Permit CITY OF TIGARD
PLUMBING PERMIT
` : '' 71 COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00110
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/17/2008
PARCEL: 1 S 126CA -00100
SITE ADDRESS: 09225 SW HALL BLVD ZONING:
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: LAROG JEWELERS
Project Description: Remove and replace (1) water closet and (1) lay, adding (2) sinks.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MENASHE, R BARRY
621 SW ALDER, STE 605 Description Date Amount
PORTLAND, OR 97205 [PLUMB] Permit Fee 3/17/2008 $83.00
[TAX] 12% State Surch 3/17/2008 $9.96
•
Phone : Total $92.96
Contractor:
HOLLINGSWORTH PLUMBING
4 DUANE ST REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97045 -2869
Contact # : PRI 503- 655 -5533
FAX same
Reg #: LIC 65325
PLM 26 -324PB
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.
I , �
Issued y: a Permittee Signatur f , .,,'irl M
/>
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.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
• City of Tigard Received 1/07 0� Permit No.: V / #e Lj�/t/ e 0 lit /��
_
Date/By: ,? �(J(
a 13125 SW Hall.Blvd., Tigard, OR 97223
Plan Review /t
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
Date/By: �2k}:) U0037
Inspection Line: 503.639.4175 Date Read /B
Internet: www.ti s ®See Ps e utal 2 for
TIGARD ard - or, ov y o g
g g Notified /Method: (� Supplemental
_TYPE' OF WORK, , ' FEE* SCHEDULE,
❑New construction ❑Demolition For special information use checklist
`/ Description Qty. Ea. i Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
. CATEGORY OF CONSTRUCTION . SFR (1) bath 249.20
❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00
D.Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder ❑ Other: Each additional bath/kitchen 45.00
Fire sprinkler ( _ sq. ft.) Page 2
JOB' WE INFORMATION LOCATION
Site utilities
Job site address: �' J27ri� �, 81t, -1 Catch basin or area drain 16.60
City /State /ZIP: 'j 1 ! / e)e)-1--- / Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: / �. e � t J 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
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: l g I d` e/1 Fixture or item
/ ' ' �,�� Absorption valve 16.60
DESCRIPTION' OF WORK _ C Backflow preventer Page 2
p l�erf i /2)41...71/ x i'7 5 2 S 141::".5 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
' Q] PR OWNER [ ❑ TENANT ,
( C � ) 1 3/ Ejectors /sump 16.60
Name: / z17 Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
r - ❑, APPLICANT . ❑ CONTACT PERSON' Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) Sink/basin/lavator( L- () S 3 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet / 16.60
Business name:.-/; y 7 j e,� F`V L yrz. / Water heater / 16.60
Address: (3‘,Z4 6 v c).L ,S7-: ,a -L Other:
City /State /ZIP: F jryi a n 6,,7-t off' 176 45 Subtotal
"`�� / Minimum permit fee: $72.50
Phone: ( 3)_ 6,55-__S Fax: 6i 3 . .5 - 5333 Residential backflow minimum permit fee: $36.25 «? > '
1a5-3Z g Zb-324 A� Pla r ev i ew ( 25% of permit fee) _- 3
CCB Lic.: Plumbing Lic. no.' � g�I
State surcharge (12% of permit fee)
Authorized signature , . - , -i`�` 9 ) , 4l
TOTAL PERMIT FEE U 0
•
,,e.
Print nam .1�G t ` t q > r . Date: 3. '7�g This permit application expires if a permit is not obtained within
E 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
C\Building\Permits\PLMF- PermitApp doc 12/27/06 440- 4616T(10/02/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 & RairrDram - 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 orfraction 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
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Plumbing Installation
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' ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor /Water Aspirator Submit 2 sets of plans with any of the above. .
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain
Garbage -Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains '
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower. -Gang
-Stall
Sink - Bar/Lavatory -2, i , - / '
- Bradley *Note: If the fixture work under this permit results in an
- Commercial 'Z. increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued. .
Washer - Clothes
Water Extractor -
Water. Closet.- Toilet . 'Z. • / I
•
Urinal
Other Fixtures:
i \ Building \Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008-00110
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 311712008
Phone: (503) 639-4171 Jig:1W\
Inspection Requests (24 Hrs.): (503) 639-4175 IL
INSPECTION WORKSHEET FOR DATE: 5/6/2008 TIME: 7:00AM PAGE: 4
SITE ADDRESS: 09225 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: LAROG JEWELERS
DESCRIPTION: Remove and replace (1) water closet and (1) lay, adding (2) ":ink.
OWNER: MENASHE, R BARRY, PHONE #:
CONTRACTOR: HOLLINGSWORTH PLUMBING PHONE #: 503-655-553
Inspection Request Scheduled For: Date: 5/6/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 069448-01 503-319-4921
Corrections/Comments/Instructions:
C t..e-,1494 91
N A PASS PARTIAL APPROVAL Ei CANCEL n NO ACCESS
n FAIL El CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: CriN (1 " 4 " /
Date: (clic) VOC) Phone #: (503) 718-
CITY OF TIGARD •„-4 ,
.--
BUILDING DIVISION PERMIT #: PLM2008-Q0110
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/1712008
Phone: (503) 639-4171 J 1 1
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 4/2/2008 TIME: 7:00AM PAGE: 30
SITE ADDRESS: 09225 SW HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: LAROG JEWELERS
DESCRIPTION: Remove and replace (1) water closet and (1) lay, adding (2) $::inks.
OWNER: MENASHE, R BARRY, PHONE #:
CONTRACTOR: HOLLINGSWORTH PLUMBING PHONE #: 5B-655-6533
Inspection Request Scheduled For: Date: 4/2/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough 067718 503 N
Corrections/Comments/Instructions:
LA) ta,--i 4e-'-'-- SL 1 ff-e_ E-f, tt;
1 -- - 1 1,-.•et L
PASS Li PARTIAL APPROVAL 0 CANCEL pi NO ACCESS
n FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector
( C12ilt/Lii - ) 1,----___„" Date: (---) 1240? Phone #: (503) 718-
. ' •
CITY OF ��n m n n�'m TIGARD � —
BUILDING DIVISION PERMIT #: PLM3008.0U110
13125SVV Hall B|vd.. Tigard, ORg7223 DATE ISSUED: 3/17Y2008
Phone: (5O3)G3Q-4171 : d i,
Inspection Reque�s(24Hna.):(5O3)G3A'4175 .J� ^ �J�
INSPECTION WORKSHEET FOR DATE: 3/19/2O08 TIME: 7:01AkH PAGE: 20
SITE ADDRESS: 09225 HALL BLVD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: LAROG JEWELERS
DESCRIPTION: Remove and replace (1) water closet and (1) lay, adding (2) sinks.
OWNER: MENASHE, R BARRY, PHONE #:
CONTRACTOR: M0LLlNGEWORTMp|JJmEQNG PHONE #: 6O3 -655 - 5G93
Inspection Request Scheduled For: Date: 3119/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
306 P|u/nbingundera\eb 066968-01 603-319-4921 N
'
Corrections/Comments/Instructions:
.
.
�� PASS -- PARTIAL �� CANCEL -- NO ACCESS
�� �� __
|-| FAIL ri CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED
Inspector: �]/�� �^����� W Date: 3 ).^�14���, Phone (5O3>718-
•
� � —' /. ^�. . #: ` '