Permit CITY TIGARD PLUMBING PERMIT
r I DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00463
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/9/2006
PARCEL: 1 S126DB -02800
SITE ADDRESS: 09370 SW GREENBURG RD 412 ZONING: C -P
SUBDIVISION: PP1991 - 018 LOT: 001 JURISDICTION: TIG
Project Description: BOSTON MEDICAL. Relocate (1) water heater.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
NORRIS & STEVENS
621 SW MORRISON SUITE 800 Description Date Amount
PORTLAND, OR 97205 [PLUMB] Permit Fee 10/9/2006 $72.50
[TAX] 8% State Surcha 10/9/2006 $5.80
Phone : 503- 223 -3171 Total $78.30
Contractor:
GILLESPIE PLUMBING
PO BOX 1474
BORING, OR 97009 REQUIRED ITEMS AND REPORTS
Contact # : FAX 503- 658 -2970
PRI 503- 750 -3449
Reg #: LIC 166917
PLM PB 17
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 to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: � t' Permittee Signature:
v
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.
. .,
' PlumbinE Permit Application
. . ..
Building Fixtures OFFIC
.4i,
FOR E 1.:1S,E OL
City of Tigard Received ---'it
• Date/By ‘0,71( - c i Permit N63 AN-2A 6-- a a ( i s 3
• all 13125 SW Hall Blvd., Tigard, OR 9
1
1600 9 2006 Plan Review
Phone: 503.639.4171 Fax: 503.5M1 Other Permit No.:
Date/By.
Inspection Line: 503.639.4175
TtGARO Date Ready/By: "is: RI See Page 2 for
. - Internet: www.tigard 1 i y ii c luildj J Notified/Method: ) . Supplemental Information
- - -
. • TYPEAFTROR: h- 7'37 nrci:rfr, -, . FEE* SCHEDULE . , ‘ • -' ,, . .
. ,
ew construction 0 Demolition
For special information use checklist.
El
911 Addition/alteration/replacement
11
0 Other: Description I Qty. I Ea. I Total
New 1- 2 dwellings (includes 100 ft. for each utility connection)
. . -
CATEGORY OF CONSTRUCTION ' ' ' - , SFR (1) bath 249.20
• 0 1- and 2-family dwelling dommerciallindustrial SFR (2) bath 350.00
0 Accessory building 0 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
0 Master builder 0 Other:
. Fire sprinkler ( sq. ft.) Page 2
. _ .
JOB SITE INFORMATION ,AND LOCATION
- .. - . '' Site utilities
• Job site address: 9 3 - 70 5 W (y (e dro
.bi
1/4J R 0 i Catch basin or area drain 16.60
City/State/ZIP: i 0 .R, Drywell, leach line, or trench drain 16.60
Suite/bldg/apt. no.: Li I 2_ I Project name: b s Td t - N n e l ' - ' cox 1 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
Water service (no. linear ft.: ) Page 2
Subdivision: p p pm I -o ) g I Lot no.: ty) I
Fixture or item
Tax map/parcel no.:
Absorption valve 16.60
DESCRIPTION OF . WORK
, - -
Backflow preventer Page 2
le_f, ) d CATc_ WA to Hect te r Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
. .. Drinking fountain 16.60
PROPERTY OWNER , - - Li:TENANT. ,
Ejectors/sump 16.60
Name:
Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: (
Garbage disposal 16.60
Hose bib 16.60
VAPPL1CANT Fax: ( )
, _ . 1:3 CONTACT 'PERSON
.
Ice maker ' 16.60
Business name: & . Ile .5? ,'c... P! ,„,b ' ,, Interceptor/grease trap 16.60
Contact name: -- , - . 5eFe(cth- N 6 ; 1 ) 5 c.... Medical gas (value: $ ) Page 2
Address: PO 6d1( I H7 il Primer 16.60
City/State/ZIP: R ., r ^
6 - R 9 Joo ci Roof drain (commercial) 16.60
1 ) 0 1 ' n e)
Sink/basin/lavatory 16.60
Phone: (50S ) 750 - 3 Fax: : ( 503 ) 4 , ,
•
Tub/shower/shower pan 1660
E-mail: . 76 Urinal 16.60
CONTRACTOR . Water closet 16.60
\›... Business name: 6,11 c j6) i' c e) ni b :fli Water heater i 16.60
Other:
Address: PO A d tk I i ll 'I
Subtotal
s City/State/ZIP: 130 .r ■ 6 g., 1 )66 1 Minimum permit fee: $72.50
Phone: ( co3) 7 0 - 3t,)1 C Fax: ()b ) 6 5 ___ gei 7,c, Residential backflow minimum permit fee: $36.25
CCB Lic.: j a y ) 7 Plumbing Lic. no.: p 6 j 7 I Plan review (25% of permit fee)
•■
State surcharge (8% of permit fee)
Authorized signature: / 4 1-1 - ' TOTAL PERMIT FEE .7 .1/..
Print name: -5- f_ ! G.;' 1 ) ec r (.',... Date: )0_ q _.() 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.
1:\BuildingTermits\PLMF-PennitApp.doc 04/06/06 440-4616T(t 0/02/COM/WEB)
Plumbing Permit Application - City of Tigard .
• Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities • Qty. Fee (ea) Total ' Square Footage: . 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 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: • Plan Review for. Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and
•
Quantity by (Fixture) Work greater, except systems designed and stamped by licensed
. Fixture Type: Replace engineer.
Previous, Capped Added Existing ❑ Any new exterior plumbing site utilities.
Baptistry/Font ❑ Medical gas and vacuum systems for health care facilities.
Bath - Tub /Shower ❑ Any multipurpose fire sprinkler system.
- Jacuzzi/Whirlpool ❑ Any complex structure as defined in OAR918- 780 -0040.
Car Wash - Each Stall
• - Drive Thru Submit 2 sets of plans with any of the above.
Cuspidor/Water Aspirator
• Dishwasher - Commercial •
Domestic Isometric or Riser Diagram. -
Drinking Fountain ❑ Isometric or riser diagram is required for new buildings
Eye Wash that meet the qualifications above.
Floor Drain /sink - 2"
• -3„
-4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
• Shower -Gang
-Stall
Sink - Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley increase of sewer EDUs, a sewer permit will be issued and
- Commercial fees assessed for the sewer increase must be paid before the
• - Service plumbing permit can be issued.
Swimming Pool Filter
- Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 09/22/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006-00463
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/9/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 AM LL.
INSPECTION WORKSHEET FOR DATE: 11/17/2006 TIME: 7:01AM PAGE: 70
SITE ADDRESS: 09370 SW GREENBURG RD 412 CLASS OF WORK:
SUBDIVISION: PP1991 LOT #: 001 TYPE OF USE:
PROJECT NAME: BOSTON MEDICAL
DESCRIPTION: BOSTON MEDICAL. Relocate (1) water heater.
OWNER: NORRIS & STEVENS, PHONE #: 503
CONTRACTOR: GILLESPIE PLUMBING PHONE #: 503-750-3449
Inspection Request Scheduled For: Date: 11/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 039908-01 503-750-3449
Corrections/Comments/Instructions:
• i
PASS I I PARTIAL APPROVAL fl CANCEL I I NO ACCESS
I I FAIL n CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
a in - 1
Inspector: r ‘. ° Date: / 1[0i) Phone #: (503) 718- •
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006 -00463
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /0/9/2006
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/9/2006 TIME: 7 :02AM PAGE: 0
SITE ADDRESS: 09370 SW GREENBURG RD 412 CLASS OF WORK:
SUBDIVISION: RP1991 -01B LOT #: 001 TYPE OF USE:
PROJECT NAME: BOSTON MEDICAL
DESCRIPTION: BOSTON MEDICAL. Relocate (1) water heater.
OWNER: NORRIS & STEVENS, PHONE #: 503-223 -3171
CONTRACTOR: GILLESPIE PLUMBING PHONE #: 503-750-3449
Inspection Request Scheduled For: Date: 11/9/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
339 Plumbing final 039545-01 503-750-3449 N
Corrections/Comments/Instructions:
1 .e∎ 1 07 - to /P —
r _
� X Mr r 7" 1°
op—
•
�; ' £ SS Fij "A RT I A L APPROVAL ❑ CANCEL n NO ACCESS
FAIL r.A CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: /4 V Date: il Phone #: (503) 718
CITY OF ��mm n ��m un�m��wn�� ^ .
BUILDING DIVISION ' ~ '
~�~°,~~~°,,~~~ ~~.°"~°"~~"~ , . PERMIT #: pLhA3OO6'DO403
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/9/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 „).4'
INSPECTION WORKSHEET FOR DATE: 10/10/2006 TIME: 7:08A&4 PAGE: 3
SITE ADDRESS: 09370 SW GREENBURG RD 412 CLASS OF WORK:
SUBDIVISION: pp19g1'018 LOT #: 001 TYPE OF USE:
PROJECT NAME: BOSTON MEDICAL
DESCRIPTION: BOSTON MEDICAL. Relocate (1) water heater.
OWNER: NORRIS & STEVENS. PHONE #: 603-22a'3171
CONTRACTOR: GILLESPIE PLUMBING PHONE #: 503-750'3449
Inspection Request Scheduled For: Date: 10U102006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough-in 037965-01 503-750-3449 N
Corrections/Comments/Instructions:
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N ~ASG | I PARTIAL APPROVAL ri CANCEL I NO ACCESS
FAIL ri CALLFOR|NSPECT|ON ADDITIONAL FEES ASSESSED
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Inspector: M
|nap�cto | 1../ �� Date: i/ � b L^ Phone #: (503) 718-
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