Permit CITY TIGARD PLUMBING PERMIT
rnr I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00177
c ' I � l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/19/03
SITE ADDRESS: 10215 SW HALL BLVD PARCEL: 1S135AA-01400
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -N
BLOCK: LOT: 037 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 2
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 130 ft
WATER CLOSETS: WATER LINE: 106 ft
DISHWASHERS: RAIN DRAIN: 77 ft
Remarks: Site utilities for new 2 -story dermatology clinic. Other items are: (1) french drain, 300' of footing drain, (1)
manhole and (8) rain drain connectors.
FEES
Owner:
Description Date 'Amount
INTEGUMEND LLC BY SCOTT COLLINS MD
& MARIA ROSS MD [PLUMB] Permit Fee 6/19/03 $604.80
9495 SW LOCUST STREET [PLMPLN] Plan Review 6/19/03 $151.20
PORTLAND, OR 97223 [TAX] 8% State Tax 6/19/03 $48.38
Phone : Total $804.38
Contractor:
REQUIRED INSPECTIONS
Phone : Sewer Inspection
Storm Drain Insp
Reg #: Storm Drain Insp
Storm Drain Insp
Rain Drain Insp
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
Issued By GZ,�(/L__ Permittee Signature: /"'"
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bus ness day
•
CITY TIGARD PLUMBING PERMIT
l ir I'�I DEVELOPMENT SERVICES PERMIT #: PLM2003 - 00177
e 13125 SW Hail Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/19/03
SITE ADDRESS: 10215 SW HALL BLVD PARCEL: 1S135AA-01400
SUBDIVISION: METZGER ACRE TRACTS ZONING: C -
BLOCK: LOT: 037 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 2
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 130 ft
WATER CLOSETS: WATER LINE: 106 ft
DISHWASHERS: RAIN DRAIN: 77 ft
Remarks: Site utilities for new 2 -story dermatology clinic. Other items are: (1) french drain, 300' of footing drain, (1)
manhole and (8) rain drain connectors.
FEES
Owner:
Description Date Amount
INTEGUMEND LLC BY SCOTT COLLINS MD
& MARIA ROSS MD [PLUMB] Permit Fee 6/19/03 $604.80
9495 SW LOCUST STREET [PLMPLN] Plan Review 6/19/03 $151.20
PORTLAND, OR 97223 [TAX] 8% State Tax 6/19/03 $48.38
Phone : Total $804.38
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005
REQUIRED INSPECTIONS
Phone Sewer Inspection
hone : 643 643-7619
Storm Drain lnsp
Reg #: MET 00001047 Storm Drain lnsp
LIC 12889 Storm Drain Insp
PLM 34 -4PB Rain Drain Insp
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 to OUNC by calling (503) 246 -6699.
Issued B �► ` ":„„ �� , Permittee Signature: ) ( 2 J J
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day J
h Site Utilities RECEIVE " ,
FOR OFFICE USE ONLY'
1(.; MAY Permit Application Received J Plumbing D
MAY 0 b 2003 Date /By: / 570 j� Permit No.: j� -CMG/ 7 7
Planning Approval Sewer
City of Tigard CITY OF TIGARD DateB : Permit No.:
13125 SW Hall Blvd. Plan Revie '� / � Other
Tigard, Oregon 97223 BUILDING DIVISION Date /B : i d J Permit 'o.: ; #0•�r=
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post- Review Land Use �
/UrNi�"I DGt' (.I l,
Date/By: Case No.: ✓ - DdO�'/1 ` •
Internet: www.ci:tigard.or.us ■ �.f Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 C 2"" W Name/Method: .. , .
Erma ion.
'�r ViVION:20:W:,.w TI' +P.E';OFOWORI{ AKargi:W ;'n ! ..ni:''F _ _. -� .� ..... � -..... (foP .. _�e e .. ,. _ _� a . ...�
rEE *�aSCHEDULE" s
ectal`.> nfortnattonii §e " "�:
❑ New construction ❑ Demolition Description I Qty. 1 Fee(ea) I Total
❑ Addition/alteration/replacement ❑ Other a e to & f fam wel s
o
�°�' ; gCA _GORY, OF CONSTRIRTOT- N �? :sj," , . FR (i f . o " _ a art co t ._ 4 n i
l y n
clu s 0, eac iiuti nne
S (1) bath 249.
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00
['Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
„ °,`,JOB „SITE +INFORMATION andL'OCATiIQN <'s :;1s., r Fire sprinkler - sq. ft Page 2
Job site address: : L(,. VC) Q , .,' ¢ •.. ",..xS tte,Utilities r:w ` .: g4``Tzi,:. ,x
Suite #: Bldg. Apt. #: Catch basin/area drain 0. 16.60 3 3. i-
Project Name: • 4_ I ...• 0 l 1) L- Drywell /leach line /trench drain / 16.60 l (I , le
Footing drain (no. linear ft.) fr Page 2 / 8a
`
Cross street/Directions to job site: Manufactured home utilities "tom 110.00
Manholes � 16.60 (().(0)
Rain drain connector 16.60 p 32, (30
Sanitary sewer (no. linear ft.) Page 2 /0/t y 1
Subdivision: I Lot #: Storm sewer no. linear ft.) _ ± Pare 2 S 0 `
Tax map /parcel #: • Water service (no linear ft.) D �I Page 2 0 l lid
3' >, . DESCRIPTION OF WORK <` � rate . �. `~ '� • rFL it 9 ,110 i * . z,�'
.
` , _,.. '" Absorption valve � igl��l 10TE. ;rt
9.r.) �` - �Srv25/ ���Qry g r o L CD 6 e (air B ackflow preventer , / 'age 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
. ` PROPERTY OWNER ' ' I6 :,1%-MANN, ..,, ,a 4_ e"> Ejectors /sump 16.60
Name: ) kr v . Expansion tank 16.60
Address: rj 1 L C{)' T '"'T', Fixture /sewer cap 16.60
City /State /Zip: re -T` & ,P - , 972277 Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phone: _i . -a., ' �, A rA Fax: J ,, r . Hose bib 16.60
g fAPPLIC T ". .r:.... CONT80401ERSON
11 Ice maker 16.60.
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Clt City/State/Zip: Primer 16.60
Y P Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory . 16.60
E -mail: - Tub /shower /shower pan 16.60 '
�2 i s 3:t Urinal 16.60
- ��..,��� x..� �,���.... CONTRACT_ '�OR � ,e..sr . � ......
Business Name: 894..ti�r►, I , J nL.f/., �? Water closet 16.60
Water heater 16.60
i)
Address: L 3 q f 5()), 7i"4 4-7 i 4/ 1)L�y Other:
City /State /Zip: 0 i ro- i�d-ry,r - A/ p !4 ! �/ Other:
Phone5O3- • `,3 19 le( Fax: 5 G t-(",3-- 7/� 2,® � :tamm Rlumbin eiffir ees*.,a: °. r:. „.: ,. '� :
Subtotal $
CCB Lic. f -rjj /�' . L lumb ic•# 3 P Minimum Permit Fee $72.50 $ /_ t p
Authorized /Arm/A, / Residential Backflow Minimum Fee $36.25 (00 L/ '
Signature•. ,►' =, ., D ater• '2' C53 Plan Review (25% of Permit Fee) $ j 'j I • d
State Surcharge (8% of Permit Fee) $ `I S ' N
(Please print name) TOTAL PERMIT FEE $ KO (4 • 3g
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information -
Fee Schedule: Residential Fire Suppression Systems:
-. Site Ublittes 'Qty Fee (ea) Total ° Square Footage:. Perrrut,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 ,Valuation:," PCI?ITIIt Eet ; '
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
additional $100.00 or fraction thereof, to and
;f ;Eizture or It441e Q_ty Fee (ea)t f fiotal ) 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 *.
Comments regarding fixture work:
� � Quanhty,by�(Fixture)�Work Performed g g
rag � �� � � � ` �Re lacer T
Fixtureype i p :�
f f, New MoXeds Fads n d tipped ':.
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"
-3"
-4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
•
i:\Dsts\Permit Forms \P1mPermitAppPg2.doc 01/03
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received 121 2 - Z.3 `• 'i7Eate Reque ted _Z 2 b AM PM BUP
Location /02 l Suite MEC
Contact Person - o i0,6i./A PLIP}a ( c: 3) zrigar ' ( — b 2 / L M ' 3 - 0 0 / 7 7
Contractor _ , •. _.. t/�J1 � Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access' R ELC
Ftg Drain j°‘/114, 7Q ,Z d ELR 7
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation �Will ✓er _ / A � a A
Drywall Nailing
Firewall
le
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final `r /
PASS PART FAIL _
PLUMBING
Post & Beam
Under Slab — /
Rough -In G /�/�, ' ♦ — r : —7
Water Service ®C-E� �l/� L
Sanitary Sewer „ / ir
Rain Drains , -`
Catch Basin / Manhole /
Storm Drain / ” � - / - ` -��iii.
Shower Pan
S PART FAI 4 �� I � J; ' � �--
Post & Beam . i
Rough -In
Gas Line
F Fr A rie I ��
Smoke Dampers
Final
PASS PART FAIL r / .
ELECTRICAL 1 __.'`
Service
Rough -In . d
UG /Slab j.ANNIfigi
Low Voltage
Fire Alarm
Final 0 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
Approach /Sidewalk Date - _ Inspector Ext
Other: -
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL