ORQ7223 DATE ISSUED: 11/10/2.005
Phone: (SD8) O39~4171
Inspection Requea�C24Hmj: (503) 639-4175 1 . : .14 «�-..
INSPECTION WORKSHEET FOR DATE: 1110/2086 TIME: 7:00AM PAGE: 62
SITE ADDRESS: 11545 SW DURHAM RD 8-6 CLASS OF WORK: .
SUBDIVISION: \ML.LOWBROOK BUSINESS PARK LOT #: TYPE OF USE:
PROJECT NAME: DR.VNLLC0X
DESCRIPTION: TI with vacuum & air sy-tem ¶0' dental office. Medical Gas Value: $1.800
OWNER: QURNA1v1/99 ASSOCIATES LTD PTNSH. PHONE #:
CONTRACTOR: DPPLUM[NWG/QARRENTPLACIDK PHONE #: 537-9492
Inspection Request Scheduled For: Date: 1/10/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 024661'01 505'888-0214 Y
Corrections/Comments/Instructions:
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Ti PARTIAL APPROVAL 111 CANCEL Ell NO ACCESS
n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 01 Oatg� / � /v Phonm #� (SO3\ 718'
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CITY OF TIGARD 1 .
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BUILDING DIVISION PERMIT #: PLM200S-006?3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/10/2006
Phone: (503) 639-4171 llit
Inspection Requests (24 Hrs.): (503) 639-4175 A. - - - _ --.
INSPECTION WORKSHEET FOR DATE: 1/6/2006 TIME: 7: amtvi PAGE: 20
SITE ADDRESS: 11645 SW DURHAM RD B - 6 CLASS OF WORK:
SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT #: TYPE OF USE:
PROJECT NAME: DR. WILLCOX
DESCRIPTION: "Ii with vacuum & air system for dental office. Medical Gas Value: $1,800
OWNER: DURHAM/99 ASSOCIATES LTD PTNSH, PHONE #:
CONTRACTOR: 0 P PLUME3ING/DARREN T PLACEK PHONE #: 637-3492
Inspection Request Scheduled For: Date: 116/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 024507-03 803.888-0214 N
Corrections/Comments/Instructions:
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fl PASS fl PARTIAL APPROVAL El CANCEL El NO ACCESS
4 1■FAIL l] CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: ii irl4" Date: I. ( g0 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: PLM2005"00873
13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 11/10/2005
Phone: (50.3) 639-4171
Requests (24 Hrs.): (503) 639 -4175 :_..
INSPECTION WORKSHEET FOR DATE: 11/16/2005 TIME: 7 :03AM PAGE: 103
SITE ADDRESS: 11545 SW DURHAM RD Tr CLASS OF WORK:
SUBDIVISION: W ILLOWNBROOK BUSINESS PARK LOT #: , TYPE OF USE:
PROJECT NAME: (DR. W�ILLG' X J
DESCRIPTION: I I with vacuum & air system for dental office. Medical Gas Value: $1,800
OWNER: DURHAM /99 ASSOCIATES LTD PTNSH, PHONE #:
CONTRACTOR: D P PLUMBING /DARKEN T PLACEK PHONE #: 537 -9492
Inspection Request Scheduled For: Date: 11/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 021320 -01 503 -888 -0214 N
•
Corrections /Comments /Instructions:
- PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: " _�� Date: r 7 Phone #: (503) 718-
1- CITY OF TIGARD
BUILDING DIVISION ak. PERMIT #: PLM2006 -00823
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/10/2005
Phone: (503) 639= 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/14/2005 TIME: 7 :12AM PAGE: 168
SITE ADDRESS: 11545 SW DURHAM RD B-6 CLASS OF WORK:
SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT #: TYPE OF USE:
PROJECT NAME: DR. W1LLCOX
DESCRIPTION: TI with vacuum & air system for dental office. Medical Gas Value: $1,800
OWNER: DURHAM /99 ASSOCIATES LTD PTNSH, PHONE #:
CONTRACTOR: D P PLUMBING /DARREN T PLACEK PHONE #: 537 -9492
Inspection Request Scheduled For: Date: 11/14/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 021042 -02 603.888 -0214 Y
Corrections /Comments /Instructions: •
OAri -At /
I I PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
n FAIL In LL FOR INSPECTION n ADDITIONAL FEES ASSESSED
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Inspector: )9472 Date: 1, I Phone #: (503) 718
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00623
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/10/2005
Phone: (503) 639-4171 / Nit
Inspection Requests (24 Hrs.): (503) 639-4175 ■=10.•
INSPECTION WORKSHEET FOR DATE: 11/14/2006 TIME: 7:12AM PAGE: 159
SITE ADDRESS: 11645 SW DURHAM RD B-6 CLASS OF WORK:
SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT #: TYPE OF USE:
PROJECT NAME: DR. WILLCOX
DESCRIPTION: TI with vacuum & air system for dental office. Medical Gas Value: $1,800
OWNER: DURHAM/99 ASSOCIATES LTD PTNSH, PHONE #:
CONTRACTOR: D P PLUMBING/DARREN T PLACEK PHONE #: 537-9492
Inspection Request Scheduled For: Date: 11/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
315 Post/beam plumbing 021042-01 503-888-0214
Corrections/Comments/Instructions:
fl PASS n PARTIAL APPROVAL El CANCEL NO ACCESS
n FAIL 7 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-