Permit CITY TIGARD PLUMBING PERMIT
M A DEVELOPMENT SERVICES PERMIT #: PLM2004 -00490
Ail SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/4/2004
SITE ADDRESS: 11945 SW PACIFIC HWY 248 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; 2 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 4
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: T.I.: (1) lay & (1) water closet capped. Add (1) 2 "floor drain, (1) refrig. drain, (2) sinks and (1) primer.
FEES
Owner:
Description Date Amount
TIGARD PROPERTIES INC
2106 SE OCHOCO ST [PLUMB] Permit Fee 11/4/2004 $132.80
MILWAUKIE, OR 97222 [PLMPLN] Plan Review 11/4/2004 $33.20
[TAX] 8% State Surchari 11/4/2004 $10.62
Phone : Total $176.62
Contractor:
ALDER PLUMBING INC
2773 N CLARK CT
CORNELIUS, OR 97113 REQUIRED INSPECTIONS
Phone : 503 - 515 - 5920 Underfloor /Underslab
Top -out Insp
Reg #: LIC 153699 Final Inspection
PLM 34 -411 PB
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 -- •99.
Iss -d By: Permittee Signature: v
Cto
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the xt business day
Plumbing Permit A 1 L • t,11 IL!) . IVED FOR OFFICE USE ONLY f.
City of Tigard Received (� /�,�/ -a) �yy
g Date/By: / � 0 I PemritNo �`\ / y9O
13125 SW Hall Blvd., Tigard, OR 97223 rt S (1, B 200 4 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 LI . Oyntip iA Date/By: / //3` f o y �1A/ Other Permit No /� 4I -c,? k ,
24- Hour Inspection Line: 503.639.4175 �..��, r • J `"
Internet: www.ci.tigard.or.us G1T of F TI A :' " -� Date Ready/By: See Page 2 for
olvisiO N Notified/Method: � '176- S Supplemental Information
TYP� ' W _ FE . SCHEDULE . ..
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
10 Addition/alteration /replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
' CATEGORY OF CONSTRUCTION ` ' ' .: r. SFR (1) bath 249.20
❑ 1- and 2- family dwelling 0 Commercial/industrial SFR (2) bath . 350.00
El Accessory building ID Multi-family SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
❑ Ot her:
Fire sprinkler ( sq. ft.) Page 2
. - ` ' . JOB SITE INFORMATION AND LOCATION , c ° Site utilities
Job site address: i g qij Ste, pi crvie 14 rr✓y Catch basin or area drain 16.60
City/State/ZIP: . j d z t r 0 1 2,.. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: ! yp Project name: ] Si M kP_K Footing drain (no. linear ft.: ) Page 2
` Manufactured home utilities 110.00
Cross street/directions to job site: WALL @i IL U D
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
6 / 3 �a .. O 2 � Fixture or item
Tax map /parcel no.: J
Absorption valve 16.60
' DESCRIPTION OF WORK Backflow preventer Page 2
/kip a N 11..E Pa-vi/(le/ oksost. Ara P Backwater valve 16.60
C. t1/44 Pe - o fit.) or aS 1 1J it 014 Clothes washer 16.60
/ Dishwasher 16.60
'❑ PROPERTY OWNER ' I 0 TENANT Dunking fountain 16.60
Ejectors /sump 16.60
Name: 7 �• w i S 0 04 L,X e'w Expansion tank 16.60
Address: e4- Sir C it,l(+ rA s P IL i4 g 1-v1) Fixture/sewer cap /a 16.60
City/State/ZIP: pQ +2 a e v , o p. . q .3. 24, Floor drain/floor sink/hub a :0 i 16.60
Phone: (5o ) 'J ,,. '. , 2 . . . 9 11 3 Fax: ( ) ??_p - 3- y y Garbage disposal 16.60
❑ TXasrG12 0 Hose bib 16.60
APPLICAN
0 PERSON
Ice maker ., 1 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer , 4 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax :: ( ) Sink/basin/lavatory ,- 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: •q L. Q PLQ M 4li. t,) [a 11.1 C . Water heater 16.60
Address: a 7-1, A i C r Other:
City/State/ZIP: LO (LN 6 J L 0 ra , 6141 1 3 _ Subtotal �j�, 6'0 Minimum permit fee: $72.50 �
" Phone: (bps) 5 16 .- Fax: (c,-03. ) 6 36 .5 Residential backflow minimum permit fee: $36.25
N.
CCB Lic.: r 556- 4 Plumbing Lic. no.: 3z - ii ii p& Plan review (25% of permit fee) r3S
t' State surcharge (8% of permit fee)
Authorized signature: Q (�,� //Pot"- OS
K,
"�� - d' TOTAL PERMIT FEE
Print name: 1%.34 Qa tj ` tav r t _ I Date: fVi/Q470if This permit application expires if a permit is not obtained within
�`�V 180 days after it has been accepted as complete.
*Fee ethg set by Tri-County Building Industry Service Board.
i:\ Building \Permits\PLM- PermitApp.doc 17/03 4404616T(10/02/COM/WEB) / 2° 7S
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site'Utilities 'Q Fee (ea), - Total Square Footage: r :, 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
Storm & Rain Drain - 1st 100' 55.00 Valuation: f 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
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
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"
-4"
Car Wash Drain •
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice MachiRefrig. Drains increase of sewer EDUs, a sewer permit will be issued and
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 I x Quantity Total
- Bradley
- Commercial Isometric or riser diagram is required if fixture quantity
I
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet x Plan review is required if fixture quantity total is >9.
,Urinal
Other Fixtures:
is Buiiding \Pemtits\PLM- PcrmitApp.doc 3/03
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: PLM2004 -00490
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 11/4/2004
Phone: (503) 639 -4171 falt Inspection Requests (24 Hrs.): (503) 639 -4175 -_..
INSPECTION WORKSHEET FOR DATE: 5/13/2005 TIME: 7 :12AM PAGE: 28 ,
SITE ADDRESS: 11945 SW PACIFIC HWY 248 CLASS OF WORK:
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT #: 002 TYPE OF USE:
PROJECT NAME: FISH MARKET
DESCRIPTION: T.I.: (1) lay & (1) water closet capped. Add (1) 2 "floor drain, (1) refrig. drain, (2) sinks and (1) primer.
11/17/04, ADDING (1) 2" FLOOR SINK & (1) HAND SINK.
OWNER: TIGARD PROPERTIES INC, PHONE #:
CONTRACTOR: ALDER PLUMBING INC PHONE #: 503 - 515 - 5920
Inspection Request Scheduled For: Date: 5/13/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 006833-01 503-515-5920 N
Corrections /Comments/ Instructions:
/
/ i
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: D/ Date S Phone #: (503) 718 -