Permit t 'CITY OF TIGARD PLUMBING PERMIT
*woo& DEVELOPMENT SERVICES PERMIT #: PLM2005 -00048
I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/18/2005
SITE ADDRESS: 12230 SW MAIN ST PARCEL: 2S102AA -04100
SUBDIVISION: MORINS ADDITION ZONING: CBD
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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Rough & finish bathroom /breakroom. Adding:(3) roof drains,(2) sinks,(2) Iays,(2) water closets & (1) water
heater.
FEES
Owner:
Description Date Amount
INTEGRITY INVESTMENTS INC
2229 NE BURNSIDE SUITE 86 [PLUMB] Permit Fee 2/7/2005 $166.00
GRESHAM, OR 97030 [PLMPLN] Plan Review 2/7/2005 $41.50
[TAX] 8% State Surcharl 2/7/2005 $13.28
Phone : Total $220.78
Contractor:
EAGLE PLUMBING
13801 S FORSYTHE RD REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97008
Phone : 503- 650 -8703
Reg #: LIC 47914
PLM 3 -154PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: �` =� G� �� /lfcC� Permittee Signature: _e/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next r. siness day
, • .--- - - aFD -3(K-czar - 0(10
Plumbing Permit l! 'cation -
City of Tigard 3,,,;, Ve 2 _,� Qs Z Permit No.: T 1 5 0 y �/
13125 SW Hall Blvd., Ti OR 9722 fEB 07 200 r.
Phone: 503.639.4171 Fax: 503.598.1960 / .., Plan Review
p , ,: . i s Date/By. /llQl0,�6` SL ✓ OtherPermitNo. aca
24- Hour Inspection Line: 503.639e�$,�, C j l i
Internet: www.ci.tigard.or.us jj 11 - = - / Y y Date Ready/By. Bar ✓ I(q Notifed/MethoNotified/Method: ) ' ® See Page 2 for
Supplemental Information
B lifidaR1WORie .. FEE* SCHEDULE
, New construction ❑ Demolition For special information use checklist.
Description I Qty. I 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 ACotlunercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑� Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: O ZZZc C ' ali pM ) Catch basin or area drain 16.60
City /State/ZIP: ‘tA42,4) ts1&.- Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: ( Avi A C �� 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
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
ti C. t e m Pat 1 ‘ SN ahi)' /t. S / •^'b t M Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Fq D
PROPERTY OWNER I ❑TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: 3:1411. (LN ( J' T , Expansion tank 16.60
Address: 2•2 1 , 1 e' A o t 5 , ,0 „i$ ` Ic Fixture/sewer cap 16.60
City /State/ZIP: � � - Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ 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
i
Roof drain (commercial) .
City / State/ZIP: 3 1660 f �I �
Phone: ( ) I Fax: : ( )
Sink/basin/lavatory 1 16.60 6 „
Tub /shower/shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet Z i 16.60 3Y.4c)
Business name: e L` T Qty 6 Water heater I 16.60 f 6, 4 d
Address: i .),15(\ , S ft.. -? N Other:
City /State/ZIP: t ... -a wo (. /2Z
Subtotal
Minimum permit fee: $72.50 50
Phone: W)3) G,5 --?�2 ; Fax: ( yJ 3 )6/13 ' 7 j Residential backflow minimum permit fee: $36.25 /i‘( al
CCB Lic.: Tri Plumbing Lic. no.: ` e� Plan review (25% of permit fee) c//...)15 �,� (�
State surcharge (8% of permit fee) /,.?, 2-3''
Authorized signature: Ctist.s. TOTAL PERMIT FEE p4,,10 78
Print name: C L c 1 c > I Date: Z -7 _ (N6 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.
i:\ Building \Pennits \PLM- PennitApp.doe 12/03 4404616T(10/02/COM/WEB)
L
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 - l st 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
Q ty. Fee (ea) Total additional $100.00 or fraction thereof to and
Fixture or Item 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
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:
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 *.
Quantity by (Fixture) Work Performed • •
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
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"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
-Industrial
Ice MachJRefi;g. Drains ' increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory 2..
Quantity Total
- Bradley
-Commercial 1 Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter •
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet .. Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures: - - -
i:\ BuildingTermits \PLM- PennitApp.doc 3/03
CITY OF TIGARD
•
BUILDING DIVISION PERMIT #: PLM2005 -00048
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 2118/2005
Phone: (503) 639 -4171 4, 4 t 1,, ,
Inspection Requests (24 Hrs.): (503) 639 -4175 - - :. 1 .
INSPECTION WORKSHEET FOR DATE: 4/20/2005 TIME: 7:11AM PAGE: 4
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Rough & finish bathroom /breakroom. Adding:(3) roof drains,(2) sinks,(2) lays,(2) water closets & (1)
water heater.
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: EAGLE PLUMBING PHONE #: 503 - 6508703
Inspection Request Scheduled For: Date: 4/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 004960 -01 503-740-1234 Y
Corrections/Comments/Instructions:
i
/ /
❑ PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: " I Date: (6s �V Phone #: (503) 718-
CITY OF TIGARD ilk
BUILDING DIVISION PERMIT #: PLM2005.00048
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/18/2005
Phone: (503) 639 -4171 � i phi , a"i jl '�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/2/2005 TIME: 7:12AM PAGE: 10
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Rough & finish bathroom/breakroom. Adding:(3) roof drains,(2) sinks,(2) Iays,(2) water closets & (1)
water heater.
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: EAGLE PLUMBING PHONE #: 503650 -8703
Inspection Request Scheduled For: Date: 6/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 008222-01 503740.1234 Y
Corrections/Comments/Instructions:
(
• ,
•
IN 'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-