Permit ..: CITY OF TIGARD PLUMBING PERMIT
II , DEVELOPMENT SERVICES PERMIT #: PLM2000-00444
- I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/7/00
SITE ADDRESS: 09225 SW HALL BLVD E PARCEL: 1S126C0 -00100
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION: TIG
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing tenant improvement. Added (4) new lays, (1) 2" floor drain and relocating (1) existing sink.
FEES
Owner:
Type By Date Amount Receipt
MENASHE, R BARRY PRMT CTR 12/7/00 $83.00 27200000000
621 SW ALDER, STE 605 5PCT CTR 12/7/00 $6.64 27200000000
PORTLAND, OR 97205
Total ' $89.64
Phone 1:
Contractor:
MAREK PLUMBING
3229 SE 160TH AVE
PORTLAND, OR 97236 REQUIRED INSPECTIONS
Phone 1: 761 -0105 Top -out Insp
Reg #: LIC 75624 Final Inspection
PLM 34 -229PB
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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 -0080.
You
Ca
t in copies of these. rules or direct questions to OUNC by calling (503) 246 -1987.
Issue a tf . deC Permittee Signature: I� d .
i
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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=, . , • Plumbing Permit. Application
Date received: /2 -7 - a 0 Permit no.: /?ij1�0 - luol,/rf
a > , City of Tigard
i s Sewer permit no:: Building permit no.:
- - - -° Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire da
Fax: (503) 598 -1960 6 u p — Od a-7 Da te issued: By: Receiptno.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory Cl Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: 9'2 z 5 i4/ Mr/A /3 /tom c/ Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: IBlock: I Subdivision: SFR (2) bath
Project name: /eCt' .3 � i D e lv A-L. SFR (3) bath
City /county: 7- on,/ , I ZIP: 772 2 3 . Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells / leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: //' RE it Plat 2./ 14 - Manholes
Address: `3 2 29 -•.S'. /6'9 -11 f,,, , p, _ Rain drain connector
City: P � -f / cwt rV • I State: 2/ I ZIP: 77 ' 3 u6 _ Sanitary sewer (no. lin. ft.)
Phone: 7 / 7 Z I Fax: 76'/ - 0/0.1-E-mail: Storm sewer (no. lin. ft.)
CCB no.: t9 .5 6' 2. c /. I Plumb. bus. reg. no: 3 e ? Water service (no. lin. ft.)
City /metro lic. no.: . ..5---c}-) ..5---c}-) f Fixture or item:
6'
Contractor's representative signature: /c Absorption valve
Back flow preventer
Print name: 1 f44'E /r 6 / ? 24 - e 114r Date: /2 -3 . Backwater valve •
CONTACT PERSON Basins/lavatory 4 / ((,.( (., 4
Name: Clothes washer
Dishwasher
Address:
Drinking fountain(s)
City: I State: . I ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): Floor drains/floor sinks/hub lb ,c
Garbage disposal
Mailing address:
Hose bibb
City: I State: I ZIP: Ice maker
Phone: I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other: •
Phone: I Fax: I E -mail: Total 2 3 4 1'
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 3 ���
Notice: This permit application Plan review (at %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires TOTAL $ I e " • `f
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount - 440 -4616 (6/00 /COM)
PLUMBING PERMIT FEES:
1 .
:PRICE': " A TiNevil letif:2=teftiNfst:WellttiOtehtii: :,,,, '''. ; ,,z,,A,,,T:..-_,,.!,
FIXTURES la's:livid6i") ' „,"r--';' ,,-,,z„, ,, ;,,,,,z'aryy-,„;, ,, ,lea) , ...,_ 0, ' 4 , -AMOUNT _ _ , .,„ includesall.plum Josi.414,14rml , -0. ,..-0 .4 , .,,,,...
Sink 16.60 . the dwelling aricIthe,tOt1 ft
0,0,,,.,, ,-,, , : c..".„,4 -,.- ,
utility d6iiiecitiiiii ; '
i." >, ‘, ' •' t e','','
Lavatory , 16.60
One (1) bath $249.20
Tub or Tub/Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60
SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL _
- - 2' : , • •
' Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
' ,,, - ; '•;;;,;';;;-,• t ":, .,; ,, ; :lk`Perfomed
r
Water Heater 0 conversion 0 like kind ' ,,:. QUaiitity by WO
16.60 1 ,
Gas piping requires a separate mechanical Fixture Type - ;:, ,., :e. :1%19ye..., , Replaced Remov
permit.
MFG Home New Water Service 46.40 Sink Alg
M FG Home New San/Storm Sewer 46.40 Lavatory
. Tub or Tub/Shower
- Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures (Specify) 16.60 Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2" /
S ewer - 1st 100' 55.00 3"
Sewer - each additional 100' 46.40 4"
W ater Service - 1st 100' 55.00 Water Heater
Other Fixtures Pkestev- .
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40 ,.
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device* 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL ,
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL ''',:,-', : S:14 '•';:,,i.
:k '',,:
8% STATE SURCHARGE ;'''r ::';'!,',:,:
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is >9 .
TOTAL ,- -;:::,- ; ''',:n '''; $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
- Prevention Device, which is $36.25 + 8% state surcharge.
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i:\dsts\forms\plm-fees.doc 10/10/00 •
Accumulative Sewer Tally
Tenant Nam,: This SWR#
Address: This PLM #:
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added '# added #s total
Count off #s count value values
Baptistry/Font 4 ,
Bath - Tub /Shower 4
- JacuzzilWhirlpool 4 .
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator • 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1
Eye Wash 1 •
Floor Drain /sink - 2 inch 2 / r .
- 3 inch 5
- 4 inch 6
- Car Wash Dm 6
Garbage Disposal 16 •
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32 ,
- Industrial (over 5 HP) 48 • .
Ice Machine /Refrigerator Drains 1
.. Oil Sep (Gas Station) 6 i
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2 ) S q
Sink - Bar /Lavatory 2 / r / 4 /
- Bradley 5 ,.
- Commercial 3
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 ,
Urinal 6
TOTALS SO 3 /0
Total fixture values: S divided by 16 = 5+ �y EDU — 5 �5 1
HISTORY ' o f 7't .e.A el-Q.4—i 6 E - D'-c ' 1.,16 r--
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR# •
PLM# EDU# SWR# PLM# EDU# SWR# .
PLM# EDU# SWR# PLM# EDU# SWR# .
i:ldstslswrtaly.doc
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