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v CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00335
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/12/2008
PARCEL: 2S 102 BD -00500
SITE ADDRESS: 12705 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. LOT: 050 JURISDICTION: TIG
PROJECT: GENIE CAFE
Project Description: Installing 96 ft. of water line. For business in accessory building behind New York New York.
8/15/08 ADDED (1) backflow preventer.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 96 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
FARID ADRANGI
4289 ORCHARD WAY Description Date Amount
LAKE OSWEGO, OR 97035 [PLUMB] Permit Fee 8/12/2008 $72.50
[TAX] 12% State Surch 8/12/2008 $8.70
Phone : [PLUMB] Addl Permit 8/15/2008 $28.90
[TAX] 12% State Surch 8/15/2008 $3.47
Contractor: Total $113.57
THUMBS UP PLUMBING
208 NE 4TH ST
BATTLEGROUND, WA 98604 REQUIRED ITEMS AND REPORTS
Contact # : PRI 360 - 666 -3092
Reg #: LIC 171747
PLM PB196
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 or 1.800.332.2344.
Issued B _ `:i Permittee Signatur-
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
V454) ,, Buildin Fixtures FOR OFFICE USE ONLY
g
City of Tigard
Received , 4 _, �G(-f �`
IN g 1R Date/13y: , �a 11 Permit No.: • i _
a 13125 SW Hall Blvd., Tigard, O 23 1 � '
Plan Review
C . Phone: 503.639.4171 Fax: 503.598.19 Other Permit No.:
Inspection Line: 503.639.4175 l
QO Date/By: ``
T I G A R U GO n Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov ��""�� �`�p ` �`�* Notified/Method: * Supplemental Information
TYPE OF WO
RP ` 1.� '' '' : • FEE* SCHEDULE
•
❑ �`��` For special in ormntion use checklist
construction �' molition P I
Description I Qty. Ea. I Total
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- d 2- family dwelling ❑ ConunerciaUindustrial SFR (2) bath 350.00
Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. fl.) Page 2
4 D JOB SITE INFO ION AND LOCATION Site utilities
Job si� ddress: Peki. f'rC (-6AJ Catch basin or area drain 16.60
City/State /ZIP: 1 (7l142-F 6 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: 1 it-ter L.,1‘ IN � Footing drain (no. linear fl.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: ///c/(04/2 ie_ Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
• Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: / Page 2 Ss--
Fixture or item
• Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2 'Z p G
•1,9
13n re- of Ne ct) 04 46 r Lif ve • Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: 5-,,,-4 ru�� //�, Expansion tank 16.60
Address: �/% Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
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: Roof drain (commercial) 16.60
Phone: Sink/basin/lavatory 16.60
( ) Fax::( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: T tp Grp plconarivo $ ,2(lLCE Water heater 16.60
Address: zU a N€ ( sj ! Other:
: , / /� Subtotal 5
City/State/ZIP: 3f} f fie , r0 u� U4. c s-c o y` Minimum permit fee: $72.50
Phone: % O) 6,66 30, Fax: ( ) Residential backflow minimum permit fee: $36.25 "3,,
CCB Lic.: / 7 / 7 L(? Plumbing Lic. no.: 24/ 9, Plan review (25% of permit fee)
State surcharge (12% of permit fee) $, Zc)
TOTAL PERMIT FEE
Authorized signature: �� _ -✓✓ Q
Jtx011/ q/Q at , / V g / /ol /t�18/ u � �d tI
Print name:
S D ate: L This permit application expires if a permit is not obtai��cu w
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \Permits\PLMF- 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 - 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 55- 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
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: 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 (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities 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 Diagram I or Riser Dia
Drinking Fountain g •
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
- 4 „
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial •
- Industrial
Ice Mach./Refig. 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 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:
is Building \Permits\PLM•PermitApp.doc 12/27/06
CITY OF TIGARD , • .
BUILDING DIVISION PERMIT #:
PLM2000 00335
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639- 4171�.fll 8J12/2000
Inspection Requests (24 Hrs.): (503) 639 -4175
r- , INSPECTION WORKSHEET FOR DATE: 811512008 TIME: 7 OOAM PAGE: 14
iy 6
SITE ADDRESS: ..----p<11 OF WORK:
SUBDIVISION: ACIFIC HWY LOT #: TYPE OF USE:
NO.TIGARDVILLE ADDITION AMEND. 050
PROJECT NAME: ADRANGI
DESCRIPTION: Installing 96 ft. of water line. For business in accessory building behind New York New York.
r OWNER: ADRANGI, FARID PHONE #:
CONTRACTOR: THUMBS UP PLUMBING PHONE #: 360,666 -3092
( Inspection Request Scheduled For: Date: 8115J7008 Pour Time:
fi Code # Inspection Description Confirm # Contact # Message
330 Water service 074235 -01 360 -909 -8343 Y
Corrections /Comments /Instructions:
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,.rC 1 1 Date: 71 l‘l 6 Phone #: (503) 718-
CITY Of TIGARD . • • d
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1 BUILDING DIVISION PERMIT #: PLM200r00335
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8!12J2008
Phone: (503) 639 -4171 em
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
7.- INSPECTION WORKSHEET FOR DATE: I � 20 � TIME: 7:00AM PAGE: 13
SITE ADDRESS. ( PACI H11 CLASS OF WORK: •
SUBDIVISION: NO: FIi, AROVILLE AI)Dli ION AMEND. LOT #: Q50 TYPE OF USE:
PROJECT NAME: ADRANGI
DESCRIPTION: Installing 96 ft. of water line. For business in accessory building behind New York New York.
OWNER: ADRANGI, FARID PHONE #:
CONTRACTOR: THUMBS UP PLUMBING PHONE #:
360-666-3092
Inspection Request Scheduled For: Date: 8f15/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 074235.02 360-909-8343 N
Corrections/Comments/Instructions:
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: `► 1A ‘, 71-..Q., Date: ?) l.cl f 7) Phone #: (503) 718-
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: PLM2006 00335
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6i12f2008
Phone: (503) 639 -4171 A4.0
Inspection Requests (24 Hrs.): (503) 639 -4175 `'I �..
INSPECTION WORKSHEET FOR DATE 8/18/2008 TIME: 7:00AM PAGE: 8
SITE ADDRESS: 12705 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT # : TYPE OF USE:
NO.TIGARDVILLE ADDITION AMEND. 050
PROJECT NAME: GENIE CAFE
DESCRIPTION: Installing 96 ft. of water line. 8/15/08 ADDED (1) backflow preventer.
OWNER: ADRANGI, FARID PHONE #:
CONTRACTOR: THUMBS UP PLUMBING PHONE #: 360- 666 -3092
Inspection Request Scheduled For: t` , Date 8/18/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 07429901 360-909-8343 N
Corrections /Comments /Instructions:
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1$ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cji te1 -r ►A'1S - Date: V I7/ 6 ' Phone #: (503) 718-