Permit CITY OF TIGARD
PLUMBING PERMIT
1 ' 4 /I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00113
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/31/03
SITE ADDRESS: 08205 SW HUNZIKER ST D PARCEL: 2S101 BC -00200
SUBDIVISION: ZONING: I -L
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 0 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 3 GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Remove and replace existing fixtures: (2) lays, (3) water closets and (3) urinals.
FEES
Owner:
Description Date Amount
US NATURAL RESOURCES INC
c/o KNEZ REALTY GROUP LLC [PLUMB] Permit Fee 3/31/03 $132.80
ATTN: JOHN S KNEZ SR [TAX] 8% State Tax 3/31/03 $10.62
TIGARD, OR 97223 Total $143.42
Phone :
Contractor:
MARXMEN PLUMBING INC
9665 SW 163RD AVE
BEAVERTON, OR 97007 REQUIRED INSPECTIONS
Phone : 579 Rough -in Insp
Final Inspection
Reg #: MET 00001112
LIC 102432
PLM 34 -161PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued B , � ' Permittee Signature: U �•'�
t1 %!
Call (503) 639 - 4175 by 7:00 P.M. for an inspection needed th ne t business day
Building Fixtures
_ FOR OFFICE - USE ONLY
Pl�l�bin Per 1 1 UIl Received . Plumbing d
��� Date /By: / / /,a I r Permit No.P Mc O3 CYO /
City f Tigard Planning Approval Sewer
y g Date /By: Permit No.:
13125 SW Hall Blvd. MAR 3 1 2003 Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 06TX 41 EROAR D Post - Review Land Use
//gi � y �,,, ttiv I Date /By: . Case No.:
Internet: www.ci.tigard.or.BUtLDING DIVISI a r J Ii Contact Jurist: ® See Page 2 for
24 -hour Inspection Request: 503 - 639 -4175
` Supplemental Information.
Name / Method: �G
t ri.;u:` ; FEE * SCHEDJL Eg fors ectal information;yse,clieck
�.� �,.� _ i ..�` s ,.�•: ��, �TYEE.OF �WORK�_ z. _s_ � �� �: , .. �.,� � ) z-&
❑ New construction ❑ Demolition Description I Qty. I Fee(ea) I Total
❑ ri P n - z�•$�� H r c Asa .
Addition /alteration/replacement El Othe � ( l -v--$4,, c am ity
h ry ll -. , % -, ; ;i
. ,- 4 a WE:2 1 - Inc udesi , < t fo eac ttitIl ,i0 iiiiYL. �. b
Ogitla i ektkGORY.OF `CONS ROCTION -Zt . fkg
SFR (1) bath 249.20
❑ 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
a..,�_��` Fire sprinkler s ft.: Page 2
" >;;�; a, .� -� JOB SIT�E°lI1VFORIVIA'I'# #ION and LOCATION '�� p q
.t. :: s N� Sit .iJtiltttes d i :" � 3
q� Job site address: S`6S9 1.6 0 ZtkRh S • °
n U Catch basin/area drain 16.60
�j Suite #: Bldg. /Apt. #:
Drywell /leach line /trench drain 16.60
Project Name: •.
4 K'2r Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map/parcel #: Water service (no linear ft.) Page 2
Flxtute or Item Lt roan ,. .. `
r. , , _ , T DESC•RI IMIST=OF W,OM ., 4 E7,1,,. . Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
' /EROPERTYUWNER ° „ t &ANT€ ,, :' ...
Drinking fountain 16.60
Ejectors /sump 16.60
Name: S Li kk 4 (IT }'� ' � Expansion tank 16.60 •
Address: Z o S ,1,� 1, .1^ / I e.0 1 f' Fixture /sewer cap 16.60
City /State /Zip: T yzIANN Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
i Li iAPPLICANT ..;; , :, `. 'CONTACT PER - SON ', Ice maker 16.60
Name: ) j A-2X k . 6 IA Interceptor /grease trap 16.60
Address: c-Q q(p q S,uu , t Cp 3 Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip:v�?� Q2�r Roof drain (c al) 16.60
Phone:$ ^224 Fax: 3a33- ';' -a°2 l Sink/basiri6avatog z. 16.60 3- -2,a/.O
E-mail: Tub /shower /shower. pan 16.60
_.. „_. Urinal "5 16.60
4su�`"�"�A. � ;,k��,�� -. F `'' a `CONfTRA'CTOR_ . � :` >. ��`�, >A„ .. ��., .. . Y`'~ }. :, Nf, Po
Business Name: )LL Arot,IA.I -1).) T. (wt/4C, Wl,\ Water closet 16.60 yg , ,Pd
Water heater 16.60
Address: ?6 4 s' ..C4d /4.3 /�-6/E Other: R.e"..t ay..
e ` e.s .r
City /State /Zip: Ai-E - � ,4 g7DM1/ dg- 9200 7 Other:
Phone: .5 9 ea :2-472 Fax: ` P'MO ; ' :. :Elumbrng P,ermrt Feest* 1°. a F'
Subtotal $ /� e ? , �,�
CCB Lic. #: (3„ i , q I Plumb. Lic. #: 61 -'i6/ Ps Minimum Permit Fee $72.50 $
Authorized �� � /i /?d /O 3 Residential Backflow Minimum Fee $36.25
Signature: 1► t Date: Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ /4 , 6 02.i
(Please print name) TOTAL PERMIT FEE $ f V 3, V t..
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:
ems.. t .Fee1ea Total
z.`.�'�s Site iJtd►t�es, ,.� Y�� ( f ) � Square;Foofage: , ,. PermitFee:_
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 -
Valuati Re
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
Total: additional $100.00 or fraction thereof, to and
- yr` , FIXtUI e0[ Iteltl �r= t; : . Qty z f Fee (ea) s VOW! .. , r 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 *.
'. i, s aQuanttty by1(Frxture) W Comments regarding fixture work:
,Fixture Type � Replace C
`son ' . ;;.Moved E sting .Cappedt.�=
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:
is \Dsts \Permit Forms\P1mPermitAppPg2.doc 01/03
CITY OF TIGZ
BUILDING I n spection Line: -'n7
INSPECTION DIVISION • Business Line: (503) 639 -4171 MST
BUP
Received G Date R quested -- 7 AM PM BUP
P'
Location o 0 5 Suite MEC
Contact Person Ph ( ) c, PLM < 3 —06 f
Contractor Ph ( ) S ! �Z�� SWR
BUILDING Tenant/Owner ELC .
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall -
Fire Sprinkler
Fire Alarm /
Susp'd Ceiling , i
Roof
Other:
Final
PASS PART FAIL •
PLUMBING / _ /. . r 1 _
Post & Beam
/r/ /4// '.A9
Under Slab
Rough -In
Water Service 4110%,
Sanitary Sewer
Rain Drains
Catch Basin / Manho i'I /
Storm Drain �/
Shower Pan
Other: _ r
afRij
PAR _ '/
HANICAL Vir .4e /
eiv
Post & .Beam /
Rough -In
Gas Line
Smoke Dampers
Final •
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Ej Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: nable to inspect — no access
Fire Supply Line
ADA ]� 677/ Approach /Sidewalk Date / i Inspector Est
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL