Permit C ITY OF TIGARD PLUMBING PERMIT
�; DEVELOPMENT SERVICES PERMIT #: PLM2003 -00312
°` �'� I- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/30/03
SITE ADDRESS: 11847 SW PACIFIC HWY PARCEL: 1S135DD -00800
SUBDIVISION: HOFFARBER TRACTS NO.2 ZONING: C -G
BLOCK: LOT: 022 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: A3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 1
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: ft
Remarks: Installation of (1) catch basin in new parking lot.
FEES
Owner:
Description Date Amount
SANOKEE
375 NW GILMAN BLVD STE C -203 [PLUMB] Permit Fee 6/30/03 $72.50
ISSAQUAH, WA 98027 [TAX] 8% State Tax 6/30/03 $5.80
Total $78.30
Phone : 425 391 - 0570
Contractor:
G T CONSTRUCTION
3280 SW 170TH AVE #205
BEAVERTON, OR 97006
REQUIRED INSPECTIONS
Phone : 503 - 330 - 2270 Storm Drain Insp
Final Inspection
Reg #: LIC 139089
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 ' 1
Is ed By: F _...:� ,. ti..1L'. ' Permittee Signature:
Call (503 .39 -4175 by 7:00 P.M. for an inspection needed the next business day
Site Utilities
FOR OFFICE USE ONLY
c " Plumbing Permit Application Received // __ Plumbing 9
Date/By: (o 0 3
Permit No.: Ltlo 7A
a Planning Approval Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
/aa. ";
Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 Post - Review Land Use
I I � Date/By: Case No.:
Internet: www.ci.tigard.or.us 1� e l 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. I Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION _ (includes 100 ft. for each utility connection)
SFR (I) bath 249.20
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial - 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: // $r Sw AS 4i;c /e._ "{w�! ,-3-5,9p,rie Site Utilities ,
Suite #: I Bldg. /Apt. #: 7 ei^ � Catch basin/area drain r 16.60
�� Drywell/leach line /trench drain 16.60
Project Name: k7./i/e/i/ (.1.E37. 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
Sanit. se er no., ine. ft. Pa:e 2
Subdivision: I Lot #: �`�'1:±_ • irr. � Pa:e 2
Tax map /parcel #: Water service no. linear ft.) Page 2
Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name: /TA- v ,v Expansion tank 16.60
Address: us- 444 y/4ipf / QL 576 0"• 203 Fixture/sewer cap 16.60
City/State/Zip: Floor drain/floor sink/hub 16.60
}� p: 9S Sj1Gt�,A / wi g g8o2 Garbage disposal 16.60
Phone: 4,2 - 74.5 - 3 3// Fax: Hose bib 16.60
❑ 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
p Roof drain (commercial) 16.60
Phone: I Fax: sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
Business Name: - Water closet 16.60
U • r �°' "e"� �� °y Water heater 16.60
Address: 327o sw X70 .41fE - Other:
City /State /Zip: ,QEn . • p/p • 9700(_ Other:
Phone: S03 -37a - 2270 Fax: ` Plumbing Permit Fees*
Subtotal $
CCB Lic. # :/? 7,, S 9' , Pl Lic. #: Minimum Permit Fee $72.50 $
Authorized / t o tO 4j / Residential Backflow Minimum Fee $36.25 j7
Signature: Date: n /Ad /7 Plan Review (25% of Permit Fee) $
/ State Surcharge (8% of Permit Fee) $ 6 • gG
(Please print name) TOTAL PERMIT FEE $ 7 , 3d
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 Boa d.
'A,' �
is \Dsts\Permit Forms\PlmPermitApp.doc 01/03 am.. t a.�
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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 - l 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 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 $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 *.
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 Mach. /Re£rig. 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:
i:\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 7- AM PM BUP
p
Location I I P 1/7 Suite MEC
Contact Person � Ph ( ) 3 Z 7 6 PLM .3 - DO 3/ ;_
Contractor Ph ( ) SWR
BUILDING Tenant/Owner X %-e/Yl .O,.t �/ ELC
Footing
ELC
Foundation ' . cess:
Ftg Drain ELR
Crawl Drain
Slab I ° • • emotes: / r j , SIT
Post & Beam �� L;
Shear Anchors '
Ext Sheath/Shear 4
Int Sheath/Shear -
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam �r
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
for rain
Shower Pan
Other:
F' al
PA PART FAIL
ECHANICAL
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: �^ El Unable to inspect - no access
�� /
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL