Permit C ITY OF TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00224
��' - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/1/2005
PARCEL: 2S 102AA -04100
SITE ADDRESS: 12230 SW MAIN ST ZONING: CBD
SUBDIVISION: MORINS ADDITION LOT: JURISDICTION: TIG
Project Description: Commercial irrigation backflow.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
INTEGRITY INVESTMENTS INC Description Date Amount
2229 NE BURNSIDE SUITE 86
GRESHAM, OR 97030 [PLUMB] Permit Fee 6/1/2005 $72.50
[TAX] 8% State Surcharl 6/1/2005 $5.80
Phone : Total $78.30
Contractor:
TERRA -SOL LANDSCAPING
21685 SW HEDGES DR REQUIRED ITEMS AND REPORTS
TUALATIN, OR 97062
Phone : 503- 691 -6105
Reg #: LIC 5019
This permit is issued subject to the regulations contained in the Tigard Municipal Code, S . - if OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approv . . This p- rmit will expire if work is
not started within 180 days of issuance, or if work is suspended for more • -n 180 ATT' NTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification : ter. Those rule ar - set forth in OAR
952 - 0001 -0010 through OAR 952 -0001 -0100. You may obtain copies of these rules or dir:- tquestions to OUNC by
calling 503 - 246 -6699 or 1-800- 332 -2344.
Issued By: / ;� i Permittee Sign. ture. _11.1 a , A
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 corn .letio of the project.
Approved plans are required on the job site at the time of each ins ' '.n.
B Fixtures RECEIVED
• y
Plumbing Permit Applicatio) 6` 0 1 201 FOR OFFICE USE ONLY
City of Tigard CITY OF TIG ` Da 6 7/ /o5 6 � Permit No.:,// 0� 9
13125 SW Hall Blvd., Tigard, OR 97223 BUILDING ®I / ISI®
Plan Review fF 7
Phone: 503.639.4171 Fax: 503.598.1960 //�aa -d*:d' 0 Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 _41. of I I Ju '
Date Ready/By: ®See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
.
TYPE OF WORK . ' • ' FEE* SC DULE . - "
,=:INc1■ew 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 C',ommercial/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 A ND LOCATION '
Site utilities
Job site address: 1 22. (:) } 11,4 q IRA � t Catch basin or area drain 16.60
City/State/ZIP: VV °° Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
05-ka.0-\\A /V Manholes 16.60
IL/o 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.:
Abso . ' • . e 16.60
1 3 ''Pes14, DESCRIPTION OF WORK • : ackflow preventer Page 2
`��1 er va ve 16.60
t,4°1/4? Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ' '':1 ' . ` • ❑ TENANT " Drinking fountain 16.60
Ejectors /sump 16.60
Name:
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
Hose bib 16.60
' _. 0 .. "APPLICANT , , ❑ CONTACT PERSON 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: ( ) I F ax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONT CTOR Water closet 16.60
Business name6 VG�1 _ V` 'll�l oveDk.so Water heater 16.60
Address: 9) Ca e 5 S t,„„A3 (01,tgc (`V Other:
City/State/ZIP: -" „qv2TelAilr I ' - 70(0 2- _ Subtotal
Minimum permit fee: $72.50
Phone: $)) a ! -(p ('i Fax: ( ) Residential backflow minimum permit fee: $36.25 '7� 4
CCB Lie.: '' (�l t Plumbing Lic. no.: _ Plan review (25% of permit fee)
Auth• signs e: �� State surcharge (8% of permit fee) 1
�*: Al TOTAL PERMIT FEE 7'. 30
Print na 1 - • . �v) \p I oiwA 1S v1/4�.i■ J Date:6 - /--f , 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.
is\ Building \Permits\PLMF•PermitApp.doc 17103 440- 46161(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 & Rain Drain - 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 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
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"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice MachiRefrig. Drains
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
Quantity Total
- Bradley
Commercial 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:
is tBuilding \Pmnits\PLM- PemtitApp.doc 3/03
CITY OF TIGARD
i BUILDING DIVISION PERMIT #: PLM2005 -00224
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/1 /2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ' 1_
INSPECTION WORKSHEET FOR DATE: 6/3/2005 TIME: 7:09AM PAGE: 26
SITE ADDRESS: 12230 SW MAIN ST CLASS OF WORK:
SUBDIVISION: MORINS ADDITION LOT #: TYPE OF USE:
PROJECT NAME: CROWN CARPET
DESCRIPTION: Commercial y
OWNER: INTEGRITY INVESTMENTS INC, PHONE #:
CONTRACTOR: TERRA -SOL LANDSCAPING PHONE #: 503-691-6105
Inspection Request Scheduled For: Date: 6/3/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 008366 -01 971-404-4501 N
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � Date: / Phone #: (503) 718-