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Permit C ITY OF TIGARD PLUMBING PERMIT PERMIT #: PLM2003 -00436 ��; - 13125 'DEVELOPMENT H O BMENg Tigard, ) 639 -4171 DATE ISSUED: 8/15/03 SITE ADDRESS: 13165 SW PACIFIC HWY PARCEL: 2S102CB -00303 SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: C -G BLOCK: LOT: 033 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; 2 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 0 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ' ft • Remarks: Repair 1 floor sink, add 1 floor sink. FEES • . ' Owner: Description Date . Amount POORMAN, JOHN AND MARTHA 14243 NW EVERGREEN ST [PLUMB] Permit Fee 8/15/03 $72.50 PORTLAND, OR 97229' . [TAX] 8% State Tax 8/15/03 . ' $5.80 Total ' $78.30 Phone : Contractor: MARXMEN PLUMBING INC 9665 SW 163RD AVE BEAVERTON,. OR 97007 REQUIRED INSPECTIONS Phone : 579 - 2200 Rough -in Insp Final Inspection Reg #: MET 00001112 _ ' LIC 102432 PLM ' 34 -161PB • • 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 Y Issued By: � Li /� Permittee Signature: '_0 Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ne t busi ess day ' • Building Fixtures Plumbing Permit A lica tion FOR OFFICE USE ONLY UA Received p /� Plumbin g n / Date/B : p /` V' U Permit No.: ( 800.3 -O 4 'T 3 6 City of Tigard fREPRIVED C Planning A .pro al Sewer DateBB : Permit No.: 13125 SW Hall Blvd. Plan Review Other 1 5 Tigard, Oregon 97223 AUG 2003 DateB : Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use bAn,�di� t� DateB : Case No.: Internet: www.ci.tigard.or.us OI Y OF u � ,� 1 Contact Juns.: 0 See Page 2 for 24 - hour Inspection Reque • . - Name/Method: Su • • lemental Information. TYPE OF WORK . . FEE* SCHEDULE (for special information use checklist) ❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total ❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) SFR (I) 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 LOC ION Fire sprinkler - sq. ft.: Page 2 Job site address: 1 j 1 (p C S,u,3 ,Ts:K iC O 03..'\ Site Utilities Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60 Drywell/leach line/trench drain 16.60 Project Name: A € it) I L ...S ' Footing drain (no. linear ft.) , Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 . Rain drain connector • 16.60 • Sanitary sewer (no. linear ft.) Page 2 • Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: Water service (no. linear ft.) Page 2 Fixture or Item • DESCRIPTION OF WORK Absorption valve 16.60 4C0 -P X ZxV•e..g Backflow preventer Page 2 • Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 ❑ PROPERTY OWNER I ❑ TENANT ' Ejectors/sump 16.60 Name: Expansion tank 16.60 Address: .i Fixture/sewer cap - 16.60 x% City /State /Zip: Floor drain/floor sink/hub i�t p(toed 2 . 16.60 4 r'3i Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 ❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60 Name: 1 Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: R drain (commercial) 16.60 Phone: Fax: Sin asin/lavatory 16.60 E -mail: 'I�'ub /shower /shower pan 16.60 CONTRACTOR 1 r Urinal 16.60 Business Name: pi A 12 X men cp l u m 6 r� s Water closet 16.60 Water heater 16.60 Address: q 6 Co S S.w , 1 423 Other: City /State /Zip: gm ye rtt u. Other: Phone: 5o3•S 74- ).261!1 Fax: S °7Q -27.0 ( Plumbing Permit Fees* CCB Lic. #: io.2�c Plumb. Lic. #: X4'1 I . Subtotal $ gq,Sd i Authorized 1 . (; - 22 t3 Residential B Minimum Fee • . 2 ? . 50 /0 Minimum Permit Fe .50 $ 3 Signature: , I � . Date: 8. -1C1 0, Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) $ .. Xd_. lease print name) TOTAL PERMIT FEE $ '� 60 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\PlmPemmitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • 1 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 - 1st 100' 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 additional $100.00 or fraction thereof, to and • Fixture or Item Qty. Fee (ea) Total 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 _q) ` l• �� « « 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 MachJRefrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory I - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor • Water Closet - Toilet Urinal Other Fixtures: - i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received �o3D Date Requested 1 AM PM BUP Location ,' 9/h � ' ) Gl� Suite MEC Contact Person /4(i /tea �i� h Ph ( ) 512 C5 PLM 3--9d /36 Contractor Ph ( ) SWR BUILDING Tenant/Owner )4 ELC Footing Foundation Access: ELC Ftg Drain /, G ELR Crawl Drain K Slab Inspec on Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm /6714 Susp'd Ceiling Roof Other: Final PASS PART FAIL Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Oth- : �ri::11► 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 ❑ Please call for rein • pection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date Inspector r Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL