Permit CITY TIGARD PLUMBING PERMIT
f i DEVELOPMENT SERVICES PERMIT #: PLM2004 -00234
�- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/25/2004
SITE ADDRESS: 11565 SW DURHAM RD PARCEL: 2S110DC -02400
SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of (2) roof drains, (1) lay & (1) water closet in new office building.
FEES
Owner:
Description Date Amount
DOUG FRY
2423 REMINGTON CT [PLUMB] Permit Fee 5/25/2004 $72.50
WEST LINN, OR 97068 [TAX] 8% State Surchari 5/25/2004 $5.80
Total $78.30
Phone : 503 348 - 2237
Contractor:
CENTURY PLUMBING
2710 E HANCOCK
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone : 538 - 2388 Rough -in Insp
Top -out Insp
Reg #: MET 00003257 Final Inspection
LIC 19085
PLM 36 -24pb
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 qb-stions to OUNC by ring (503)
246 6699: /
Iss 'ed By: / //� � / Permittee Signature: A
'" Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY •
,
Received i �,/ /
City of Tigard Date/By: 8-5 U cf
Plan Review Permit No.' • // _a� �..3
13125 SW Hall Blvd., Tigard, OR 97223 1
Phone: 503.639.4171 Fax: 503.598.1960 Gy //w # Date/By: Other Permit No. 4l D0 /S ^
24- Hour Inspection Line: 503.639.4175 I1
d Date Ready/By: Juris. ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist
Description Qty. Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
1 '_ ,, .�_ f`' GATEGO 0 C4'STRQC'I'IO1Y `,' F °'44 SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/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
a' «:+°tzi�ykxs*tt<.'ra.. ,
oB kii i Il\ Q TIOg aA.ND ®CATION X �� ti
„ 1 r. v a1 4 y,4 �r w ;; �.. w r ; . .. t x.,. 1'.q.:,• Site utilities
Job site address: -C 5 t...; t... ` . Catch basin or area drain 16.60
,
City/State /ZIP: 1G p/e- £ C. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: W t 1_4_„.„,/ 75 noalC t t t 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
5/ /0-De.- O _ / Fixture or n 16.60
item
Tax map /parcel no.: g (. G�J
Absorption valve � � � ,� a ,� � �
-^, s � ' DESC R I PTIO N , liCli la r� . p Bac]<flow preventer Page 2
L. v ...... a - t 4 --cc__+" - I ,1 Backwater valve 16.60
2 .- (0_,..,.. c p (2._ A-1 Hs• Clothes washer 16.60
Dishwasher 16.60
2.If anti 'tiag Ri r a s h s�: ". 0: � it Drinking fountain 16.60
b, � �� .4,,,� ,. , .,�: _ t;... e , ,,, ,,, ,t 44: 11; Ejectors /sump 16.60
Name: O t✓ 6 FA " Expansion tank 16.60
Address: zy 2 3 I - ye N 6 :4,,,, j Fixture /sewer cap 16.60
City/State /ZIP: e S T (__ f vi if.)1 Q Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
" � .a„ ���: �� „�..r� = u�;, ": �., .,3,��, ,�> , � ..� � 7ii �.. Hose bib
16.6
.: r o . � 1, - . ", ; APPI IC e,.. , j ;L - , , . ,«CONTAC :P R$ O , r <
x<, �,�_��. .� � ,;��s,- �� °x,���: "� <;� ���r�w��:;:�... ol.,., 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) 2_ 16.60 .33, 2)
Phone: ( ) I Fax: : ( ) Sink/basin/lavatory / 16.60 9 (- 6C>
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
r 4 1 . GOON $g re URA a J /
4 ,,, , "ta ' v, ...S . E`s' ^s.."'.' , ° -: , , .4, x,, _ »� »,z'r.,5,,, k t i n a: �' -='.'.." , - 'i W ater c 1 16 ( 4 , c
Business name: e. E. of -, oM 43 I r: Water heater 16.60
Address: Other:
City/State /ZIP: 4 e> E-14-6 Subtotal y�
(t 7� Minimum permit fee: $72.50 .IA
Phone: (503) 538 - .339 Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee)
/
State surcharge (8% of permit fee) 6 96
Authorized signature, • - TOTAL PERMIT FEE
Print nam 1' - / L Date: - _ ® 1 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.
1:\ Building \ Permits \PLMF- PermitApp.doc 12/03 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: • Residential Fire Suppression Systems:
e t ltt1CS 0 7ee,(e4 Total S U a o bta es
tea Q ` g FermutRe
,
Footing drain - 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 �
Valuation r 1 P 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
°' �`�Plv Qty Ree (ea}d �Total3' additional $100.00 or fraction thereof, to and
1*X4llr P -Ill C1T1 ^ 41 a , 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 first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees
tta ' ; r Quanttfy by (Ftxtur "e) Work .grforme$
Fixt xe Typ6 , r A OAP., y place , F W� x
'4U 4A. M ed di: kW w g c p 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"
•
- 4"
Car Wash Drain
Garbage - Domestic
Disposal -Commercial *Note: If the fixture work under this permit results in an
• . - Industrial
Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
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 •
Bradley Quantity Total
Commercial Isometric or riser diagram is required if fixture quantity
- 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:
i:\ Building \Permits\PLM- PermitApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
Q BUP
Received / Date Requested p -7 AM PM BUP
Location r l5 63 Suite MEC
Contact Person liOil vt Ph ( ) Co 3 (o — 038/ PLM
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
C.6
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:
•
! 'AS • PART FAIL
M ' 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 0 Please call for reinspection RE: - ❑ Unable to inspect — no access
Fire Supply Line
ADA 1
Approach /Sidewalk Dat r Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL