Permit •
CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00262
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/20/2007
PARCEL: 2S102AA -00602
SITE ADDRESS: 11960 SW PACIFIC HWY ZONING: CBD
SUBDIVISION: TIGARD HIGHWAY TRACTS LOT: 010 JURISDICTION: TIG
PROJECT: KAUFMAN STREAMBORN & CO
Project Description: Relocate (1) breakroom sink. No change to EDU's.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M 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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
AMAN ENTERPRISES, INC
PO BOX 19089 Description Date Amount
PORTLAND, OR 97280 [PLUMB] Permit Fee 6/20/2007 $72.50
[TAX] 8% State Surcha 6/20/2007 $5.80
Phone : Total $78.30
Contractor:
REAMECH
30330 SW GRABEL RD.
HILLSBORO, OR 97124 • REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 969 -6252
FAX 503- 640 -9344
Reg #: LIC 148437
PLM 34 -389PB •
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 • - t questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
of ",
I sued By: OLLth 1 / Permittee Signature: %
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building:Fixtures FOR OFFICE USE ONLY
Received /
City of Tigard Date/By: ` Q OK 7 Permit No.: � 7 -tV 2-
111 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.:
T I G A R I� Inspection Line: 503.639.4175 Date ReadyBy: la See Page 2 for
Internet: www.tigard - or.gov Notified/Method: <r Lis Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
V 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 X1 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: i 1 ok c. 0 S L.l ? C c..- 4ti✓-i Catch basin or area drain 16.60
City /State /ZIP: 'ri Q c..�,r-t� OK. 5 _7 2 Z) Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: J I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: 16.60
Manholes
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
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
� t- O-r•.
, k < - Backwater valve 16.60
-jJ- t N ' (1) , - I I 4) , Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) I Fa ( ) Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP:
drain (commercial) 16.60 ( Si asin/lavatory I 16.60 ` 6o
Phone: ( ) Fax: ( ) Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: �2C31\kQ+ .t1.-.c Water heater 16.60
Address: 3o I 33 S G Y?k l V._04 O
a! Subtotal
City/State /ZIP: t-,; \lSv,, 01,k_ 9 "I (2-3
Minimum permit fee: $72.50
Phone: I Q3 ) ) L 9 �O Z Fax: (5 ) (.4 0 ' 53 4 9 Residential backflow minimum permit fee: $36.25 --7, ..'
CCB Lic.: 148437 Plumbing Lic. no. :34 -,789 pe Plan review (25 % of permit fee)
� �
State surcharge (8% of permit fee) 5 S
Authorized signature: rc.� TOTAL PERMIT FEE 7g. 50
Print name: i C.v�kQ.( Kest I Date: Cp -2.0 - o / This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \Permits\PLMP- PermitApp.doc 12/27/06 440-4616T(10 /02/COM/WEB)
1
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 - I st 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
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
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
•
Fixture Work: • Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result 'in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by re) Work Performed • greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer
Previous ap Added Existing New exterior plumbing site u
1:3 tilities for any complex structure -
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal -Commercial
- industrial •
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory •
- Bradley *Note: If the fixture work under this permit results in an
- Commercial i it t increase of sewer EDUs, a sewer permit will be issued and
- Service • fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued. .
Washer - Clothes
•
Water Extractor
Water Closet - Toilet
Urinal .
Other Fixtures:
i:\Building\Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00262
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/20/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/2/2007 TIME: 7:00AM PAGE: 21
SITE ADDRESS: 11960 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 010 TYPE OF USE:
PROJECT NAME: KAUFMAN STREAMBORN & CO
DESCRIPTION: Relocate (1) breakroom sink. No change to EDU's.
OWNER: AMAN ENTERPRISES, INC, PHONE #:
CONTRACTOR: RF AMECH PHONE #: 503 - 969 - 6252
Inspection Request Scheduled For: Date: 8/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 053275-01 503-969 -6252 N
Corrections/Comments/Instructions:
(a4-eciLL-71 t
.PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ` \14 """ Date: I2 tor) Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2001 -00262
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/20/2007
Phone: (503) 639 -4171 � »," III
Inspection Requests (24 Hrs.): (503) 639 -4175 VII
INSPECTION WORKSHEET FOR DATE: 6/28/2007 TIME: 7:01AM PAGE: 30
I SITE ADDRESS: 11960 SW PACIFIC HWY CLASS OF WORK:
' SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 010 TYPE OF USE:
PROJECT NAME: KAUFMAN STREAMBORN & CO
DESCRIPTION: Relocate (1) breakroom sink. No change to EDU's.
OWNER: AMAN ENTERPRISES, INC, PHONE #:
CONTRACTOR: REAMECH PHONE #: 503- 969 -6252
Inspection Request Scheduled For: Date: 6128/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 051131 -01 503-969-6252 Y
Corrections/Comments/Instructions:
LI 50
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
�P_ cc Inspector: 1 K Date: 2q k 7 Phone #: (503) 718- 2 7J)