Permit CITY OF TIGARD
PLUMBING PERMIT
' 1 DEVELOPMENT SERVICES PERMIT #: PLM2006 -10013
DATE ISSUED: 3/6/2006
`--' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25101 BB -01400
SITE ADDRESS: 12070 SW GARDEN PL BLD5 ZONING: C -G
SUBDIVISION: PARK 217 LOT: 002 JURISDICTION: TIG
Project Description: Cap (1) lay & (1) sink, add (1) hub drain, (1) primer, (1) dishwasher & (1) lay. Relocate water
heater.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES
CALWEST INDUSTRIAL HOLDINGS Description Date Amount
PO BOX 4900
SCOTTSDALE, AZ 85261 [PLUMB] Permit Fee 4/1/2006 $116.20
[TAX] 8% State Surchan 4/1/2006 $9.30
Phone : Total $125.50
Contractor:
M P PLUMBING CO (MILWAUKIE)
P O BOX 393 REQUIRED ITEMS AND REPORTS
CLACKAMAS, OR 97015
Contact # : PRI FX 655 -1726
PRI 655 -9161
Reg #: LIC 5002
PLM 3 - 17PB
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 yo - • o • rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -000 -0010 throu!h • A R 952 - 0001 -0100. You may obtain copies of these rules direct questions to OUNC by
calling •03 246 - 6699 , 1 - 8. P - 332 - 44.
Issue • By: 1 A ./ Perm ittee Sign s Q /a
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.
` 03- 03 —'06 01:19 FROM —MP PLUMBING CO. 5036507150 T -126 P01/03 U -772
c,', (I
Y iuulbrng' Permit A lice • ED „.()K (),:„.c USE ONLY City Of 'Tigard Received No.: /
13125 SW Halt Blvd., Tigard, OR 97223 pam/HY: o& 1 4v �� � - oor3
Plan Review
Phone. 503.639.417E Pax: 503,598.19 �� s 2006 � iNi�� i b �� ' D are�8y: Other Permit No. ��_ /OW /
4 Hour Inspection Line: 503.639,417 - � i i Data Ready/By: n:;s: lZf gam, page z for
36it { n ¢- t r
w ci.tigard or.uts � * � Notified/Method: Su pplemental Information
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❑ New construction ❑ Demolition For specialli{formation use checklist;
Description f Qty. l Ea. i Total
Pi Addition/alteration /replacement ❑ Other: New '1- 2- family dwellings (includes 100 ft. for each utility connection)
� r� +i'� ��'�' ;�' 1" { 1�i7 1t s t� �,�1� ::, ('I + {.. t rr �
1 .` .:. 1 . r i i[ i Witttt Y Ice. , 1 ` Lb ;3'0: + t r 113 ■ i : a �' I t f 33s3 I f ` l l r if SP k {1) bath 1 24920 —
ID I- and 2- family dwelling IF Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ED Multi-family SFR (3) bath 399,00
El Master budder Each additional bath/kitchen 45,00
❑ Other
l l`” 11 + ) uYY , .1 ri>!?�t( 11 it nip - -:=i tr
ig Firesprinkler { sq.it.) Paget
}i� t� 1:1 r " 4 � • � . !. 1 }' V; 6 'i ll It1' � i ( �� + ) IRAN SS t let iscl t'1 r� . (,+. -.- , 1 Site u
Job site address: A 1 , .l , , y/' j Catch basin or area drain 16.60
City /State /ZIP; ,, , ;.i,: 9 Drywall, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: y £ 5/1 Footing drain (no. linear H.: ) 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 fl.: ) Page 2
•
Tax map /parcel no p a 5 i& 6-011-too Fixture or item
gg T ti , ; {F + x + i , , t rri! r r, +a:qn > v [ � ° e m u s A� +4, -' .
` _. +ii b 0 pp r ink: Absorption valve 16.60
k --.1,1 � . i •1 MA �
i i a, 1:I /MR AW'rh} 'rS4r - rrr,�rg� I! ;DUI dP k7•MC R i 4 i r.. !.∎tilk n( it i . +°
�'�- 1r � „,, s r. 1 1 v Backflow preventer Page 2
..F- . Backwater valve 16.60
Clothes washer 16,60
Dishwasher ) 16.60 /lr ig .
i i , '<;, ritw4imi s , i /r a 4 ,' r r ,, s�1ry•`1 ;' • < m Drinking fountain 16.60
SI � Itt1t : v a ,1�� nwt�, l } �,gi � t #i 1 �1 6 !' � � ��, - t � i , 4 ,. *MUER
` EjxtorsJsump 16.60
Name: 'CA- L� �`�T / t. b (4,072 l4L bhp 1 r N4, 1 - 1 -C-- Expansion tank 16.60
Address: b p q q6 0 Ft :: ire/sewer cap 16.60 q ,
City /State /ZIP; orrc q- Lee-. ,sq c54, I Floor drain/floor sink/hub ---- 16.60' 4, ((J�
Phone: ( ) Fax; ( t � ) Garbage disposal 16.60
, >. I � E .a'rr a +,: 1� r 1 n 17'4 1 , ro
ss � , ((gg {� a � lt, '!� +y .:, s{ �j� , fy, t � ! , t t Hose bib 16.60
(
�1 r41 i -t P , ,+ is1011r ...a, >ltit .IEIs ,. i Ili Y 1. + 1 a 1111111 fr U .� . ,.�: � 61� T j IeC maker
16.60
Business name: MP PLUMBING CO. Interceptor /grease trap 16.60
Contact name: TA MI Medical gas (value: $ ) Page 2
Address: PO BOX 393 Primer I F 16,60 /',. It-
City /State /ZIP: CLACKAMAS OR 97015 Roof drain (commercial) 16,60
Phone: (503) 655-9161 I Fax: : (503) 650 -7050 Sink/basin/lavatory ) 16.60 16 Y...
Tub /shower /shower pan 16.60
E-mail:
t � , t r Urinal 16.60
n asi Fit „�� +•.+ t r t; ',t,�ji , w i IN, 'i it 1i f t r 1i OM
1-ril ,:t iilkia, d! Vsli - . 1 i .: r !av:! n l.; fiUy , ;„1,.. 1 l io,, " .„..4 4 ',',N4 Water closet 16.60
Business name: MP PLUMBING CO. Water heater •- re & i 16.60 4 -, „/
Address: PO BOX 393 Other;
Subtotal � Z 014 _, „ .. 2 City /State/ZIP: CLACKAMAS OR 97015
Minimum permit fee: $72.50
Phone; (503) 655 -9161 Fax: (503) 650 -7050 Residential backflow minimum permit fee: $36.25
CCB Lie.: 5002 Plumbing Lic. no.: 3 -17P8 Plan review (25% of permit fee) •
State surcharge (8% of permit fee) i
Authorized signature:ie°'✓d.
TOTAL PERMIT FEE Af r „......
Print name: TAMI GEORGE Date: j- 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:\BuildingU P ermits \PLM- PmnitApp.doc 06/05 440.4616T(10/02 /COM/W5O)
03- 03 -'06 01:19 FROM -MP PLUMBING CO. 5036507050 T -126 P02/03 U -772
t Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su + + ression S stems:
��,<,.:,,... ioJ i' , � i� a �! Ill i a i k - i : i! � ' . . � t � !{. ., i yl - ar } a
t , ;� 1 f �r 1 � f �r:aa . ac'n . r,tIf} � uR» . : n !, r r... r Awl,
, .. 14 f11 .;E r, . fir {y� i i �; l i s` 1i1 1 0 !! � ys Foal �d f yy�.{ �^tjl44f((��}jj cap: ;; .;q7.1
,. - ,! -..- ,r r,c FYt..117, 11111 .::.i 1 . : : ,'' F ,,;il.y r,;1 1. 120 " 41: ,94iii : 11 i . J. i
r :: ..,t,- .r,.,,. 1a�3ts. �s .aa�,. e � d - t� ;�4' � :; °Jtt3,.
Footing dram • 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46,40 2,001 to 3,$00 $160,00
3,601 to 7,200 $220 -00
Sewer- 1st 100' 55.00 7201 and rt_reatcr $309.00
Sewer - each additional 100' 46,40
Water Service - 1st 100' — 55.00 Medical Gas S stems:
Water Service each additional 100' 46,40 7'1112414W f [� to u l I F ( F l t l l � 'l ,
storm &Rain Drain - 1st 100' a r ,. �' E �E .i , U ,, fir' '„,,<i ‘ ..'. � , .. P&{ i :� <.0 �J 3 ? I
55 .00 51,00 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 $1.52 for each
s r ' .a. .: if ,42; ; ° l! 1, ' 11 f l FI S$ a tS`S b k1 additional $100.00 or fraction thereof, to and
.1:M .MI b!? 0 ;v. ' . 1 s ,,,.1 J;,n4 ;51;5, ., ;'5c tJJ7': i :q I inoluding$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
Inspection of existing plumbing or each additional 5100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including t e $50,000.00.
first 0 00.
$50,001.00 and op $742.00 for the fast $50,000.00 and $1,20 for
Subtotal: I
each additional $100,00 or fraction thereof.
Fixture Work: PFIf ` +r ,i. ' L' a .•tit a r tr;y! t ..a a1 !: Ili • q y � kk '1
. s ..1 { €i! a >, ., s ; , E> ?_ ll L 11(i8ki i:a1.'
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 fi:tures could result in increased sewer fees *. Please check all that apply.
,(� [+ , pp ' 1 t u 1?( t t F t , rn [> n d ❑ Any new commercial building.
'''° k U{ ", 1 + �, r�, c 14r i713� l]<1 , .� r ��.`It1?'rA CfA.'.17�4
t l $ - a . . . g 6 G r
,r x1 -. 1il
! , E ,X i i l l+ F s Op t : ❑ Any new exterior plumbing site utilities.
!......� d, 1. . . ,
: ac v, r . r � 1'I r kp d A commercial building with installation, alteration or addition
Baptistry /Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower E] Medical gas and vacuum systems for health care facilities
- lacuxxi/'Whirlpool providing services to human beings.
Car Wash -Each Stall 0 Plumbing installations, alterations or additions to food service
- Drive Thin _ _ facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic / dwelling units.
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain/sink - 2" S ubmit 2 s ets of plans with any of the above.
_ 3 ,> p
Car Wash Drain . i 1-11111r111446 d i iill sir ;"" i iiii aiii;[ z ! i r
!!1� F��ilf� ' �l ,�J���"�J�1�- #�����1���
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 -. 1." 11119 /litiA ?q 76 X- /,,dvY. e , 4 I1 / /i9.e dii
Shower -Gang 99 /
-Stall /' ,i .!: / // • i ' .s 1 _..dam/ 4,.
Sink - Bar /Lavatory / / .D /i;
- Bradley t
-Commercial
- Service
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: 1 plumbing permit can be issued.
i:\ Buildingw .irs\r'LM- PatnitApp.doe 07/06/05
• CITY OF TIGARD
BUILDING DIVISION A PERMIT #: P /rv.2DD4 / OO /3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 /�ou
Inspection Requests (24 Hrs.): (503) 639 -4175 =r
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 1,x.,0 7O C.7-4w-de, Pt CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #: 3 —!0 53 `1 1 f° I
CONTRACTOR: AlACt e--51 PHONE #:
Inspection Request Scheduled For: Date: 3 -- 2.7 - e Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 t
Corrections/Comments/Instructions:
PASS 7 PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _ l) Date: , Phone #: (503) 718 -
l
CITY OF TIGARD p�m
BUILDING DIVISION PERMIT #: ,2006_ /
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 4N� y pi g1 8� ' I I �
Inspection Requests (24 Hrs.): (503) 639 -4175 _2.
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / oZ 0 ---- i 74---tvtda ll /L, CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 --9 ,a, Pour Ti -: A, in ,
Co. - # Inspection Description Confirm # Contact # Message
/ A " r 6S 91
U
Corrections /Comments /Instructions:
X PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ele -/L- A V\- Date: 3)9 10 4 Phone #: (503) 718-