Permit 1
CITY OF TIGARD
PLUMBING PERMIT
i� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00056
. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/1/2005
SITE ADDRESS: 13500 SW PACIFIC HY 15 PARCEL: 2S102CC -00500
W
SUBDIVISION: SHERWIN - WILLIAMS ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW 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: 5
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 133 ft
WATER CLOSETS: WATER LINE: 70 ft
DISHWASHERS: RAIN DRAIN: 90 ft
Remarks: Site utilities for new 5,000 sq ft retail store.
Owner:
FEES
13500 PACIFIC CORP BY CAP ADVISORS Description Date Amount
38345 TEN MILE RD STE 170
FARMINGTON HILLS, MI 48335 [PLUMB] Permit Fee 3/1/2005 $340.80
[PLMPLN] Plan Review 3/1/2005 $85.20
Phone : [TAX] 8% State Surchari 3/1/2005 $27.64
Total $453.64
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 - 0001 -0010 through OAR 952- 0001 -0100. You may obtain copies of these rules or irect questions to UNC by
calling (503) 246_A699.
Issued By: / , 0A) Permittee Signatur . /,G1G;
Call (503) 639 -4175 by 7:00 P.M. for an inspection the next 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.
Site Vtilities
Pluuibini Perm' on FOR OFFICE USE ONLY
City of Tigard 4 1 �OO� Received 4/
Permit I � s.�5�j
13125 SW Hall Blvd., Tigard, OR 9722a 1 1 Date/By: i
� Plan Review
Phone: 503.639.4171 Fax: 503.598.1 06 1 i e�y;A. .!W; ;1 , 4I Date/By: Z f 2 5 / 0 Other Permit No.:, rr 5
24- Hour Inspection Line: 503.639.4175 v / `
Internet: www.ci.tigard.or.us �� LE ---� Date Ready/By: Duns: 0 See Page 2 for
g cY GI)" �� Notified/Method: C IA - Supplemental Information
13 �V V0RK FEE *.' SCHEDULE
❑ New construction Demolition For special information use checklist
Description I Qty. I 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- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/ldtchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB. STTE INFORMATION AND LOCATION ' - '
• •• Site utilities
Job site address: ' b Sbt A L oy Catch basin or area drain v / aie 16.60 y3,0()
City/ State/ZIP: - j ,a 00p.„,, (, 7? 5 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: , r Footing drain (no. linear ft.: ) Page 2
1 `1.4 ,4iNS Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear . 40 4 Page 2
Storm sewer (no. linear ft.: to Page 2
Subdivision: Lot no.: Water service (no. linear ft i e2 ) Page 2
Fixture or item a57. $U
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
l?'f_ Wei L. l Ti f. S kD 2 /V E.ecJ 5 0D0 i d Backwater valve 16.60
R_ L ro2+___ Clothes washer 16.60
Dishwasher 16.60
['„PROPERTY OWNER „ I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name:
35c0 PAc-, rl G Costa A Y CA A J►60,Q6 Expansion tank 16.60
Address: 3_5(,) 51113 H i '`D 1-7.2) Fixture/sewer cap 16.60
City/ State/ZIP: ii A ) p j Mo ig 335-- Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT - Hose bib 16.60
r) 0 .PERSON
i Ice maker 16.60
Business name: /6 �J ' / > '���i+ (/ Ay' �� /J, yc� 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: ( ) �'N -7,x) . / Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
� � Urinal 16.60
CONTRACTOR W ; et c Water closet 16.60
Business name: y .e \ - \ r•k\/�� . a�q Water heater 16.60
Address: n S u, l 1 1 $ } A �, ‘--J Other:
City/ State/ZIP: V e 003- Subtotal /, 54 O
Minimum permit fee: $72.50
Phone: (lea ) e/ 4 • ' ( / Fax: ( ) Residential backflow minimum permit fee: $36.25 z
CCB Lie.: /a? cYse 7 Plumbing Lic. no.: fc/ J f 77, Plan review (25% of permit feel F61.20
State surcharge (8% of permit fee) 71
Authorized signature: TOTAL PERMIT FEE
Print name: Date: This permit application expires if a permit is not obtaiueu within
180 days after it has been accepted as complete.
• *Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Pennits\PLMU- 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 Footage:
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 i
7,201 and greater $309.00
Sewer - each additional 100' f 46.40 4 . 40
Water Service - 1st 100' 55.00 'T
Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: >Y ';` °` Peixmit Fee:;;:
Stone &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 Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device / 46.40 4.,4 $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
and including $50,000.00.
specially requested inspections - per hour 72.50
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:
•
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 Mach./Refrig. 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
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:\ BuiidingTermiu \PlM- PermitApp.doe 3/03
I
02/28/2005 15:26 FAX 5035981960 CITY OF TIGARD 0 001
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
PREMIER PLUMBING
20 SW 131ST AVE
BEAVERTON, OR 97005
Plumbing Signature Form
Permit #: PLM2005 -00056
Date Issued:
Parcel: 2S102CC -00500
Site Address: 13500 SW PACIFIC HWY 15 SHERWIN - WILLIAMS
Subdivision:
Block: Lot:
Jurisdiction: C -G
Zoning: TIG
Remarks: Site utilities for new 5,000 sq ft retail store.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for
the plumbing permit to be valid, please have the appropriate individual from your company sign below and
return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building
Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
13500 PACIFIC CORP BY CAP AL PREMIER PLUMBING
38345 TEN MILE RD STE 170 20 SW 131ST AVE
FARMINGTON HILLS, MI 48335 BEAVERTON, OR 97005
Phone #: Phone #: 503 -469 -8631
Reg #: LIC 124547
PLM 34 -318PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
Signatu of Authorized Plumber
If you have any questions, please call 503.718.2433.
I
CITY OF TIGARC
BUILDING DIVISION PERMIT #: PLM20000056
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 -4171 i° �u,� iiP. 311 2005
Inspection Requests (24 Hrs.): (503) 639 -4175 .._• Vi
INSPECTION WORKSHEET FOR DATE: PAGE:
5/10/2005 TIME: 7:16AM 76
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 13500 SW PACIFIC HWY 15 SHERWIN- VNIiMS TYPE OF USE:
PROJECT NAME: TIGARD MARKETPLACE
DESCRIPTION: SHERWIN- WILLIAMS PAINT STORE
Site utilities for new 5,000 sq ft retail store.
OWNER: PHONE #:
13500 PACIFIC CORP BY CAP ADVISORS,
CONTRACTOR: PREMIER PLUMBING PHONE # ' 503-469-8631
Inspection Request Scheduled For: Date: 5110!2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 006480-01 971 - 235-3910 Y
Corrections /Comments /Instructions: /9-/
'/"../
- .3 -ze — C q
/ ,
E: PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: , Date: G , Phone #: (503) 718-