Permit C ITY OF TIGARD PLUMBING PERMIT
A DEVELOPMENT SERVICES PERMIT #: PLM2005 -00202
,. DATE ISSUED: 5/11/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 102CC -00500
SITE ADDRESS: 13500 SW PACIFIC HWY 15 ZONING: C -G
SUBDIVISION: SKIARAMININFIKIEJAMS10E LOT: JURISDICTION: TIG
Project Description: Plumbing building fixtures. Other fixture: 1 drinking fountain.
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
13500 PACIFIC CORP BY CAP ADVISORS Description Date Amount
38345 TEN MILE RD STE 170
FARMINGTON HILLS, MI 48335 [PLUMB] Permit Fee 5/11/2005 $116.20
[TAX] 8% State Surchart 5/11/2005 $9.29
Phone : Total $125.49
Contractor:
PREMIER PLUMBING
20 SW 131ST AVE REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97005
Phone : 503 469 - 8631
Reg #: LIC 124547
PLM 34 - 318PB
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 -000 I • rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 03- 246 -66•`9 o 8 1- 332 -2344.
Issue. By: k � LI / /� � i 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.
Building Fixtures c.S jpae.c.. -UOSoo
Plumbing Permit A pp
FOR OFFICE USE ONLY
_I! �• •
EIVii:' Received
City of Tigard DateBy::�l t/O 131'5 Permit No.��„� 9005 „ ,GOB --
I
13125 SW Hall Blvd., Tigard, OR 97223 I Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 a.nd: ,� Other Permit No ,
'SAY 11 o�� Date/By:
. - ` -- • ...CIO � 1 4.
24- Hour Inspection Line: 503.639.4175 er' Date Ready/By: Jurist ® See Page 2 for
Internet: www.ci.tigard.or.us
CITY ®' TIC -4. Notified/M �
ethod: ‘ Supplemental Information
.. i i f e F r _ r i • r _ FEE *, SCHEDULE
,rob ` =w construction • 1 emo itio
• \ For special in ormation use checklist.
Description Qty. Ea. 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- and 2- family dwelling r - -mmercial/industrial m 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 LOCATIO Site utilities
Job site address: S-00 ,. (t A. > > „i _ L I r Catch basin or area drain 16.60
City/ State/ZIP: 41 . Drywell, leach line, or trench drain ■ 16.60
Suite/bldg. /apt. no.: Project name: `' Footing drain (no. linear ft.: ) Page 2
A' 1 t A`._: Manufactured home utilities 110.00
Cross street/directions to job site:
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
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
A ' 1 � i flak a 1l S Backwater valve 16.60
I - / j IM Clothes washer -■ 16.60
CA�A . Dishwasher /- 16.60
I� ''= Dishwasher _
Drinking fountain 1 16.60
W
: •. ❑'PROPERTY OWNER ' ��� ❑ TENANT
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: (. ) Fax ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
^ Ice maker 16.60
Business name: 1°1M1� DLA. 1 =C- _ . Interceptor /grease trap 16.60
Contact name:( (.1 1 L I V tap �,.•e)ei L. j Medical gas (value: $ ) Page 2
Address: 0-y ' \.�� `g-•i- Primer 16.60
City/State/ZIP: ( a _A Roof drain (commercial) _ 16.60
Phoned , _ ► a io% I F. • too - Q �
--. Ilk ink/basin/lava ory MI 16.60
, ub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet Q 16.60
Business name: S ( e Water heater r 16.60
Address: Other:
City/State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 I I ( , -O
CCB Lie.: r- P ■ e lumbing Lic. no.:3�- l c# 1 Plan review (25% of permit fee)
`�~�' 1 State surcharge (8% of permit fee) Q Q.
� 4 i
Authorized signatur /, ���� � TOTAL PERMIT FEE ,
Print name: CArre r 1 11 A D ate: C �( U s This permit application expires if a permit is not obtained within
5 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\BuildingWermits\PLMF-PermitApp.doc 12/03 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total , Square Foot age: ' 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 F ee: : ` ;:••...
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: Lw
Are you capping, moving or replacing existing fixtures? If 5 n /
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees * .
Quantity by (Fixture) Work Performed I
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 increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
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
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ Bui lding\Permits\PLM- PemutApp.doc 3/03
CITY OF TIGARD . ,r
I BUILDING DIVISION PERMIT #: PLM2005-00202
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/11/2005
Phone: (503) 639 -4171 Ili'`
Inspection Requests (24 Hrs.): (503) 639 -4175 - �° '' r'41h `:I
INSPECTION WORKSHEET FOR DATE: 6/12/2005 TIME: 7 :08AM PAGE: 50
SITE ADDRESS: 13500 SW PACIFIC HWY 15 SHERWIN- WILLIAMS CLASS OF WORK:
SUBDIVISION: TIGARD MARKETPLACE LOT #: TYPE OF USE:
PROJECT NAME: SHERWIN- WLUAMS PAINT STORE
DESCRIPTION: Plumbing building fixtures. Other fixture: 1 drinking fountain.
OWNER: 13500 PACIFIC CORP BY CAP ADVISORS, PHONE #:
CONTRACTOR: PREMIER PLUMBING PHONE #: 503 - 469 -8631
Inspection Request Scheduled For: Date: 5/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 . Plumbing final 006696 -01 971- 235.3910 N
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date : Phone #: (503) 718-