Permit u..
CITY OF T I GA R D PLUMBING PERMIT
P ERMIT #: PLM2002 -00417
,� DEVELOPMENT H O B Ti
gard, 97223 CES 39 -4171 DATE ISSUED: 10/29/02
SITE ADDRESS: 11745 SW PACIFIC HY 100 PARCEL: 1S136CD -01000
W
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS: 2 TRAPS:
STORIES: WATER HEATERS: 2 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Add 2 bathrooms and 2 water heaters to new tenant space.
FEES
Owner:
Description Date Amount
SMART & FINAL STORES INC
PO BOX 512377 [PLUMB] Permit Fee 10/29/02 $132.80
LAS ANGELOS, CA 90051 [PLUMB] Permit Fee 10/29/02 $0.00
[TAX] 8% State Tax 10/29/02 $10.62
[TAX] 8% State Tax 10/29/02 $0.00
Phone 1: 503- 323 - 869 -7591
Total $143.42
Contractor:
THREE RIVERS PLUMBING INC
1425 ALABAMA ST STE F
LONGVIEW, OR 98632
REQUIRED INSPECTIONS
Phone 1: 360 - 425 -5171 Rough -in Insp
Top -out Insp
Reg #: LIC 148667 Final Inspection
PLM 37 -526PB
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 thes- les or direct questions to OUNC by calling (503) 246 -6699.
I u ed By: h_ �_A`_� t� ,' J. / Permittee Signature: j� /./19.- Call (503) 639 -175 by 7:00 P.M. for an inspection needed t I • - -xt business day
Building Fixtures Au/ -eag9
r I
PlumbingPermit Application OFFICE USE ONLY
4/ City of Tigard Date received: /009 -0a- Permit no.: LP/„VD? —a:' /7
S ewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 R1:7174 L_ D— -
Date issued: 11 Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement ❑ Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist A
Job address: ^ v Description Qty. Fee(ea.) Total
Mc? /� c? •3 / c . r �1'� c liv
Bldg. no.: Suite no.: �� New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (I) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: L 6-74,..5 SFR (3) bath
City /county: Aft ,tea — w ■ ZIP: • Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft
Manufactured home utilities
Business name:
7 - 0 c - ( 2 _ , . . 6 \ a 5 ,--DL e__)& les
Address: ' ■5- it C 14., 5 — S e Rain drain connector
City: (/d s I 5:7 .57E
ZIP: ' Sanitary sewer (no. lin. ft.)
�iZS.5 ) ( L_2 c Storm sewer (no. lin. ft.
Phone: Fax: ? E -mail: ( ft.)
CCB no.: I Plumb . .. no: 31 _ 5 (_ . Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Contractor's representative sig ature: , / „r /�_ `°` tion valve
Print name: II at e. ,Z _ ,Back flow preventer
� � � �'� �i ackwa�. v -
CONTACT PERSON Basi . /lavato I. .,3�
Name: Pa ,v/ W OW_,O Clothes washer ,
Address: C Dishwasher
City: c_5 /�'& I State: I ZIP: Drinking fountain(s)
Ejectors /sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
Floor drains/floor sinks/hub '
r J ,•7
(print):
rint) :
Mailing address: Garbage disposal
Hose bibb ,
City: I State: I ZIP: Ice maker
Phone: I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s) 2. 3 � N7
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs /shower /shower pan
Urinal
Name: Water closet 2. 33,Po
Address: Water heater ,
City: I State: I ZIP: Other:
Phone: Fax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ / . • ae
Notice: This permit application a
O visa 0 MasterCard Plan review (at _ %) $
expires if a permit is not obtained
Credit card number: / / within 180 days after it has been State surcharge (8%) $ •
Expires TOTAL $ /45e.
Name of cardholder as shown on credit card accepted as complete.
$ .
Cardholder signature Amount 440 -4616 (6/OO /COM)
PLUMBING PERMIT FEES: •
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (Includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00 _
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 9 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San /Storm Sewer 46.40 Lavatory
Hose Bibs 16.60 Tub or Tub /Shower
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 1,6.60 Water Closet
Other Fixtures (Specify) 16.60 Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer- 1st 100' 55.00 3 "
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 62.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required If
Quantity Total is > 9
*SUBTOTAL
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
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