Permit •
C ITY OF T IGARD PLUMBING PERMIT
PERMIT #: PLM2006 -00386
, DEVELOPMENT SERVICES DATE ISSUED: 8/15/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S136CD-01601
SITE ADDRESS: 11670 SW PACIFIC HWY ZONING: C - G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: 30' of storm sewer.
CLASS OF WORK: OTR 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:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 30 ft
Owner: FEES
DOUGHTY, J PAUL AND LILLI
10150 SW CANYON RD Description Date Amount
BEAVERTON, OR 97005 ' [PLUMB] Permit Fee 8/15/2006 $72.50
[TAX] 8% State Surcha 8/15/2006 $5.80
Phone : Total $78.30
Contractor:
T C EXCAVATING LLC
PO BOX 1733
SANDY, OR 97055 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 826 -0895
Reg #: LIC 150402
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 952-01e c ; • • : - _ • 52- 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 • 1- 800 - 332 -2344.
a 4/11I
Issued By: // .
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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.
Building Fpitures _ _
'Plumbing Permit Applica `' (L �1 �" r()lt orrlcl:. use: ()wl.i
City of Tigard Received
DateBy a - ` Permit N. 1 �_ i %-� 47
II 0 13125 SW Hall Blvd Tigard, OR 97223 • Plan Review
• . Phone: 503.639.4171 Fax: 503.598.19JG it) 2006 Date/By Other Permit No.:
r I G A It l;) Inspection Line: 503.639 Date Ready/By. Jul la See Page 2 for
Internet: www.tigard- or.gov eirlY H-. I lUi Notified/Method I 1 v Supplemental Information
TYPE OF. 4 • tywr T' ", TNT it FEE* SCHEDULE
❑ New construction ' II 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 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: 11 7 O S o c?.-„,-,4,c_ �k4.+ Catch basin or area drain 16.60
City/State/ZIP: <T 1 „),_ _ '7 2.2S Drywell, leach line, or trench drain 16.60 -
Suite/bldg. /apt. no.: I Project name:C ; --z,-1. a Cwb Footing drain (no. linear ft : ) Page 2
job site: C� / Manufactured home utilities 110.00
Cross street /directions to
J +b61 4 �o0 4..(., q ..1 -d-rti Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
�'\ Storm sewer (no. linear ft.:30 ) 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 Back flow preventer Page 2
�P LCi..J� 6 " I I . ,, . -1-es `Q $ r� 4..., + ;,._ Backwater valve 16.60
, iv- A- � s z Clothes washer 16.60
Dishwasher 16.60
ROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: ` c can 1 .t,} �r,.,,..)(N 'rTc 54- Expansion tank 16.60 •
Address: 1 Z -. Z. 5 (r ( Fixture/sewer cap 16.60
City / State/ZIP: i basvd aJ)c„ 0 jz at `robs Floor drain/floor sink/hub 16.60
Phone: (C )) d yy - .,moo 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: ( •- . 5 •3 - CN ek / ,.......4 ,.......4 s u Medical gas (value: $ ) Page 2
Address: L' 7 $ `I v �Goi'S2 - 4. efi • Primer 16.60
City / State/ZIP: (S Goa. 4 1 ZC,6 7 . %€.3. G't- i , - Roof drain (commercial) 16.60
Phone: ) - 7Yp , 00 3 5 I Fax: : ( q � o
Sink/basin/lavatory 16.60
Tub /shower/shower pan 16.60
E-mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: --\-- GK_ Water heater 16.60
Address: '.bX 733 S+ Other: �~ tia
_ Subtotal
City /State/ZIP: 54;,.,....).. t� ^ ! e *robs -
Minimum permit fee: $72.50
Phone: ( ) etc, 7 _ 2 ,6 Fax: ( ) Residential backflow minimum permit fee: $36.25 �L
CCB Lic.: j spc - Plumbing Lic. no.:
Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5-
Authorized sr lure: r TOTAL PERMIT FEE fn T d
Print name: ate: 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 \Permits\PIMF- PamitApp.doc 04/06/06 440- 4616T(I0/02/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 Back flow 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
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 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.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Lusting ❑ 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 or additions to food service
- Drive Thni facilities where new plumbing fixtures, including interceptors;
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain /sink - 2" Submit 2 sets of plans with any of the above.
- 3"
-4"
Car 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
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.
i:\ &dlding\Pumits\PLM- PrnnitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200G00386
I 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/15/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 "I —
INSPECTION WORKSHEET FOR DATE: 8/24/2006 TIME: 6:59AM PAGE: 26
SITE ADDRESS: 11670 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PIZZA CABOOSE
DESCRIPTION: 30' of storm sewer.
OWNER: DOUGHTY, J PAUL AND LILLI, PHONE #:
CONTRACTOR: T C EXCAVATING LLC PHONE #: 603 -826 0895
Inspection Request Scheduled For: Date: 8/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm drain 03549501 503-740 -2235 Y
Corrections /Comments /Instructions:
co -4 -� 2a✓ uJi i 1 1 I Q ac L " 7�:c c, -
o F
Pro A AL, e Lb o <re /v0 kc. Q a.-TA C<< 1
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CYS- � -+--J i Date: Q`I 2.,(4 OL. Phone #: (503) 718-