Permit CITY OF TIGARD
PLUMBING PERMIT
l� DEVELOPMENT SERVICES PERMIT #: PLM2003 -00074
..� I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/14/03
SITE ADDRESS: 11875 SW PACIFIC HWY PARCEL: 1S135DD -00900
W
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING: C -G
BLOCK: LOT: 021 JURISDICTION: TIG
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: 2 CATCH BASINS: j
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 3 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: 60 ft
WATER CLOSETS: 3 WATER LINE: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing tenant improvement, all previous fixtures have been capped. Other fixtures are (2) hose bibs.
Installation of an additional 60' each of sanitary and water services.
FEES
Owner:
Description Date Amount
LEFEVER, GEORGE & TAMMY
11875 SW PACIFIC HWY [PLUMB] Permit Fee 3/14/03 $309.20
TIGARD, OR 97223 [PLMPLN] Plan Review 3/14/03 $77.30
[TAX] 8% State Tax 3/14/03 $24.74
Phone : Total $411.24
Contractor:
UNIVERSAL PLUMBING
•
(DAVID RAY OAKLEY)
8811 SW SPRUCE STREET REQUIRED INSPECTIONS
TIGARD, OR 97223
Water Service Insp
Phone : 452 -7480 Top -out Insp
Reg #: LIC 111472 Storm Drain Insp
PLM 26 -589PB Final Inspection
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
Issued By: Permittee Signature: /, / 6 .0
Call (50 ) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONL
N� D /ved e^ � Permt 60,1905-6 7f/
� Date/By: �J
City of Ti and Planning Approval Sewer
ty g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review A J, Other o
Tigard, Oregon 97223 Date/By: ear /v�3 i 7 / Permit No.: /t 5- DDD 9;
Phone: 503- 639 -4171 Fax: 503 -598 -1960 / /e� l' & Post Land Use
Internet: www.ci.tigard.or.us a � my/ I Date/By: Case No.:
Contact Juris.: ® See Page 2 for
`-
24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction _ ❑ Demolition Description I Qty. Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF C ONSTRUCTION (includes 100 ft. for each utility connection)
1 & 2-Family dwelling ommercial/Industrial SFR (1) bath 249.20
❑ Y lli g SFR (2) bath 350.00
❑Accessory Building ❑ Multi - Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION • Fire sprinkler - sq. ft.: Page 2
Job site address: / /37' 9,J -- pacu tit L -4- &i9' Site Utilities
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60 >
Project Name: /n/TL/L o 2 Mori r/£5
Drywell/leach line/trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
N.
I I I/ Pau t 1 G Manholes 16.60
` J `! Rain drain connector 16.60
Sanitary sewer (no. linear ft.) (pD / Page 2 55 ' QO Z
Storm sewer (no. linear ft.) Page 2 4 %. ci Subdivision: Lot #: Water service (no. linear ft.) lP0 / Page 2 55 ' 1
Tax map /parcel #: Fixture or Item
r(�) DESCRIPTION OF WORK Absorption valve 16.60
lCt-t.l 11t.L) c- c.l,'e, V 4 CLk» V1,1 Backflow preventer Page 2
1 \ i r 12 Pi 4e`tt,WCS , Cop some_ of 4D Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER I ❑ TENANT -
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /Zip: Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: Fax: Hose bib oZ 16.60 33.10
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City/State/Zip: Primer 16.60
Y p Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 0 3- kfrIts 5 16.60 83,00
E -mail: Tub /shower /shower, pan 16.60
CONTRACTOR Urinal 16.60
_ Business Name: .n i v e,�,( Gunb c n Water closet 3 16.60 r.fig 5 Water heater a • 16.60 -2.0
Address: F$ I L di) Sprt . s-E- Other:
City /State /Zip: j ., a Q 3 Other: P"' Phone: l-I Sa - �7L-( Fax: otky - °!q2u 1 Plumbing Permit Fees*
Subtotal $ q . 9 4 9 C C B Lic. #: I (I ,-/ - 7 a Plumb. Lic. #: aCo 65q.1 Minimum Permit Fee $72.50 $
Authorized �/ Residential Backflow Minimum Fee $36.25
Signature: l'10.1till-t-le-lailate: 3 ' ! U3 Plan Review (25% of Permit Fee) $ 77. on
Deounn tc "2 O«.,i ry State Surcharge (8% of Permit Fee) $ 0 2 14,7 i
(Please print name) TOTAL PERMIT FEE $ 1 7 / 7, o 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:
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' b / 55.00 Ss` 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - lit 100' CIO/ / 55.00 5S� 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
Fixture or Item Qty. Fee (ea) Total 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 0 0 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: //O 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 fixture s could result in increased sewer fees *.
Quantity by (Fixture) Work Performed Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
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
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 MachiRefrig. 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 ,1
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
Accumulative Sewer Tally
Tenant Name: Interior Motives This SWRt N/A
Site Address: 11875 Sw Pacific Hwy This PLM# 2003 -00074
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
_ Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 _ 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drr 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 _ 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 3 6 3 6
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 1 3 1 3
- Service 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 3 18 3 18
Urinal 6 0 0 0 0 0
Previous EDU Count 2 32 32
Capped EDU Credit 2 32
TOTALS 0 32 0 0 8 30 8 30
Current Fixture Value 30 divided by 16 = 1.9 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 32 divided by 1. - .: Previous EDU
Change -2 divide. • 16 - -0.1 over (under) $ - s/ e,,,,a,
Enter ED hange ; e
HISTORY
Notes: 3/13/03, per Mike S. all PLM# 3/12/03 - Acct. EDU# 2 • SWR#
previous fixtures have been PLM# EDU# SWR#
capped. PLM :
t EDU# SW R#
C .I: ' at0a,1 Date: 1�4
Signature of • erson that calculated this tally sheet and date perfro ed is required
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested S o? 4 AM PM BUP
Location / / g 7g - Suite MEC
Contact Person Ph ( ) 76 3 ` 431 / PLM - DD D 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL e„,r,
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
V��
• PART FAIL
ANICAL
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 ❑ Please call for reinspection RE: D Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final D • NOT REMOVE this inspection record from the Job site.
PASS PART FAIL