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Permit A ` CITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2003 -00052 I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/20/03 SITE ADDRESS: 13855 SW PACIFIC HWY PARCEL: 2S103DD -00900 SUBDIVISION: ZONING: C -G BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 3 URINALS: GREASE TRAPS: LAVATORIES: 3 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: 1 RAIN DRAIN: ft Remarks: R FEES Owner: Description Date Amount COMMUNITY OF CHRIST CHURCH 5321 WINDSOR TERRACE [PLUMB] Permit Fee 2/20/03 $116.20 WEST LINN, OR 97068 [TAX] 8% State Tax 2/20/03 $9.30 Total $125.50 Phone : Contractor: WESTERN PLUMBING 9460 SW TIGARD STREET • TIGARD, OR 97223 REQUIRED INSPECTIONS Phone : 503 - 639 - 5296 Underfloor /Underslab Reg #: MET 00001703 RoOG LIC 2439 PLM 34 -29PB 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: ,/ / G Permittee Signature��'L�l/ Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Plu mbing Permit Application FOR OFFICE USE ONLY Received n Q, Plumbing .Y17� 7 y -' ' Date/By: aZ' / "/ -03 L3 Permit No.: I pfY/7 �� � • City of Tigard ? - 0 v o o 3 Date/By: Approval Sewer Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 �un0 Post - Review Land Use kJ i ' Date/By: Case No.: Internet: www.ci.tigard.or.us /P � Contac luris.: El See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information. uj TYPE OF WORK FEE* SCHEDULE (for special information use checklist) ❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total ® Addition/alteration/replacement ❑ Other: New 1 - & 2- family dwellings CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) SFR (1) bath 249.20 ❑ 1 & 2- Family dwelling © Commercial/Industrial SFR (2) bath 350.00 DAccessory Building ❑ Multi- Family SFR (3) bath 399.00 • ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 (Z JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2 k Job site address: /337,5 au. nic,X6 ilia y Site Utilities Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: Cam% i )y e l , //S7t akreh Fo drain line/trench . linear ar drain 16.60 Page -b Footing drain (no. linear ft.) Page 2 ---. Cross street/Directions to job site: Manufactured home utilities 110.00 C %u g'7 4,1A Of WR /gr'tem A' - #9? Manholes 16.60 t- J't aar�e.., Rain drain connector 16.60 Z Sanitary sewer (no. linear ft.) Page 2 Subdivision: I Lot #: Orly Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: e7. /a.3 VD Water service (no. linear ft.) Page 2 DESCRIPTION OF WORK Fixture or Item - _ / J Absorption valve 16.60 have. .F///' �Ca/ indoor 7.b,/ . 1 17 /!1 dram s Backflow preventer Page 2 lop- 74,0171K- kl4P.1Ltt.Yt bG,o r<. cslaA a Backwater valve 16.60 . J Clothes washer 16.60 �C�l Dishwasher I. 16.60 Drinking fountain 16.60 Ar PROPERTY OWNER I ❑ TENANT / Ejectors/sump 16.60 Name: enfiIAtaf Tf al &' jv i e/I ` Lc reI Expansion tank - 16.60 Address: /3 li/ Pole. Hzedy Fixture/sewer cap 16.60 City /State /Zip: r Floor drain floor sink/hub 16.60 Met Garbage disposal 16.60 Phone: Gg4v - 66 Z(J Fax Hose bib 16.60 0 APPLICANT CONTACT PERSON Ice maker 16.60 Name: 4,,,,, 1/4 _74 0 ,-,...p Interceptor /grease trap 16.60 Address: S3z./ ezhAgt J O r l �,r /'L e,e, Medical gas - value: $ Page 2 W 41t /7 Di Primer 16.60 City/State/Zip: .(1� Roof drain (commercial) 16.60 Phone:, ( Algid/ I Fax: ($V - Oa/ 7 Sink/basin/lavatory 4 16.60 E -mail: sh A I`+S @ a.1411," beowt Tub /shower /shower pan 16.60 CONTRACTOR Urinal 16.60 Business Name: G(,Z., , 3,/1, I%'}L7 Water closet 16.60 _ `J Water heater r 16.60 Address: `74/ LD sW 11 4t� Other: City /State /Zip: a , pi„ X172 Other: Phone: L a q_ saq, Fax: G Qy- lo/a' 7 Plumbing Permit Fees* a ,18q Plumb. Lic. #: ,3ya g.. p Subtotal $ // ' Z<J CCB Lic. #: M inimum Permit Fee $72.50 $ Authorized � (�� Residential Backflow Minimum Fee $36.25 • Signature: [ �'J ii,r1/Y Date:*//a3 Plan Review (25% of Permit Fee) $ Ann Sho•/' State Surcharge (8% of Permit Fee) $ q. 30 (Please print name) TOTAL PERMIT FEE $ /c3-5 5d 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. is \Dsts\Permit Forms\PlmPermitApp.doc 01/03 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 first $5,000.00 and $1.52 for each additional $100.00 or fraction thereof, to and Fixture or Item Qty. Fee (ea) Total 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for Subtotal: 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 Comments regarding fixture work: Fixture Type: Replace New Moved Existing Capped 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 *Note: If the fixture work under this permit results in an Garbage - Domestic Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i :.Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 ', i2'• SWIMMING POOL REMODEL Outside wall Outside wall r co 9-: F,+'i 57""M/C 2't e ; w Adult Classroom Open to below [01 t• 12'x21 I - fling open above r 0 Nape 5 n o � cG� _� 1k r o ,nk' �,� 5� o ` \ F ure Storage ..,,. .1, k 2.:2 I _ itchen o 14'4"x24.8" 0 6 " q Servinc window d \ 14 Storage above �1 r Staircase to storage Staircase to storage F up down .- —'i 111 ' _ _ ' 6 No. of risers = 15 51 Actual riser = 0.6 ft. IpO� Actual tread = 10.1 in. 1 L • 1 �` 9 Ail) r , I 111/4, f ,s fota � c,o f 0._