Permit { r CITY OF TIGARD PLUMBING PERMIT
"Wel DEVELOPMENT SERVICES PERMIT #: PLM2003 -00457
..� II DATE ISSUED: 9/3/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 11945 SW PACIFIC HY 100 PARCEL: 1SI35DD -03301
W
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G
BLOCK: LOT: 002 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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 128 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect one commercial sink to private sewer. Espresso shop located in the Safeway parking lot
FEES
Owner:
Description Date Amount
TIGARD PROPERTIES INC
2106 SE OCHOCO ST [PLUMB] Permit Fee 9/3/03 $101.40
MILWAUKIE, OR 97222 [TAX] 8% State Tax 9/3/03 $8.11
Total $109.51
Phone :
Contractor:
EURO PLUMBING INC
10659 SE 172ND AVE SE
BORING, OR 97009 REQUIRED INSPECTIONS
Phone : 503 - 558 - 0903 Final Inspection
Reg #: PLM 37 -486PB
LIC 152186
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
Iss ed By j ;1• Permittee Signature* _
Ca (503 9-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures •61.4J 4..1o0 .3Y t -
• Plumbin Per mit Application FOR OFFICE USE ONLY
{ Received Plumbing
Date/By: 9 /al D 3 ! , • Permit No./ R OO 3 " 450
City Of Tigard Planning Approval s . •�
By:
13125 SW Hall Blvd. Plan Review OT
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post Land Use
Internet: www.ci.tigard.or.us .�L'i � Date/By: Case No.:
24 -hour Inspection Request: 503 -639 -4175 - ° ='� Name/Method: Juris.: Su See Page for
P Q Name/Method: Supplemental l Information.
T kPE OF WORK .. FF.F, *- S special Information use chgcklist) .
❑ New construction ❑ Demolition Description Q ty. I Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: - - Nay -1 2- family, dwelling' : , ' `
:. . CATEGOR'S� - ` CONSTRUCTIION +•. ` • :' ncludes 100 ft. for each: ati ty connection), ,±: • .
SFR (1) 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'SPTE INFORMATION andLOCA.TION - Fire sprinkler - sq. ft.: Page 2
Job site address: // ' s _
f� �� 7'.' '' .... ' • ' - : Site Utilities `; :.. ,_..., .. .. _ .
Suite #: I Bldg./ Catch basin/area drain 16.60
Project Name: 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
q 5 i f �( Manholes 16.60
' ` Rain drain connector 16.60
• Sanitary sewer (no. linear ft.) / ' A Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2 _
• . ' `: MSC TION OF WORK - ..� , . - Fix ture'or- Ite ni;,: - ' . �, ' , •
i Absorption valve 16.60
Q(-n /1L Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
. Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER :. ENANT Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: ,! �i 1 1.,21.'�a ✓4i. z, Fixture/sewer cap 16.60
City/State /Zip: / Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: I Fax: Hose bib 16.60
:=.,G APPLICANT - ' l ❑"CONTACT PERSON' - Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
City /State /Zip: Primer 16.60
Roof drain (commercial) 16.60 /
Phone: I Fax: Sink/basin/lavatory / 16.60 l to t/ e,
E -mail: Tub /shower /shower. pan . 16.60
: , :. •CONTRACTOR ` •: ' Urinal 16.60
Business Name: . J,, ,, _ __�„ �` Water closet 16.60
Address: )b (oS ' se lea A-v.e_ s Otht heater 16.60
City/State /Zip: ( B . ^ ,c' ) 2 Other:
Phone: Fax: • . 'Plumbil,g PermitFees *' . jj �" . •
ubtl f D I ' '-� 0
CCB Lic. #:)5 �) '4, Plumb. Lic. #:37 G, p /3 Minimum Permit Fee S $72.o5ta0 $ $ �
Authorized P Residential Backflow Minimum Fee $36.25
j Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ g i J I
(Please print name) TOTAL PERMIT FEE _ $ / D ' , 5 I
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
f•
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' 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 _V,.alualjo.: Permit Fee: - 'k
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 • Q ty: ,Tree (ea) TOtaX 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 $37940 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
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 (Fiixtur9,Work Performed Comments regarding fixture work:
Fixture Type: Replace.,
Neev Moved hinting '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"
•
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./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:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
FROM : VARGA P &C FAX N0. Sep. 04 2003 07:45AM P1
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• CITY OP TIGARD
13125 S.W_ HALL BLVD,
TIGARD, OR 97225 RECEIVED
IMPORTANT PERMIT NOTICE SEP 0 4 2003
EURO PLUMBING INC CITY OF TIGARD
SE 172ND AVE SE BUILDING DIVISION
BORING, OR 97009
Plumbing Signature Form
Permit #: PLM2003r00457
Date Issued: 913103
Parcel: 15135CD -03301 •
Site Address: 11945 SW PACIFIC HWY 10a
Subdivision: HOFFARBER TRACTS NO.1
Bloch: Lot: 002
Jurisdiction: C-G
Zoning: 'SIG
Remarks: Connect one commercial sink to private sower. Espresso shop located In the
Safeway parking lot
Your company has been indicated as the plumbing contractor tor trts permit indicated above. In order for the
plumbing parmit to no valid please have the appropriate individual from your company sign below end return
Ihia Plumbing Signature Form prior to the start of tree work to the address above, ATfN: Building Division.
No plumbing inspections will bd authorized until thin completed tams is received
OWNED — PLUMBING CONTRACTOR:
TIGARD PROPERTIES INC EURO PLUMBING INC •
2105 SE OCHOGO ST 10669 SE 172ND AVE SE
MILWAUKIE, OR 97222 BORING, OR 97009
Phone #: Phone #: $
Reg #: PIN 37
LiC 1521130
AN INK SIGNATURE IS REQUIRED ON T IS FORM
Signature of Au red Plumber
if you have any questions, please cap 603,718.2433.
c •o 5'43 4098 f 96a •
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