Permit ' rh CITY OF TI•GARD PLUMBING PERMIT'
i& DEVELOPMENT SERVICES PERMIT #: PLM2004 -00006
. .� I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/14/04
SITE ADDRESS: 13855 SW PACIFIC HWY PARCEL: 2S103DD -00900
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ADD GARBAGE DISPOSALS: 1 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: 3 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Building fixtures: Add 2 sinks, cap 1, move 1 dishwasher and 1 disposal. Other fix. Cap swim pool filter
FEES
Owner:
Description Date Amount
COMMUNITY OF CHRIST CHURCH
5321 WINDSOR TERRACE [PLUMB] Permit Fee 1/14/04 $99.60
WEST LINN, OR 97068 [TAX] 8% State Surcharl 1/14/04 $7.97
Total $107.57
Phone :
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Phone : 503 - 771 - 9449 Rough -in Insp
Top -out Insp
Reg #: LIC 42671 Final Inspection
PLM 34 -70PB
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: vilo Permittee Signature/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures 5toR, 00 - _ oco0 S
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received 2� Permit JJo:��M_ / (�
Y g Date/By: ' - / c 2----01 (J 7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /o .d , ' A Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 ■� E Date Ready/By: Jura: I ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE •
Demolition
For special information use checklist.
Demo
❑ New construction ❑ Description I Qty. I Ea. I Total
14 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
SFR (3) bath 399.00
❑ Accessory building ❑ Multi - family
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB. SITE INFORMATION AND LOCATION Site utilities
Job site address: / S " ow ":414, � Catch basin or area drain 16.60
City/ State/ZIP: 8RP' dit 8722 y t// I Drywell, leach line, or trench drain 16.60
C/ Footing drain (no. linear ft.: ) Page 2
�l� �
Suite/bldg /apt. no.: Project name j ,7 1 � �f �j�/Y"
Manufactured home utilities 110.00
Cross street/directions to job site: / /fir /vtujR Manholes 16.60
NO ii ,,-/ ll/a/g rjtdfs 017 -09 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: I Lot no.:
//-�. Fixture or item
Tax map /parcel no.� Si 62 2 - . P 0_0 00 Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher / 16.60 /6p, 61
Drinking fountain 1 16.60
[PROPERTY OWNER I 0 TENANT 16.60
/ �l / J Ejectors /sump
Name: e � yi9/ 6 e p G%/j^ /S� ('/fas - -c- j Expansion tank 16.60
�,
Address: ,9'$- a') 7 jaz. • X/(,�,�/ Fixture/sewer cap 16.60
City/ State/ZIP: , ,if 7 �(( Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60 /t0 - I0
Hose bib 16.60
❑ APPLICANT Jr CONTACT PERSON 16.60
- Ice maker
Business name: Interceptor /grease trap 16.60
Contact name: AA 12 /l,r71- Medical gas (value: $ ) Page 2
Address: S /.Ui11q/s6r Primer 16.60
r�
City/State/ZIP: axes/ X / /7i/ 0, 4 g' Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60 4Lj•', d 0
Phone: ( 2,3) 65 7 Y4 7 Fax: : (s- y) &re/ - 0,.2/ 17
Tub /shower /shower pan 16.60
E -mail: ,,,,,;/ e . s%,,/ C e 2CAJ/• /2,07 Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: arOLV,, /2h„,„,lv,n Water heater `w �j 16.60 /
Address: ii 9 07A-- /^C4/'I!� /•r Other: AQPI 1.Iw TfDeL r / I rta. ! b' / , %4
Subtotal
City/ State/ZIP: P flG (7e 2.Q ' / Minimum permit fee: $72.50
Phone: (,S -el `7., - 9 ii i/9 Fax: ( -a') 7 e VS 5 / Residentialbackflow minimum permit fee: $36.25 W,�/
CCB Lic.: Plumbing � � 6 , 7 / Plumb Lic. no.: 30 7 P, Plan review (25% of permit fee)
_...--1 - ..- � State surcharge (8% of permit fee) , 9 7
Authorized signs e: ����, �'� � TOTAL PERMIT FEE / 67
I Print name: `� ��171«� D ate: , % 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:t Building \Pennits\PIMF- PemtitApp.d°c 12/03 440 -4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information .
a
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
Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item 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
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 „
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *l *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains fees assessed for the sewer increase must be paid before the
Oil Separator (Gas Station)
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar /Lavatory Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
-Commercial total is >9.
- Service
Swimming Pool Filter X
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures: -
i:\ BuiidingWennits \PLM- PermitApp.duc 3/03
i
01/1412004 11:31 FAX 5036500217 NSA lj 001
Building Fixtures 1
plumbing Permit Application 14114 (11111 I . l ISI• r
City of T
Mac: 7oa.b]9 -1 1
1� �,-
8aoelved Permit o.:
191243W 61�d,T5 Olb s� ^�` P a - f
)� � is , ` - Plan goyim
15125 SW 5
Tigard, 0 . D< \ �r ._•' >,. t�ar/Br: altherPet Permit No.!
24 -Hour Inspection Lino: 303.6 $ 1 I Om Smdyis Tvrfr eJ Stt voce a nor l
• tnrcvnat www.oi.ti>m'd.er.us htou&cd/b[athed: Su • , te laformeeen
i ,_yam v ,. 3 - .. ., .,- L_r� ;;41c+ tip_ , ...,r ' _ .^ ,:. .4... v-�
*a .81�'ti^ �,`:� �� r , r . �- i7�• u h. 'u'ypl(' bi^i =,_, zrf�.,l.:_5�:;Q= ��:�.nM�_i. �. ;. �A•s
° �, �0' 1 - .
n Now construction 0 Densoliti0s For ;pedal Ibrrwadon rsc checklist.
Description au . Ea, Tota.
Addibonialteratioi / rcplaCcmcui ❑ Other Nov 1- 2 dwellings ( naludes 100 ft. for each utilib connection;
.:YS aFJF7f o1 . > 7 r* g .1 t" ' T. ..r $P (1) bath 249.20
i- and 2-family dwelling XCntetslteaelalliaduatrlel SPR (2) bath __ 350,00
0 Aoeaea ey heeding ❑ Malta- fsrnily SPR. (s) bath 399_00
• - Each additional beth/kitchen ' 45.00
Master builder D Other Fire sprinkle s • . re.) Pase 2
Feb trite terittta3s: - ' Catch twin or arca Clain 16.60
City/State/ZIP: �% to ar., Off' q9 y Drywall, leash line. or arertc drain 16.60
Suitelbldg lapt. no.: I Project nnme�l , - Poe n drain (no. linear ft: 'S Page 2
street/directions !Pleb site: , McGT�eWtcd home utilities 110.00
Crass street/directions
3 / � f/i^ /!/CL�� -•ry9 Role drain connector 16.60 - �J - Manholes �.}r 16.60
1.4110795 1.4110795 1.4110795 oat 1 �/ lAt(,ty1.S -.40, '� I - --
ll// unitary pewwr (ae. linear [t: Page 2
._ Stern, awe (no. hnaar R.: ) Page 2
9abdiyiaion Lot 1W.. Water eervlee (10, linear ft: 3 Page 2
Mauro or Kern
floc map/pater.' no.. Absorption valve 16.60
•',w _' ��l'i�• '. "� .F `*t;r,elrys.A•.Vic.. `,k. P,, ', „ • -_. rte•` -'.. / iti _ .'o �" .:i HackQOW Freventer Page 2 __..
Baekwatcr valve 16.60
Clothes washer 16.60
Diawasher , / 16.60
- ,
- -^�� .' .. �cgcs „ .4s,„ _ ,. �; '+rl .0 • , Drirtldng tbuntaln 16.60
., 1. ,e L r s
, e r. ,. k..: .. , . u , : }a � f e . �',l� ��' Wiz: - a'� ., .� ., c �jestuttlsemtp 16.60
News: e _ . ../ . I i i ' 6xpansimt rank - -- -. - 16.60
Add»: /3'$S.S ,s L I 1GBL AGtLdL Pti sewersewercep 16.60
C' its►1StatdZ>P: 7&r'/ 9 te Floor drain/floor sink/hub 16.60 ,
Phone :( )
Flit: ( ) Garbage disposal 1 10.60
'';':71 Hose bib
∎•W ' ?rl r r�3 P 1-, ..i
ii"'pi 17, : . . d am .
) � ' -_
. : „, ,, ,-1�,,_ .._ w , .� y .. . 1 , I
+`n.? t„.„.„ .„ -=.c+ .t .t.•..:Y. - kc makrr 16.64
Business mtereaP�l�se .._....1 16.60
Camaet name: ,p• Medical gas (Value s ') . page 2
Adam ,s - f_ ,/ !L,✓i�ei 'X t P .r rr.,�le Primer t 16.
CSty /Srate/ZtP: We/1/c/ �Jt111 t -e 4 • . (carom ncia:) 16.60
6htlt/bain/1aYaiOry 1- 0 -.- 16.60
Pl (103 OX 4 "v I Pa1t ; Ar ° TubI.b wcr /shower pan ^ 1 16.60
S-mntl y ; - a/ • ' . sr' • / Uriaa1 .. 16 -60
� �. W `(r 1 ? g ti s Wamr closet I6.60
Sttsimstuma: � j . Waterh ®re- 1 6.01►
/"edlflll / °M ertaeP s �°a
Admesil _At (/ F(e fib 1 b• ._-,
�
subtpal
ci y /Sfstp/zip: +TOIr t, 4 /7.z.4 1 . Mini num permit fern $72.50
p 1ptacC b) '7 -7, .. 9 Fa11 : tS, . gyS ( tesidnntialbacldlowrinimumpermitfee: 536.25
GCB !Jo.: _�/Jr 1 / =bin Lic. no.: ,,Q 74 y5 State �trah
Plan review (25% of permit Ike)
/ !^ mde (8 efQsrmit fee)
A nth rlsed signature! 6w • TOTAL PERMIT FEE I
Print - This permit application expires If a permit Is not obned within
+ vy-o�,, � Y 1i v / 0 v 0.��� � I Dom ( I (4-t-- , ml 1.80 days afar It has been accepted as complete,
`Fes methodology sat by Tn.- County Building Industry Service Board.
a IlaildeaPhsttile Rl��eerd was aea4el(Tpe oitrWht)
1 O ' d 1Sb6 ILL EOS ONIBW(l1d 'NMOIO Wd OO:ZI ti002- 0I -Ndf
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / '" oZ - 7 AM PM BUP
Location / 8A Suite MEC
Contact Person ,i-PAA.A t' Ph ( ) _ !Q S 7 - `4-1 7 T PLM 1 _ p o cop
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Access:
Ftg Drain 5 , L t3Ox _ 7 ER
ELR
Crawl Drain O
Slab Inspection Notes: SIT
Post & Beam
Ext Sr Sh ea Anchrs
th / ear teler- . Ext eah/h ,
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm V A' /
Susp'd Ceiling V - /
Roof
Other:
Final
PASS PART FAIL
PLUMBING . /
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pa
yv WO/
S PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector 77.1 Ext
Other:
Final DO OT REMOVE this Inspection record from the job site.
PASS PART FAIL