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Permit Re-er CITY TIGARD PLUMBING PERMIT P ERMIT #: PLM2002 -00358 e DEVELOPMENT SERVICES DATE ISSUED: 10/4/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13727 SW PACIFIC HWY 100 PARCEL: 2S103DD -00400 SUBDIVISION: ZONING: BLOCK: LOT: JURISDICTION: CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: M FLOOR DRAINS; 3 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 3 URINALS: GREASE TRAPS: 1 LAVATORIES: OTHER FIXTURES: 4 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: 1 RAIN DRAIN: ft Remarks: Kitchen only: 3 floor sinks, 1 dishwasher, 1 ice machine, 2 sinks, 1 mop sink, 1 grease trap, other fixtures 3 primers and 1 backflow preventer. FEES Owner: • Description Date Amount WILSON'S TIGARD RETAIL CENTER BY BOMCC ESCROW ADMINISTRATION [PLUMB] Permit Fee 10/4/02 $229.00 TX 1 -2495 [PLUMB] Permit Fee 10/4/02 $0.00 DALLAS, TX 75201 [TAX] 8% State Tax 10/4/02 $18.32 [TAX] 8% State Tax 10/4/02 $0.00 Phone 1: [PLMPLN] Plan Review 10/4/02 $57.25 Contractor: [ PLMPLN] Plan Review 10/4/02 $0.00 (additional fees not shown here) AKITA PLUMBING 3550 SW 178TH Total $322.50 BEAVERTON, OR 97006 REQUIRED INSPECTIONS Phone 1: 503 Top -out Insp RP /Backflow Preventer Reg #: LIC 151026 Final Inspection PLM 34 -404PB 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 Issued By: / Permittee Signature: L_ l Call (503) ;39 -4175 by 7:00 P.M. for an inspection needed the next business day r ■6 faL°(—' J - 171 C ITY OF TIGARD PLUMBING PERMIT PERMIT #: PLM2002 -00358 ��;� DEVELOPMENT SERVICES DATE ISSUED: 10/4/02 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 13727 SW PACIFIC HY 100 PARCEL: 2S103DD -00400 W SUBDIVISION: ZONING: BLOCK: LOT: JURISDICTION: CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM . WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: M FLOOR DRAINS; 3 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 3 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 4 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: 1 RAIN DRAIN: ft Remarks: Kitchen only: 3 floor sinks, 1 dishwasher, 1 ice machine, 2 sinks, 1 mop sink, other fixtures 3 primers and 1 backflow preventer. FEES Owner: Description Date Amount WILSON'S TIGARD RETAIL CENTER BY BOMCC ESCROW ADMINISTRATION [PLUMB] Permit Fee 10/4/02 $229.00 TX1 -2495 [PLUMB] Permit Fee 10/4/02 $0.00 DALLAS, TX 75201 [TAX] 8% State Tax 10/4/02 $18.32 [TAX] 8% State Tax 10/4/02 $0.00 Phone 1: [PLMPLN] Plan Review 10/4/02 $57.25 Contractor: [ PLMPLN] Plan Review 10/4/02 $0.00 AKITA PLUMBING Total $304.57 3550 SW 178TH BEAVERTON, OR 97006 REQUIRED INSPECTIONS Phone 1: 503 - 642 - 7776 Top -out Insp RP /Backflow Preventer Reg #: LIC 151026 Final Inspection PLM 34 -404PB 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 Issued By: — Permittee Signature: �y�j . ..1110 . Call (503 639 -4175 by 7:00 P.M. for an inspection needed the next business day _ r Building Fixtures _ oa D.�.. Plumbing Permit Application OFFICE USE ONLY Date received: �. Permit no.: I, _ o _ - 'F.) 4 ''• City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: : • .� Receipt no.: Land use approval: Case file no.: Payment type: • TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory J Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: : JOB SITE INFORMATION ` ., FEE SCHEDULE (for special information use 'checklist) Job address: /3727 SW Mo,tiz, 1, - /015 •. Description Qty. Fee(ea.) Total • Bldg. no.: Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: 2 2O , rlij/ arevr, 1 SFR (1) bath Lot: (Block: I Subdivision: SFR (2) bath Project name: 'DA_ iAz6",9pp gig S' SFR (3) bath City /county: L olds N I ZIP: g7ZZ3 Each additional bath/kitchen Description and location of work on premises: Site utilities: 7 4 ti / Cd>,9ti ( C i1 Catch basin/area drain Est. date of completion/inspection: Drywells /leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: ` Y 4. � 1 N #-1 ' ' Manholes Address: 3 s5 ip 5(j / Rain drain connector City: 1 Qwst 0 _ State: Cf ZIP:' 7006 Sanitary sewer (no. lin. ft.) Phonetg t(1.7 7 70, Fax: �c/ ti`I E -mail: Storm sewer (no. lin. ft.) CCB .no.: / 5 f 0 4.. ( 7 ^_ Plumb. bus. reg. no: 2. �i- Y 0 yp� Water service (no. lin. ft.) • City /metro lic. no.: 12.2_0 � _ Fixture or item: • Contractor's representative signature , . l � Back valve Back flow preventer A Print name: ' , i , Q . , , Date: 9-0W Backwater valve :,,,:` CONTACT PERSON Basins /lavatory Clothes washer Name: -rDV'41 1/44.t10441 Dishwasher _I Address: /0 J? ("O. a )p Drinking fountain(s) City: dg,tiv,14„rW I S te:ept I ZIP: xZj 7S . Ejectors /sump Phone; ;S Fax: E -mail: Expansion tank , . OWNER Fixture /sewer • e — Name (print): `vow l f Ma y Floor drain floor sink ub *- I t / Garbage di , • sa Mailing address: 76 7 Z OA o. Ito ) Hose bibb City: d eoafj , v .- ) I State?" I ZIP:7711 7f Ice maker i . Phone: sta- lZq. j I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. t1` s), basin(s), lays(s) //p/9 Sa r Owner's signature: Date: _ ump ENGINEER Tubs /shower /shower pan • , Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: • Phone: Fax: E -mail: Total credit cards, please call jurisdiction for more information. Plan Minimum fee $ % . Not all jurisdictions accept p jurisdiction N otice: This permit application Plan review (at %) $ = = = i> ❑ Visa ❑ MasterCard expires if a permit is not obtained a / Credit card number: / / within 180 days after it has been State surcharge (8%) $ Expires TOTAL $ 30 '1 5 7 Name of cardholder as shown on credit card accepted as complete. Cardholder signature Amount 440 -4616 (6/00 /COM) PLUMBING PERMIT FEES: PRICE TOTAL New 1 and 2- family dwellings only: FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures In PRICE TOTAL Sink al- 16.60 33. the dwelling and the first100 ft. QTY (ea) AMOUNT Lavatory 16.60 for each utility connection) ry One (1) bath $249.20 Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00 Shower Only 16.60 Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher , / 16.60 /L , (j PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16 Washing Machine 16.60 Floor Drain/Floor Sink T?, - 3 16.60 `- ird 16.60 PLEASE COMPLETE: 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory Tub or Tub /Shower Hose Bibs 16.60 Combination - Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Urinal Other Fixtures (Specify) 16.60 Dishwasher 1( /Yi I4C14-1 06 I I to, iD Garbage Disposal D 1 5/A./14- J 16 10 d Laundry Room Tray O eY- tKO Washing Machine _ FloorDrain/Sink: 2" Sewer - 1st 100' 55.00 3" Sewer - each additional 100' • 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 _ Commercial Back Flow Prevention Device / 46.40 7(O , tiO Residential Backflow Prevention Device' 27.55 . • Catch Basin 16.60 Inspection of Existing Plumbing or Specially 62.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL ; Isometric or riser diagram is required if Z'.vd Quantity Total is > 9 - ti *SUBTOTAL • 8% STATE SURCHARGE -PLAN REVIEW 25% OF SUBTOTAL ' a 1 Required only if fixture gty..total is > 9 , -5 • TOTAL Q 304 • * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. ** All New Commercial Buildings require 2 sets of plans with isometric or riser diagram for plan review. i:\dsts \forms\plm- fees.doc 12/26/01