Permit .
CITY OF TIGARD
PLUMBING PERMIT
�� DEVELOPMENT SERVICES PERMIT #: PLM2005 -00406
cL 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/1/2005
PARCEL: 2S 103DD -00800
SITE ADDRESS: 13815 SW PACIFIC HWY 110 ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Buiding fixtures. Other fixture: Primer.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 4 URINALS: GREASE TRAPS: 1
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
D.W. SIVERS COMPANY Description Date Amount
4730 SW MACADAM AVE
#101 [PLUMB] Permit Fee 9/1/2005 $149.40
PORTLAND„ OR 97201 [PLMPLN] Plan Review 9/1/2005 $37.35
Phone : [TAX] 8% State Surcharl 9/1/2005 $11.95
Total $198.70
Contractor:
SEYLE'S PLUMBING
PO BOX 2116 REQUIRED ITEMS AND REPORTS
LAKE OSWEGO, OR 97035
Phone : 503- 209 -2594
Reg #: LIC 121862
PLM 24 -360PB
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 •-rmit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. • EN ON: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. - •se rules - - set • • h in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of u - - vs or direct • . -'! // ns to OUNC by
calling 503 - 246 -6699 or 1- 00- 332 -2344. ' 1' / /4
Issued By: Permittee Si natur _ ., ��
Call 503 - 639 -4175 by 7:00 a.m. for an inspection tha • • usiness day.
This permit card shall be kept in a conspicuous place on the'ob • e until completion of the project.
Approved plans are required on the job site at th me of each inspection.
( 3 g / 5 s Pmt.; f, 1.4w .,.
Building Fixtures ASl(q3 -- DOS
Plumbine Permit U ,: .,.'QED FOR OFFICE USE ONLY
City of Tigard Received Date/By. J a 60/11W11111111 Permit N. _ ,. d
13125 SW Hall Blvd., Tigard, OR 97 2 4 2005
Phone: 503.639.4171 Fax: 503.598.1960 Plan By. Other Permit' SW �2005 DO 2(b3
24- Hour Inspection Line: 503.639.4175 ._ _11. I ( Date Ready/By: ,9 . Date Internet: www.ci.tigard.or.us R� CIT { Y � OF y T � I � G / ARD Notified/Me mt
Notified/Method Supplemental Information CA
"TYti l y ( WOI N
FEE* SCHEDULE .�
• ❑ New construction ❑ Demolition F or special information use checklist. Q
Description I Qty. I Ea. I Total V
[ir 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/kitchen 45.00
•
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities E
Job site address: 13 it 1c S Pk., r IC gall S 0 r- / /0 Catch basin or area drain 16.60
City /State/ZIP: / ` O k Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: I Project name: 6► n C /1 ZZ4
Manufactured home utilities 110.00
Cross street /directions to job site: Manholes 16.60 ---4
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 Back flow preventer Page 2
few( 0 / et U77 _'T10 DF L-----u /Sri w6 Backwater valve 16.60
(22 14 ef_Gr p c°1/4{C--- Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
ity /State/Z1P: Floor drain/floor sink/hub . I 1 16.60 g o , (0 )
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name:
Interceptor /grease trap ' 16.60 I (r, _)
• (r Contact name: Medical gas (value: $ ) Page 2
Address: Primer / 16.60 I 6, o Q
(` , Ci ty /State/ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory ' % 7 16.60 fr./A.1/0
Phone: ( ) I Fax: : ( ) ry ¢ -�.
Tub /shower /shower pan 16.60
E -mail: • Urinal 16.60
CONTRACTOR Water closet G„,14 ( 16.60 Ito (a6
In Business name: ( q ..4 4.4 - 1 y ?Lows6 t m L. C, . Water heater 16.60 I ID (161
a Address: p, V - t zli c, Other:
Cit / State/ZIP: Subtotal
Y �rY.0 �t.9c: L0 O - ? 7030 Minimum permit fee: $72.50
Phone: (5 7 j ) 6`11- 66C S Fax: (t53 ) 67S oc %s Residential backflow minimum permit fee: $36.25 .7
CCB Lic.: 111 s6 z Plu Lic. no.: ZLI _3 6 p Q b Plan review (25% o pe rmit fe
A A C �_ - p State surcharge (8% of permit fee)
Authorized signature IJ� TOTAL PERMIT FEE / 99.'4
Pri nt name: A � I Date: I y'4 / os This permit application expires if a permit is not obtained within
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 06/05 440.4616T(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: 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 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 fir t $5,000.00 and $1.52 for each
Fixture or Item Qty. 1 I Fee (ea) Total additional $101.10 or fraction thereof; to and
including $11,000.00.
Commercial Back Flow Prevention Device r 46.40 $10,001.00 to $25,000.00 $148.50 f. the first $10,000.00 and $1.54 for
Residential Back flow Prevention Device each ad' • ional $100.00 or fraction thereof; to
(minimum permit fee $36.25) 27.55 and i uding $25,000.00.
•
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $37; .50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or h 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
eac a dd i ti ona l $100 or fra th ereo f
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures. If "yes ", A' complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Fai re to stem that meets any of the following criteria.
accurately report fixtures could result in increas d sewer fees *. Please check all that apply.
Quantity by (Fixture) Work rformed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall K. Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
❑ Any NFPA 13 -p multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink - 2" Submit 2 se of plans with any of the above.
-3"
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Com ents regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
-Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water. Extractor p
Water Closet - Toilet / increase of sewer EDUs, a sewer permit will be issued and
. •urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building \Permits\PLM- PemmitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00406
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/1/2005
Phone: (503) 639 -4171 airli �
Inspection Requests (24 Hrs.): (503) 639 -4175 �__..
INSPECTION WORKSHEET FOR DATE: 11/16/2005 TIME: 7:17AM PAGE: 16 ,
SITE ADDRESS: 13815 SW PACIFIC HWY 110 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GARLIC JIMS PIZZA
1 DESCRIPTION: Buiding fixtures. Other fixture: Primer.
OWNER: SIVERS COMPANY, D.W. PHONE #:
CONTRACTOR: SEYLE'S PLUMBING PHONE #: 503 -209 -2594
Inspection Request Scheduled For: Date: 11/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 02168E -01 503 - 209 -2594 N
Corrections /Comments /Instructions:
/
0: (4
II • ' SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00406
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/1/2005
Phone: (503) 639 - 4171," r.
Inspection Requests (24 Hrs.): (503) 639 -4175 F'I L.
INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: 7:08AM PAGE: 27
SITE ADDRESS: 13815 SW PACIFIC HWY 110 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: GARLIC JIMS PIZZA
DESCRIPTION: Buiding fixtures. Other fixture: Primer.
OWNER: SIVERS COMPANY, D.W. PHONE #:
CONTRACTOR: SEYLE'S PLUMBING PHONE #: 503 - 209-2594
Inspection Request Scheduled For: Date: 10/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 019014 -01 503-209-2594 N
Corrections /Comments /Instructions:
•
XPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / //06 Phone #: (503) 718-
1