Permit ';'- " CITY OF TIGARD
�� PLUMBING PERMIT
`'� ° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00059
TIGARD DATE ISSUED: 2/20/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S126DC 04800
SITE ADDRESS: 09495 SW LOCUST ST A ZONING: C -P
SUBDIVISION: LEHMANN ACRE TRACT LOT: 004 JURISDICTION: TIG
PROJECT: KLEIN DERMATOLOGY
Project Description: Adding (1) additional service sink.
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
BAKER, JAMES +
9495 SW LOCUST ST. #G Description Date Amount
BAKER, DIANE R [PLUMB] Permit Fee 2/20/2008 $72.50
TIGARD, OR 97223 [TAX] 12% State Surcha 2/20/2008 $8.70
Phone : NA Total $81.20
Contractor:
FIVE STAR PLUMBERS INC
PO BOX 28
BANKS, OR 97106 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 324 -0717
FAX 503- 324 -0883
Reg #: LIC 169703
PLM PB 108
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 th- Oregon Utility Notification Center.
Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 -0001 -0100. You may obtain cop:- s of th -se rules or direct questions to OUNC
by calling 503.246.6699 or 1.800.332.2344.
Issued y: // Permittee Signature:
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 projec .
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
1 V Received oO0
q 13125 SW Hall Blvd., Tigard, OR 9 22
City of Tigard EEE ... ;t p og ( Pennit No.: , G� g'�
D
Plan Review
,:51,0 /1 /l „
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Phone: 503.639.4171 Fax: 503.598.196 Other Permit No.: K OOXXC�/ $'
DE 2 0 2008 Date/By:
T I G A RD Inspection Line: 503.639.4175 Date ReadyBr luris Page
www.ti and - or. ov Supplemental See Pa t l for
g g Notified/Method: Supplemental Innformation
TYPE OF WOR it Y I !GARD - FEE *, SCHEDULE •
❑ New construction gilI C) I V i S I0IA For special information use check list
Description Qty. I Ea. Total
0 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
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE. INFORMATION AND LOCATION ' Site utilities
Job site address: -U t4 9 5 5 W tea` AA Sr. Sr STE A Catch basin or area drain 16.60
City /State /ZIP: Vori l.pavo D2 9722-3 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
/�l J� i��s�F?TU'� ly° Manufactured home utilities 110.00
Cross street/directions to job site: ce1Jbuy d �s� Manholes 16.60
5 � Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: N 151 ao' - D 1 40 I Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
Tax map /parcel no.: y , i 1 AJ S 6G 23 i, L.01 41800 t ' 4/t0/ Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
iQ EMoDe OP /4 &Xr /
Al /1126 Cloak /oak . Backwater valve 16.60
ADD / ° S S N.I BL Clothes washer 16.60
Pc Dishwasher 16.60
Drinking fountain 16.60 -
.0 PROPERTY OWNER 1:i TENANT
Ejectors /sump 16.60
Name: }le-144 D El2M 41-b L . o q 1 4 A550c--
Expansion tank 16.60
Address: 9 sq 5 50 (Cc -451- s-r STE A Fixture /sewer cap 16.60
City /State /ZIP: 88/2T , ®/Z 9 7 7- 2 Floor drain/floor sink/hub 16.60
Phone: (5(53) Z LA s 2t 9 5 Fax: (9.0) Z LICA .5Ci G 5 Garbage disposal 16.60
Hose bib 16.60
0 APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name: E x Tore Ei su D LL. G. Interceptor /grease trap 16.60
Contact name: Scot-if- GKE47029' Medical gas (value: $ ) Page 2
Address: 0 o &OX 6le® Primer 16.60
City /State /ZIP: Saar// RA-/A/5 4
Roof drain (commercial) 16.60
Phone: (3 20 244'4 Fax: : (Sea) 101/7 616 /9
Sink/basin / lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: E)(7'/ /;1E, &) /c-®eS 47AV7.'fA /L e Gbh
Urinal 16.60
CONTRACTOR ' . - Water closet 16.60
Business name: F I'd 0 5 4-G,r P J „,t b v )----_5 Water heater 16.60
Address: P-0. c3 O.� Z F4 Other:
c�
City /State /ZIP: V �..yt,' 4'6- 5 0 9 ') I ®b Subtota
Minimum permit fee: $72.50 •
Phone: (503) 3 19 - 0 71 7 Fax: (5& 3 ) 5 0 (c3 Residential backflow minimum permit fee: $36.25
CCB, Lic.: ( t9 i'703 Plumbing Lic. no.:3 N - 9 (, g f 7 Plan review (25% of permit fee)
I State surcharge (12% of permit fee)
Authorized signature:
TOTAL PERMIT FEE
Print name: fit .. P' - a : 4 2- 1 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.
t:\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
. Valuation: Permit Fee:
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
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
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 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 Performed • 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
- Bradley *Note: If the fixture work under this permit results in an
- Commercial _ 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 •
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008.0 079
13125 SW Hall Blvd.,'Tigard, OR 97223 DATE ISSUED: 2f20/2008 '
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 L
INSPECTION WORKSHEET FOR DATE: 3/14/2008 TIME: 7 :00Aliil PAGE: 41
SITE ADDRESS: 08495 SW LOCUST ST A CLASS OF WORK:
SUBDIVISION: LEHMANN ACE TRACT LOT #: 004 TYPE OF USE:
PROJECT NAME: KLEIN DERMATOLOGY
DESCRIPTION: Adding (1) additional service sink.
OWNER: BAKER, JAMES +, PHONE #: NA
CONTRACTOR: FIVE STAR PLUMBERS INC PHONE #: 503 - 321-0717
Inspection Request Scheduled For: Date: 3/14/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 05707 -02 530-201-2996 Y
Corrections /Comments/ Instructions:
•
C`o c-
tg PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ej ,J l \N Date: 81 14 1 Phone #: (503) 718-
CITY OF TIGARD . ....„
BUILDING DIVISION PERMIT #: pLm2008-0009
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/20/2008
Phone: (503) 639-4171 ' 4
koo
Inspection Requests (24 Hrs.): (503) 639-4175 ......._.,... - - ..... lt
INSPECTION WORKSHEET FOR DATE: 2/28/2008 TIME: 7:00AM PAGE: r
J
SITE ADDRESS: 094195 SW LOCUST ST A CLASS OF WORK:
SUBDIVISION: LEHMANN ACRE TRACT LOT #: 004 TYPE OF USE:
PROJECT NAME: KLEIN DERMATOLOGY
DESCRIPTION: Adding (1) additional sorvice sink.
OWNER: BAKER, JAMES +, PHONE #: NA
CONTRACTOR: FIVE STAR PLUMBERS INC PHONE #: 03
Inspection Request Scheduled For: Date: 2128/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough-in 065831-03 503-210-1299 N
Corrections/Comments/Instructions: .
PASS El PARTIAL APPROVAL 0 CANCEL 7 NO ACCESS
7 FAIL EI CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED
Inspector: ali\,\I,.\/\\._.____- Date:2A 2._\,./NC(1 Phone #: (503) 718-