Permit ,„
`' CITY OF 'TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: P -10002
�I DATE ISSUED: 3/31/20031/200 6
if '- -� 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S 136AD -04001
SITE ADDRESS: 11539 SW PACIFIC HWY ZONING: C - G
SUBDIVISION: PACIFIC TERRACE LOT: JURISDICTION: TIG
Project Description: grease interceptor
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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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS: 1
LAVATORIES: OTHER FIXTURES: 0
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SMITH, EDITA M
BY NORRIS + STEVENS Description Date Amount
520 SW 6TH #400 [PLUMB] Permit Fee 3/31/2006 $72.50
PORTLAND, OR 97204 [TAX] 8% State Surcha 3/31/2006 $5.80
Phone : Total $78.30
Contractor:
PWSC
9045 SW WASHINGTON #150
PORTLAND, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 944 -9445
Reg #: LIC 162049
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.
Issued By: , .CO �. � Permittee Signature: :Cec,h-- t /V1.
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.
Plumbii 2 Permit AREeervED H)I( UFFICL: l SE O\ 1.1
City of Tigard Received
13125 SW Hall Blvd., Tigard, OR 972 1i1 �vB ...3 - I -•ot!o Penult No' l _ mil �'
f 1 2006 Plan Review
Phone: 503.639.4171 Fax 503.598. .., i. i1 DDate/By. n Other Permit No.:
24- Hour Inspection Line: 503.639.4175 •a 1 at Ready/By. )1 °" ® See Page 2 for
Internet: www.tigard- or.gov CITY O Notified/Method Supplemental Information
TYPE'wvKIC'ION FEE* SCHEDULE
❑ New construction ❑ Demolition For spedal Information use checklist.
Description I Qty. I Ea. I Total
Addition /alteration/replacement Other: / / y ft. for each utility connection)
G•tf�ie, rtt�t[!.s//�tK New dwellin gs (includes 100
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
❑ I- and 2 -family dwelling RT Commercial /industrial SFR (2) bath 350.00
❑ Accessory build ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
JOB SITE INFORMATION AND LOCATION Fire sprinkler ( sq. ft.) Page 2
Site utilities
Job site address: //c 3 9 .S w. Pa G ,4 G Y �/ trfy Catch basin or area drain 16.60
City/State./ZIP: 1't tap Qar mt. F72 2 3 �/ Drywell, leach line, or trench drain 16.60
-
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
LLi plc ��`'�
Cross street/directions to job site: + Manufactured home utilities 110.00
l /� Manholes 16.60
t
7 3 d 4yw f 9 - Pe i•ee Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear R: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Page 2
1 ^, +/ /J is /- /i / z- vhc -yeIa Backwater valve 16.60
7 Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER
I 0 TENANT Drinking fountain - 16.60
Ejectors/sump 16.60
Name: kep14t61. k-e.T ,44r[ A. r__
Expansion tank 16.60
Address: /6, j 0 co A /4 r /5 Fixture/sewer cap 16.60 e-i
City /State/ZIP: 6e .. . 001 . e 4 A I 01., F 0o L Floor drain/floor sink/hub 16.60
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Phone: ($ p '46 /290 Fax: ($ ) GO6 • /2 /7 Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
` terceptor /grease tra. 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City / State/ZIP: Roof drain (commercial) . 16.60
Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet
16.60
Business name: po5' G, Lsf/ G Water heater 16.60
Address: 1rt' 5 -W, W4A4•1 P., Other:
City /State/ZIP: 13 J ila. o( a _ 92 Subtot
/ Minimum permit fee: $72.50
Phone: (5113) QUy_ /v Fax: (503 2 5"3" 414,2.0 Residential backflow minimum permit fee: $36.25
CCB Lic.: /�j 2 0 yy Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: /( ir__
State surcharge (8% of permit fee)
TOTAL PERMIT FEE 7 f,
I Print name: / L i f Date: T d6, I This permit application expires if a permit is not obtained within
(� J 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
l:\ Building \Pamia\PtIN- PamitApp.doc 12/30'05 440.4616T(10102/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 5220.00
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 Q4. 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 51.54 for
Residential Badcfiow Prevention Device . each additional $100.00 or fraction thereof to
(minimum permit fee $3625) 27.55 , and including $25,000.00..
Rain Drain, single family dwelling 65.25 525,001.00 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
requested inspections and including $50,000.00.
specially equ spections -per hour 72.50 550,001.00 and up $742.00 for the first $50,000.00 and 51.20 for
Subtotal: each additional $100.00 or fraction thereof
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply. .
Quaotitx by (Fixture) Work Performed ❑ Any new commercial building
Future T • g ❑ Any new exterior plumbing site utilities.
Previous Capped Added Eddied ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations; alterations dr additions to food service
- Drive Thru facilities where new plunibing'fixtures, including interceptors,
Cuspidor/Water Aspirator a4e being installed for the food service area.
Dishwasher - Commercial ❑ My new residential building containing three'(3) or more
- Domestic \ dwelling units.
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash �
Floor Drain sink - 2" Submit 2 sets of plans with any of the above.
-3"
G -4"
C wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory .
- Bradley -
-Commercial
- Service .
Swimming Pool Filter \ ,
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Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a.sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
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i:\ Building \Pennits\PLM- PennuApp.doc 07/06/05
CITY OF TIGARD /
BUILDING DIVISION . _ • PERMIT #:. "- /ddo , ,,A
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 r i � O,
Inspection Requests (24 Hrs.): (503) 639 -4175 ":
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: l / _S CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: .. PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 / Pour Time: , in ,
Code # Inspection Description Confirm # Contact # Message
T if-et-4-e- - Mt:r-O-JUL-e-p / iLirt---- ,}JAfil, 9z/zi---.7z/e/
Corrections /Comments /Instructions:
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❑ PASS % PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _01:, Lu...ji " \t w=. Date: 21)0/04:, Phone #: (503) 718-