Permit •
C 1TY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2005 -00575
��� DEVELOPMENT SERVICES DATE ISSUED: 10/18/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1 S136CD -00100
SITE ADDRESS: 11705 SW PACIFIC HWY K ZONING: C -G
SUBDIVISION: PACIFIC CROSSROADS LOT: JURISDICTION: TIG
Project Description: Fixtures: Other fix.cap sink. Replace lay and toilet and water heater.
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: 1 • CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC CROSSROADS PROPERTIES, I Description Date Amount
BY WYSE INVESTMENT SERVICES CO
200 SW MARKET ST STE 345 [PLUMB] Permit Fee 10/18/200f. $72.50
PORTLAND, OR 97201 [TAX] 8% State Surchari 10/18/200E $5.80
Phone : Total $78.30
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97005
Phone : 503- 643 -7619
Reg #: LIC 128892
PLM 34 -4PB
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 9 or 1-80 332 -2344.
Issued By: �/ Permittee Signature: ` cr~`e—
Call 503 -639 -4175 by 7:00 a.m. for an inspection that siness 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 Fixtures IV E D 2 1 ( -00/ 00
Plumbing Permit Ap� rOiz mil( 1: l 1l: Om.\
City f Tigard R C 0 C 1 7 d y Permit No.:
131 SW Ha Blvd., Tigard, OR 97223 OCT 18 2005 l Y �� /� v� � �sM�oo
Review
Phone: 503.639.4171 Fax Date/By. Other Permit No -: 503.598.1960 Plan Other
24- Hour Inspection Line: 503.639.4175 CITY OFTIGA%. ,J ' ii Rdy/By rtais: ES See Page Zfor
Internet: www.citigard.or.us • ' BUILDING DIV - - Notified/Method: Supplemental Information
�- .. _.... . _.- - . ..... �.� �.... -. _.. _.. ♦..r ...: r. �. -__.. .s- cv :..,..- '...P_
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
V Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
.�4:;� . � : ',�CATEGO. #:* .CO ST1tY7CFIOI�F- ''' -.'?: �` "�• ``. 4... 4 SFR (I) bath 249.20
❑ 1- and 2 -family dwelling )2(Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi -family SFR (3) bath 399.00
❑ Master builder Each additional bath/ltitchen 45.00
❑ Other:
_
_ - _ -_ z - - _ ....a y ;_ . 4 Fire sprinkler ( sq. ft.) Page 2
-_ -: ', J_OWS_ ;,JN ORMATION: AND ;I O,CA'TION: :: �' -� - _ Site utilities
Job site address: i ( 7QS 1 ) G.0 -, V l' f uL�/ Catch basin or area drain 16.60
City /State/ZIP: 1 Drywell, leach line, or trench drain 16.60
K I /44. H � / Footing drain (no. linear ft: ) Page 2
Suite/bldg. /apt. no.: Project name: 1 11 / � 1� Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear 8.: . _J Page 2
Storm sewer (no. linear ft.: ) Page 2
•
Subdivision: I Lot no.: Water service (no. linear 8: ) Page 2
Fixture or item
Tax map /parcel no.: -
Absorption valve 16.60
- - - DES o1 WO :- -Y y . Page 2
�Q ?:�- Backflow preventer ge
(ii.11 � S // . - < I ' I dce �V+ ,j T j o i ± I Backwater valve 16.60
.riagisipm P9:0 1 QC C (T dt X 9..1 Y I eta- .C' Clothes washer 16.60
Dishwasher 16.60
16.60
,... .
_ �;PROPEItTY�O, - -- " ' " "I'ENA1V'1" :a �. :_'::�{. - :�
.... _ . k ... Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: (tore/ wcr cap 1 16.60
City / State/ZIP: our drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) . Garbage disposal 16.60
p_'AAPPLIC r r�_ a- COl ; RSON., ; ;.
Hose b1b 16.60
_ :. . �• : = :. : Ice maker I malt 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) 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
. ,.CON: R)lCTti*: : : :- -e ∎ , :?. : t >: '
. s . � :<?
• . `� >;;::. -' ! ? - -'F . �.�. � " • -.. _:.'. - , - ,. t - :_ . :.-:.. - - .r.:�;; Water closet I 16.60
Business name: 1.?egc, F lc...Av. t
^: k : Water heater ' 16.60
Address: > 3 c 7 (c) , , 4 „ �. 7" v_ Other:
City/State/ZIP: ,..0,„. � J I G r@ 9 , Subtotal
Minimum permit fee: $72.50
Phone: (5 ) (:)L( - 7‘ (r Fax: ( 6'13 - 76 ZG Residential backflow minimum permit fee: $3625 2��
g �� -,,y p j Plan review (25% of permit fee)
CCB Lic.f✓(L�'� Plumbing Lic. no.:
State surcharge (8% of permit fee)
Authorized signature: / �, V/14 - - TOTAL PERMIT FEE I ; gl.
Print name:/1/16,,e1( r f l.-�/C t 1.1-../ I Date/t /�' /OS 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 B d.
i:\ Building \Permits\PLMF- PetmitApp.doc 06/05 4404616T(10/02/COM/WEB)
Plumbint Permit Application - City of Tigard 1. ti
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
� -= �:�- _
:. P ernut _Fee L -- - _ _ _ . -
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 $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
additional $100.00 or fraction thereof to and
>Figture. orltem:`�.- -,�;_..; _•.;_.:; =�. ..;_,Qty:;._;=- Fe`r(ea)_ �: 'Totab:;
= 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 pa hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof •
Fixture Work: Plan Review for Com pletStructui�es- •
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 futures could result in increased sewer fees *. Please check all that apply.
_Qtiauti by (Fiffir e�' oekJerformed ❑ Any new commercial building
::' ` ' ~ _° J '` ❑
. Replace My new exterior plumbing site utilities.
- 'Fattire Typee - � _ . ' •- ..: :,�1 -.: • `^
' ` }:_ ' Pteviniis - °`cavtied`= :^:ended- . •msdng ❑ 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 Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ My new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash ❑ My NFPA 13 - D multipurpose fire sprinkler system.
Floor Drain sink - 2" Submit 2 sets of plans with any of the above.
-3"
Car Wash Drain . 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.
is\ Building \Pennits\PLM- PennitApp.doc 07 /06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005.00575
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/18/2005
Phone: (503) 639 -4171 /m�md col
Inspection Requests (24 Hrs.): (503) 639 -4175 . �+�- "_ _
INSPECTION WORKSHEET FOR DATE: 10/26/2005 TIME: 7:07AM PAGE: 96
SITE ADDRESS: 11705 SW PACIFIC HWY K CLASS OF WORK:
SUBDIVISION: PACIFIC CROSSROADS LOT #: TYPE OF USE:
PROJECT NAME: H & R BLOCK
DESCRIPTION: Fixtures: Other fix.cap sink. Replace lay and toilet and water heater.
OWNER: PACIFIC CROSSROADS PROPERTIES, I, PHONE #:
CONTRACTOR: BEAVERTON PLUMBING INC PHONE #: 503- 643 -7619
Inspection Request Scheduled For: Date: 10/26/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 019332 -01 503-643 -7619 N
Corrections /Comments /Instructions:
K . ) '
Y IDASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1/ 1 2 W Date: *42_ Phone #: (503) 718-