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Permit C ITY OF TIGARD PLUMBING PERMIT PERMIT #: PLM2003 -00362 *01 • DEVELOPMENT SERVICES DATE ISSUED: 7/23/03 13125 SW Hall Blv Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 11765 SW PACIFIC HWY PARCEL: 1S136CC -00100 SUBDIVISION: ZONING: C -P BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: 2 GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 1 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Cap 10 fixtures and add (2) urinals. FEES Owner: Description Date Amount WORLDWIDE REAL ESTATE GENERAL MOTORS CORP. [PLUMB] Permit Fee 7/23/03 $72.50 DETROIT, MI 48202 [TAX] 8% State Tax 7/23/03 $5.80 Total $78.30 Phone : Contractor: RH KUNSELMAN PLUMBING 15121 NE CLACKAMAS ST. PORTLAND, OR 97230 REQUIRED INSPECTIONS Phone : 5O3 - 262 - 8337 Rough -in Insp Final Inspection Reg #: LIC 154054 PLM 26 -365PB 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. 4 _ 40 Permittee Signature: `, ✓ � Call (503) 639 -4175 by 7:00 P.M. for an inspection needed e next business day Building Fixtures Plumbing Permit Application FOR OFFICE USE ONLY Received[ Plumbing �>L�� '� y � �� Se HEC I �� Date/By: 7 �S -03 �7P} Pe No.:1 r�` City of Tigard t ® Planning Approval Sewer Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Jut- 2 3 2003 Date/By: Permit No O , 3 6o 06 , Phone: 503 -639 -4171 960 Post - Review Land Use Y I A /�i� u�1p R' I ? i � Contac t Case No.: ® Internet: www.ci.tigatl(gl� r! I Contac Juris.: See Page 2 for 24 -hour Inspection Request: 5 U3 =b4 -"" Name/Method: -r e " .j Supplemental Information. TYPE OF WORK FEE* SCHEDULE (for special information use checklist) New construction is Demolition Description I Qty. I Fee(ea.) I Total I Addition/alteration /replacement ❑ Other: New 1- & 2- family dwellings CATEGORY OF C ON TRUCTION (includes 100 ft. for each utility 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 SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2 Job site address: //]� /r m/ f. 4 e., `1 L Site Utilities Suite #: Bldg./Apt.tp Catch basin/area drain 16.60 DryweIUleach line/trench drain 16.60 Project Name: 0_ e __, ejact h�L. Footing drain (no. linear ft.) Page 2 Cross street/Directions job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 • Sanitary sewer (no. linear ft.) Page 2 _ Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Water service (no. linear ft.) Page 2 Tax map /parcel #: Fixture or Item DESCRIPTION OF WORK Absorption valve 16.60 Z 0-Pc D� X � ,V ' CJ� Backflow preventer Page 2 5 INt-i 7 Backwater valve 16.60 AW ^„L a It � F (� Clothes washer 16.60 L Dishwasher 16.60 Drinking fountain 16.60 ❑ PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60 Name: W ma vi tbe, DU& Vial WI i onks Ws, Expansion tank 16.60 Address: Q� " eFixiur - . '� d 16.60 y Cit /State /Zi '( y1/1 Il 4V t-u o or drain/floor sink/hub 16.60 p �4A'1 l& Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 ❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60 Name: f( [4405 S V'L % t >, l.- Interceptor /grease trap 16.60 Address: [ 5 ( 2 ■ I r S� Medical gas - value: $ Page 2 nU � Primer 16.60 City /State /Zip: I'q wl Q�. 7a-,lJ (7 Roof drain (commercial) 16.60 Phone: C h -4 Z 43 5 , I Fax: 913-)5 3 -)5 7--(oL 7 Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower. pan 16.60 CONTRACTOR 1 Urinal ,. 16.60 Water closet 16.60 Business Name: 4 5 ,, 4.1. GilOolic Water heater 16.60 Address: Other: City /State /Zip: Other: Phone: 2-3-(9< Fax: . _) g 0'''l Plumbing Permit Fees* Subtotal $ CCB Lic. ( cif- Plumb. Lic. #2 ,- 3 7 Minimum Permit Fee $72.50 $ Authorized 7 9 L ? Residential Backflow Minimum Fee $36.25 io. �� Signature Date: () f GJ Plan Review (25% of Permit Fee) $ g� ft 14L4 , sC-It State Surcharge (8% of Permit Fee) $ ,5 (Please print name) TOTAL PERMIT FEE $ '' 0 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 !a-3 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 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) T otal 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" -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./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 • Accumulative Sewer Tally Tenant Name: dit bible Church This SWRI3 none required Site Address: 11765 SW Pacific Hwy. This PLM# 2003 -00362 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 Dr 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 0 0 0 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 0 0 0 - Service 3 0 0 0 0 0 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 2 12 0 -2 • -12 . Urinal 6 0 8 48 2 12 -6 -36 Previous EDU Count 12.3 196.8 196.8 Capped EDU Credit 0 TOTALS 0 196.8 10 60 2 12 -8 148.8 Current Fixture Value 148.8 divided by 16 = 9.3 Current EDU 1 EDU = $ 2,400 Previous Fixture Value 196.8 divided by 16 = 12.3 Previous EDU Change -48 divided by 16 = -3.0 over (under) $ (7,200.00) Enter EDU Change Here -3 HISTORY 12.3 EDU's per Jaime. PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# Name: )et, �z4,u- h- Date: ......,73-e..2 3 Signature of person that calculated this tally sheet and date perfromed Is required CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested AM M BUP S r Suite MEC Location � ��t- cc-c1 Contact Person / YLJ Ph ( ) � / — '+0 5 7 PLM �P Contractor Ph ( ) SWR BUILDING Tenant/Owner 6 6-i 8c,Gt 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 r; t` Pt CG l \ o J-601 e u-yo Ic -koi Fire Sp ..;s1#6 / - Fire Sprinkler ° 4^ � (" '9 4 �b g ✓. Q n? kt...) Fire Alarm Susp'd Ceiling Roof Other: Final PASS • RT F P Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PART FAIL ME ANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final fl Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE LI Please call for reinspection RE: ble to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date r ! i c 3 Inspector - o " Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested / 3 6 AM BUP Location / � ' 7 (o S Suite ' / MEC F/ T Contact Person � ✓t Ph ( ) 0 / 40S7 PLM 3 -0.03 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access � G- M 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 PLUMBING Post & Beam • Under er Slab W9tl.�Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Fi PAS 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 111 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: 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 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST Received Date Re_,. ested AM M BUP Location _ _ Suite MEC Contact Contact Person r 3 / Ph ( ) '` o — d 5 7110 3_ 0,9 3 6 Contractor /� � Ph ( ) SWR BUILDING Tenant/Owner £ 0- ELC Footing ELC Foundation 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 • - (c PART FAIL I BING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: Final PASS PART FAIL MECHANICAL 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: Unable to inspect — no access Fire Supply Line ADA Date I(24(0 3 I Inspector Ext Approach/Sidewalk P Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL