Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2004 -00463
aeooreili DEVELOPMENT H BMEN9 Tigard, SERVICES 639 -4171 DATE ISSUED: 10/8/2004
SITE ADDRESS: 11945 SW PACIFIC HWY 200 PARCEL: 1S135DD -03301
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: B FLOOR DRAINS; 3 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of (3) 2" floor drains, (1) primer & (1) water heater.
FEES
Owner:
Description Date Amount
TIGARD PROPERTIES INC [PLUMB] Permit Fee 10/5/2004 $83.00
2106 SE MIL WA UKIE, OR 97222 OCO [TAX] 8% State Surchari 10/5/2004 $6.64
IL
Total $89.64
Phone:
Contractor:
ALBERTA PLUMBING
LEWIS TRANER
PO BOX 55031 REQUIRED INSPECTIONS
PORTLAND, OR 97238
Phone : 503 - 331 - 0657 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
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued :y: . 1 ���,�! � , Permittee Signature:
alP" -
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next usiness day
Building Fixtures
Plum Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit No.: ,
131 g
SW Hall Blvd., Tigard, OR 97223 /iHnt���:�;�k Date/By: /d J O q L DO t�3
Plan Review �
Phone: 503.639.4171 Fax: 503.598.1960 f� Other Permit No Date/By: W b602�
24- Hour Inspection Line: 503.639.4175 L 1 Date Ready/By: "Iu ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: i /Uy.„ Supplemental Information
TYPE OF WORK - . .. i., „c FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
12/Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION _ _, SFR (1) bath 249.20
❑ 1- and 2- family dwelling , Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
• JOB SITE INFORMATION AND, LOCATION Site utilities
Job site address: f � 4.0 5( ) a, IC i • c # Catch basin or area drain 16.60
City/ State/ZIP: "r °el ✓� v Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: jatit- go Gy ii Ai Footing drain (no. linear ft.: ) Page 2
C Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) ' Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: /d /c65 b -• 03 510/ A
�
Fixture or
n n valve Absorption 16.60
DESCRIPTION OF WORK L Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ O ER - ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: j`'i Li-- Expansion tank 16.60
Address: ! Fixture/sewer cap 16.60
City/State/ZIP: oor drai floor sink/hub af 16.60 .99. go
Phone: ( ) Fax: ( ) isposal 16.60
- ® APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: k u. try, S `ti -eit.anN q.t. Tka L (c
Interceptor /grease trap 16.60
Contact name: bgtko IQLLM. Medical gas (value: $ ) Page 2
Address: Co ( 33 1../G ,rc 8 A U D Primer + 16.60 /4.66
City/ State/ZIP: p-4 Q � 72 / 3 Roof drain (commercial) . 16.60
Phone: (s 3 ) 3 3' 3 7 2...L I Fax: : ( ) Sink /basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
. r CONTRACTOR . • ` .. • Water closet 16.60
if /1
Business name: -C ,�I /1'")C, l \ fir Water heater p 16.60 1�O ,
Address: J ' . t $r. 6 ' � a 4 -t�
1 'f Other:
City/S l - I Subtotal
�t1 1✓� -t�vr �a ( t��
I d 1 e Minimum permit fee: $72.50 -6 J Q 00
Phone: (2 3) 7 3( ot 7 Fax: ( ) c tizt1 4 7 J 11 D Residential backflow minimum permit fee: $36.25 •
CCB Lic.: Q /G7f � Plumbing Lic. no.: 7,, ( 707 _ PR Plan dr (25% of permit fee) State surcharge (8% of permit fee) e,./ .620
Authorized signature:
TOTAL PERMIT FEE crt •(0 V
Print name: Date: Qr . .Z I _04f This permit application expires if a permit is not obtained within
l� 1 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Buirding \Perrnits\PLMF- PernitApp.doc 12/03 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
•
Fee Schedule: Residential Fire Suppression Systems:
SiteUtilities.
Qty. Fee (ea) - Total Square Footage: - �`� :�.PerniitFee:' -
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 .
Storm & Rain Drain - 1st 100' 55.00 Valuation: . k. Permit Fee:'..
$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
Fixture or Item Qty. Fee (ea)' Total additional $100.00 or fraction thereof, to and
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
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 (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing capped Comments regarding fixture work:
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
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice MachiRefrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink -Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
BBuildingTermits \PlM- PemtitApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested ° �° AM PM BUP
Location / 1 93 .ice zoo MEC
Contact Person Ph ( ) g30-9vev 7 PLMaCe)g - 6 4 471 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner � '2762,c2, ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors L
Ext.Sheath/Shear '
Int Sheath/Shear --- __—
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING _
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
CHANICAL
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 E Please call for reinspection RE: Ell Unable to inspect — no access
Fire Supply Line
ADA r
Approach/Sidewalk Date l� Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL