Permit CITY TIGARD PLUMBING PERMIT
iA, DEVELOPMENT SERVICES PERMIT #: PLM2003 -00299
��, II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4 DATE ISSUED: 7/23/03
SITE ADDRESS: 13855 SW PACIFIC HWY PARCEL: 2S103DD -00900
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ADD GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: A3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 40 ft
Remarks: Site utilities for addition. 170 ' of footing drain and 40' of storm drain.
• FEES
Owner:
Description Date Amount
COMMUNITY OF CHRIST
PO BOX 23462 [PLUMB] Permit Fee 7/23/03 $156.40
TIGARD, OR 97281 [PLMPLN] Plan Review 7/23/03 $39.10
[TAX] 8% State Tax 7/23/03 $12.52
Phone : Total $208.02
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone : 503 Storm Drain Insp
Storm Drain Insp
Reg #: LIC 2439 Storm Drain Insp
PLM 34 - 29PB Storm Drain Insp
Rain Drain Insp
Final Inspection
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: / /l / .;`_/r Permittee Signature: )(,gt-t-1.--
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
• Site Utilities
' ermit Application FOR OFFICE USE ONLY
Received Plumbing �D3 - 0 62. '9q
Date/By: ;4 Q P Permit No.:
City of Tigard Planning Approval Sewer
`J g Date/By: Permit No.:, , f�a93 --- 0Ql72/
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use (rock
/a�nir�ll q ' I� Date/By:
No.: Pi - W) 3.- ()C if
Internet: www.ci.tigard.or.us , cal � Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4"175 `^ - ' Name/Method: Supplemental Information.
P43 00 P
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
W New construction ❑ Demolition Description I Qty. I Fee(ea.) J Total ,�'\
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings OC
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) 0 •
1 & 2-Family dwelling Commercial/Industrial SFR (I) bath 249.20
❑ Y g ® 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 LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: /3$5S SW Pete; i / NLv Site Utilities
- Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
• Project Name: e h il ly e 7 ( (/f r /5� �lllly x
Footing dr (no. linear drain 16.60
Footing drain (n linear ft.) !70 Page 2 /0/, Y0
Cross street/Directions to jo site: Manufactured home utilities 110.00
A/br fA Dq alA/g/-GCh,S a Ct aa►^d y' -t 7q. Manholes 16.60
Rain drain connector _ 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: po9ce
Storm sewer (no. linear ft.) 0 Page 2 „J' . CO
Tax map /parcel #: e2 S I t`Jq D 19
Water service (no. linear ft.) Page 2
Fixture or Item
(I DESCRIPTION OF WORK Absorption valve 16.60
a ee?rt 1Pt.TIhV1s +b e)14 city Cox- i-ti -N Backflow preventer Paget
h Ct S t n s �JJ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
J PROPERTY OWNER TENANT Ejectors/sump 16.60
Name: (moo i Lin vr t t -1 i 1 (h r 1 S'f ( Expansion tank 16.60
Address: 'p d 13 �c / Z,3 t f 6, Z Fixture/sewer cap 16.60
City /State /Zip: Tg b R_ G°f )2g Floor drain /floor sink/hub 16.60
tl Garbage disposal 16.60
Phone: (o YK- t 6 .2.e, Fax: Hose bib 16.60
❑ APPLICANT 0 CONTACT PERSON Ice maker 16.60
Name: A n r , k$ 0 r ?L Interceptor /grease trap 16.60
Address: ,r� A z/ (,U//idSb r /^/'ace- Medical gas - value: $ Page 2
, City /State /Zip: w.es f t te
DR 4 70 '' Primer 16.60
Roof drain (commercial) 16.60
. ' Phone: 66 7- q47'/ I Fax: 6 SD -Oa/5 Sink/basin/lavatory 16.60
E -mail: Sh a r C all h j , COSkn Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60 '
Ili Business Name: Gt'/l i1 - - - _ _ _ - Water closet 16.60
Water heater 16.60
Address: 99 1 S J T/ Ads - Other:
City/State/Zip: 7,4 q y , a g Q - • ; X7_ 2_2,3 Other:
Phone: 99 -,51 Fax: G g 9 i-a q 10 _ _ _ Plumbing Permit Fees*
CCB Lic. #: .175:19 • Plumb. Lic. #:3Y.?9t& . A • Subtotal $
Minimum Permit Fee $72.50 $ / Ste , Lip
Authorized ` Residential Backflow Minimum Fee $36.25
Signature: Date: �/ • 0,3 Plan Review (25% of Permit Fee) $ 39 • to
7� nvezr State Surcharge (8% of Permit Fee) $ / a • 5'A
(Please print name) TOTAL PERMIT FEE $ a Os • a a
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.
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1
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 16.60 the dwelling and the flrst100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
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 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 3" 16.60 PLEASE COMPLETE:
3" 16.60
4" 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
16.60 Urinal
Other Fixtures (Specify) Dishwasher
Garbage Disposal
Laundry Room Tray
•
Washing Machine
Floor Drain /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
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
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
Quantity Total Is > 9
*SUBTOTAL
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL 4
Required only If fixture qty. total Is > 9
•
TOTAL $
•
* 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.
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