Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00609
c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/8/03
SITE ADDRESS: 11705 SW PACIFIC HWY N PARCEL: 1S136CD 00100
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 2 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 2 -2" floor drains, 1 primer and 2 foot spas.
FEES
Owner:
Description Date Amount
PACIFIC CROSSROADS PROPERTIES, I
BY WYSE INVESTMENT SERVICES CO [PLUMB] Permit Fee 12/5/03 $83.00
200 SW MARKET ST STE 345 [TAX] 8% State Surcharp 12/5/03 $6.64
PORTLAND, OR 97201 Total $89.64
Phone :
Contractor:
ALBERTA PLUMBING
LEWIS TRANER
PO BOX 55031 REQUIRED INSPECTIONS
PORTLAND, OR 97238
Phone : 503 Rough -in Insp
Top -out Insp
Reg #: LIC 96782 Final Inspection
PLM 26 -707PB
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
� � �f
Issued By: •t' / �����c�C �� Permittee Signature• !A'
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ext busine .. day
Building Fixtures
Plumbing Permit Application Received FOR USE ONLY ._.,;.,., : •:-.:, :,;,,,',.. ,- '..
RECEIVED Date/By: 1,2.1c10-3
Permit No.: -093 06
Planning App ova Plumbing-17)
- 0
Sewer
City of Tigard Date/By: Permit No. :SiA,Z900 3 • 00 Nia
13125 SW Hall Blvd. DEC 5 2003 A Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: dwy,5_28._i960 Post-Review Land Use ,
ul- rIGARD tit pillil' Date/By: Case No.:
Internet: www.ci.tigard.orl, m nnun nn,101.. AI* "`
el I Contact Juris.: El See Page 2 for
24-hour Inspection Request: n°!-'6'39Y4113"' ' . -" . Name/Method: , TICt Supplemental Information.
g64z1a*COVWC:111t1(i. '-f2,: -':'„_-: ;;;INFEEI,FIS:CHEDMEVOi,:skaitintiatitinilliiiii.ClikgIIStMZ
ED New construction 0 Demolition Description I Qty. I Fee(ea.) I Total
f '.i:.;4 -7 410 - W
[71 Addition/alteration/replacement Ei Other: ?,,mr,,A;;7, -4,.:4.,'',;?-.i...4. W-tv,i't-:;,:i.i'V4'
CATEGORY OF CONSTRUCTION :":14417*IfrAMT:-=',(includesg00111:tfotetiai
each connection) :,
:,-; i.: :,;'- ''''' '
SFR (1) bath 249.20
0 1 & 2-Family dwelling 2 Commercial/Industrial
SFR (2) bath 350.00
0Accessory Building 0 Multi-Family SFR (3) bath 399.00
0 Master Builder 0 Other: Each additional bath/kitchen 45.00
401 INFORWATION;aitiVEOCATION :`• t:;.. ' ' Fire sprinkler - sq. ft.: Page 2
- ,,,,,,-- * - ,, , F,,,t, , ,„At z e, ) ,xviq, , i v , ,,iic.- , ,--, ,,,, :-. , -,.: ,-- i i-i.v.? ; , ,, , 4 - ,. , *,. : •=1.,r,,,,.:-,,,,, ; ',:, ,, ,,L,,,-,,k
Job site address: 1 1 O 5n ',?( /..t . / 4 : ...,... ,, •.,.L_ 4:, t e - ..,•.! - itt:,..,,,,.,1 , .4k;,,ANA4„.....;:,,,,',,,,,
Suite #: Bldg./Apt.#: r-- Catch basin/area drain 16.60
i DrywelUleach line/trench drain 16.60
Project Name:
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax map/parcel #:
, :i '761.404faMiiVirg4fittireel'046
toriEse-fetruiotiirmottici , :, - ;A:f .: fr ;';'
Absorption valve 16.60
--- -rAh Lei , k ) Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
, a rottatilktv tivv„Ntie;,x; 2 It ErW, 1 .k ,,.i.'' Ejectors/sump 16.60
Name: vt.i, rt_ft -pi,,, A Expansion tank 16.60
Address: ii 104 s 60 i- LA t it 14 Fixture/sewer cap 16.60
City/State/Zip:
Floor drain/floor sink/hub •-■ 1 2,... 16.60 5 c )..0
ay-
Garbage disposal 16.60
Phone: ((7 10 - F-1, on, d / Fax: Hose bib ' 16.60
r ':.CONVACTIPERS0.1;;;:''; Ice maker 16.60
Name: Interceptor/grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer il 16.60 1( (
City/State/Zip:
Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory $. 16.60
E-mail: Tub/shower/shower pan Foe 5 pi} • --)___ 16.60 33, ar..)
i c.:^.:4=,:':.'t,',.,.:'?f,']:":';',. Urinal 16.60
Business Name: 41 q --/ 7 t
wafer closet
Water heater 16.60
16.60
Address: TA. e ,7_,-,?j Other: l' -
"
City/State/Zip: jj A ,4 ( ...er- Other: -
Phone: -3 ) 2 C.:1(,=5:- Fax: 5 Ca,te_e_, ]zoe, w&i „la platiiiiiiiiiiigifeliiiieFeigtd!Ana
Subtotal $
CCB Lic. #: ,97 , 7 g 1 umb . Lic.#: Tit3 z - 70 7
Minimum Permit Fee $72.50 $
Authorized . /
Residential Backflow Minimum Fee $36.25
Signature: ,i is Al.., .44.,..4.i..., Date: 1 , i_ . - - 5( o3
Plan Review (25% of Permit Fee) $
Let) k ----rjrazth, State Surcharge (8% of Permit Fee) $ 6 . 64/
(Please print name) TOTAL PERMIT FEE $ 2c;,6,4
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
" ,'4:.;? ` ', ;� " iSite "UtilitiCS ASx: .'r =;'' .> 'a Qty °z: F,ee °(ea)w" rrotal ."
��� sx .._�. fv,,.,,� . .�_�� ,-� � • � ..� �,�R; ,v� Square Footage: .Permit -Fee:
Footing drain , l' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer 3,601 to 7,200 $220.00
ewer - 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
,,, additional $100.00 or fraction thereof, to and
-, 1 , ;Fixture or Item,a' a , ; ,Qty x ! , ;Fee (ea ? `°
���'=` °" � °`� 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 - per 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:
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 *.
r a< °; "- <<i" .° `'aN Quanti 'ti txtu a Woi li "Pei for`iiaed ; Comments regarding fixture work:
∎ e . Ri place `
-- Ftxture�TYPI e �'�'� �' � �' � �� �-�� � �
, a ;ya li za 'f' :"; s�.aa',:q . „tt „Ne4 :4 �`Movedx,:, + .Capped ';r
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"
- 4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic p
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
• - Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is \Dsts \Permit Forms \PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION . DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received Date Requested / — 3 AM PM BUP
Location / 1 7 as Suite MEC
Contact Person Ph ( ) 12 4 40 0 7 PLM 3 O
Contractor Ph ( ) SWR
BUILDING Tenant/Owner D1C7A Pk A t- ELC
Footing
Foundation ELC
Access:
Ftg Drain v _ ELR
Crawl Drain L
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear L ( 0 —5 dr.G .K
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
Fire Sprinkler `-_ •
Fire Alarm � "_
Susp'd Ceiling
Roof / ,. W✓ ��!i f_� f 1
Other: -
� � -
Final
PASS PART FAIL i
PLUMBING \
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Ma le
Storm Drain
Shower Pan
Other: /
r FAIL
CHA ' AL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Ei Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date 17VG 3/(3 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL