Permit 107(9-0 pAP;(1:a. ./e6
a,e CITY OF TIGARD PLUMBING PERMIT
CI DEVELOPMENT SERVICES PERMIT #: PLM2002 -00407
�,� I � 13125 SW Ha Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/24/02
SITE ADDRESS: 13855 SW PACIFIC HWY PARCEL: 2S103DD -00900
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
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: 4 URINALS: GREASE TRAPS:
LAVATORIES: 6 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 0 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Lays: move 4, cap 2. Sinks: cap 4, 1 drinking fountain moved.
FEES
Owner:
Description Date Amount
COMMUNITY OF CHRIST CHURCH
5321 WINDSOR TERRACE [PLUMB] Permit Fee 10/24/02 $199.20
WEST LINN, OR 97068 [PLUMB] Permit Fee 10/24/02 $0.00
[TAX] 8% State Tax 10/24/02 $15.94
[TAX] 8% State Tax 10/24/02 $0.00
Phone 1:
Total $215.14
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 503 692 - 4139 T o p out I lnsp
Top -out Insp
Reg #: MET 00001806 Final Inspection
LIC 87852
PLM 34 -166PB
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
e ,
/
Issued By: �! , _ _ , r . „e, Permiftee Signature: di/t4
Call (503) 639 -4175 by 7:00 P.M. for an inspection nee d the next business day
Q V
CLASSROOM CLASSROOM CLASSROOM CLASSROOM CLASSROOM
1361 SF. 364 SF. 12, SF.
REPLACE
DUTCH DOOR
W/ 3068
�9
0 0 ED r� B 0 0 L
elk - 68
3 68 REMOVE—
to 0� NON- BEARING
6040 i 0
61 ra ® 9 WALLS = _ -
■ SAa MENT LOBBY / FOYER
elT
O 1
806 SF.
SP. NEW DRINKING 3010
FOUNTAIN
POOL R ESTROOM - RESTROOM $TROO - MOVE EXTG. J
130 S.F. STAF NON - BEARING
NOT USED 3068 50 6F. 668 WALL a RESTROOM
FURNACE % I � : t
% x `� )
UTILITY Roots
226 5F. 3 068 KITCHEN K �� ►�
166 SF. Q � �%
• a 205 SF oat
3068
8040 3040 �. 0
A I 1 F C 3030 9 i 0
Accumulative Sewer Tally
Tenant Name: Community of Christ Church This SWRh N/A
Site Address: 13855 SW Pacific HWY. This PLM# 2002 -00407
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 _ 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 1 1 1 1
Eye Wash 1 , 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 _ 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 _ 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 _ 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 2 4 0 -2 -4
- Bradley 5 0 0 0 0 0
- Commercial 3 0 4 12 0 -4 -12
_ - Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 8 128 128
Capped EDU Credit 0
TOTALS 0 128 6 16 1 1 -5 113
Current Fixture Value 113 divided by 16 = 7.1 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 128 divided by 16 = 8.0 Previous EDU
Change -15 divided by 16 = -0.9 over (under) $ (2,070.00)
Enter EDU Change Here -0.9
HISTORY
Notes: current EDU 8 from PLM# EDU# SWR#
Jaime in Water Dept. PLM# EDU# SWR#
PLM# EDU# SWR#
Name: .6 Z r Q iti.it'i Date: /O — a g — O` ' 1
a _
Signature of person that calculated this tally sheet and date perfromed is required
Plumbing Permit' Application OFFICE USE ()NIA
A.
Date received: /0-01 -- y-O- Permit no.: RP. 0.4 / i r 7
City of Tigard
,51- n.! i 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: : J Receipt no.:
Land use approval: Case file no.: Payment type:
111'I: 01 I'l10III
131 & 2 family dwelling or accessory OCommercial/industrial CI Multi - family l] Tenant improvement
l] New construction KAddition/alteration/replacement 0 Food service ❑ Other:
.1011 SI I I . I!N'I OR!\1A II ION FEE SCIIEDI; (for spccial infortraiion Ilse chcckli >I)
Job address: /3 x'55 cam/ r adii/6 hlh, Y Descr Qty. Fee(ea.) Total
only:
Bldg. no.: uite no.: ""- . New 1- and 2-family dwellings
Tax map /tax lot/account no.:
(includes 100 ft. for each utility connection)
SFR (1) bath
Lot: Block: Subdivision: SFR (2) bath
Project name: m -' AA f SFR (3) bath
City /county: IZIP: 97 Each additional bath/kitchen
Description and ocation of work on premises: Site utilities:
SaMevioryl 1, e/7*lt4/ ,/( /eIhlivitti Catch basin/area drain
Est. date of completion /inspection: Drywells/leach line /trench drain
Footing drain (no. lin. ft.)
c Manufactured home utilities
Business name: RAY 60 ItAl S Lt Y Mtt Manholes
Address: P. .0. 8 Q , 1 C 6 ? Rain drain connector
City: -rt;L A (APT (State: I ZIP: Q 7 06.2.._ Sanitary sewer (no. lin. ft.)
Phone 0 3 01 t(/ gff I Fax: at 21741 E -mail: Storm sewer (no. lin. ft.)
CCB no.: g7 g $ 2 I Plumb. bus. reg. no: gy., ld b Water service (no. lin. ft)
City/metro lic. no.: (g O 6 Fixture or item:
Contractor's representative signature: , . 0, A — Absorption valve
J' /4 PA - - K / 2 0 a Back flow preventer
Print name:
,�, , Date: • Backwater valve (4)Li)S
(ON I: (: I I'EISON Basins/lavatoryjl, i Name: , ,, 6Z6v f Clothes washer
Address: .S3e2 / 0.4, —7",', fountain
(s) G(/L .g�' 44 I State:/, ZIP: el 76,4 Ejectors/sump () `
Fax: E -
Phone:
iC �s O d /�.4$ltpansion tank
Fixture /sewer cap
) 6 /fl,/ A' fir _1 Floor drains /floor sinkslhub
(print): rint : ST Garbage disposal
Mailing address: ig 8 ' j ' j 3u/ , r d.,,,, { Hose bibb
City: 7 p / tate:, J ZIP:' R 7L2.4/ Ice maker
Phone: G -((fz 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. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
Tubs/shower /shower pan
Name: /t/ /�1 ' In Urinal
Water closet
Address: 162.1 SGV e+, - Water heater '
City: 0:4 I State: B ZIP97.. Other.
Phone: 2 I Fax -B.y 14 E -mail: Total a //el.
Minimum fee $ / 9 " . • v
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application o
❑ visa O MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number / / State surcharge (8 %) .... $ /5 5 "(
Expires within 180 da after it has been
Name of cardholder as shown on credit card accepted as complete. TOTAL $ A 4'
Cardholder signature Amount 440 -4616 (6/00 /COM)
• 'LUMBING PERMIT FEES:
......:..., ...........:..... ::::.:::.�:.::.;::.::.;::.�::<. ::::::: :: ...:,::.
:... :..:..:
:. .:..:::::.. ... ..
:. > :....:::..:.:...
m filIfaPq p
Sink ::::;:;:
16.60 : # €ti tl iki (;:... !'(8:� a3 t i "s >E <:: 71(.? #': ;.. '..4M004W
Lavatory 6.60 i z�#fl B&Ch uUliI R;S .Vl1 :: >:;:: >:::;;.:;:i:<::' >: »:'• '•: °: < >: -> i`:'::'> >:::::::<? : >= :;z': >[ i:::!> » :
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 ........:....... «ts::s
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 Z 16.60
3• 16.60 PLEASE COMPLETE:
4' 16.60
Water Heater 0 conversion
ve 0 like kind 16.60
Gas piping requires separate stem
mechanical ca
permit.
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory Y
•
Hose Bibs 16.60 Tub or Tub/Shower
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain I 16.60 Water Closet
Other Fixtures (Specify) 16.60 Urinal
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
Storm & Rain Drain - 1st 100' 55.00 S ecdY)
Storm & Rain Drain - each additional 100' 46.40
Commerdal Back Flow Prevention Device 46.40
Residential Beddow 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 al7 k
QUANTITY TOTAL: > < €::z:::<3'•s<:' ?'.:
Isometric orrl r diagram l ���
se s required If
Quantity Total Is > 9
'SUBTOTAL: ?k ><:'' ?<';;•
8% STATE SURCHARGE:
"PLAN REVIEW 25% OF
SUBTOTAL:
Required only If fixture qty. total Is > 9
TOTAL PERMIT FEE: ':; : : ::':' ?' r. $
'Minimum permit fee is $72.50 + 5% state surcharge, except Residential Bacsfiow
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.
l:ldstslformslplm- fees.doc 02/05/02
Accumulative Sewer Tally
Tenant Name: CommUnity of Christ Church This SWRA N/A
•
Site Address: 13855 SW Pacific HWY. This PLM# 2002 -00407
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 2 4 0 -2 -4
- Bradley 5 0 0 0 0 0
- Commercial 3 0 4 12 0 -4 -12
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 1 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 8 128 128
Capped EDU Credit 0
TOTALS 0 128 7 22 • , 1 1 -6 107
Current Fixture Value 107 divided by 16 = 6.7 Current EDU 1 EDU = $2,300.00
Previous Fixture Value 128 divided by 16 = :.• Previous EDU
Change -21 divided by 16 = -1.3 over (under) $ (2,990.00)
Enter EDU Change Here -1.3
HISTORY
Notes: current EDU 8 from PLM# EDU# SWR#
Jaime in Water Dept. PLM# EDU# SWR#
PLM# EDU# SWR#
Name: " /_. _ / ., - / Date: ,U — (-
Signature of person that calculated this tally sheet and date perfromed Is required
Q V
CLASSROOM CLASSROOM CLASSROOM CLASSROOM CLASSROOM
136+ S.F. 364 SF. 12 5F.
REPLACE ` .
DUTCH DOOR
�� ,, ll i l L W/ 3068 1LL %.. ,
( LF 0 B
68 ® t
368 c c REM0I/E�-
a , 068 NON - BEAING
6040 0 el
0 ` WALLS
f a e
LOBBY / FOYER
,-- 5A� � 806 SF. vb+-4-
9 1 SF. NEW DRINKING 3010
...- -
i FOUNTAIN - . : . . - ....... ..
-- WOMENS 1 IEO E NS i d 0 . [I
POOL RESTROOM RESTROOM $T OO REMOVE EXTG.
'130 SF. ST, NON- BEARING
-
NOT USED 3068 50 SF. 668 WALL 4 RESTROOM A
FURNACE i I 0 A
k x Cri
UTILITY ROOM
226 S.F. 3068 KITCHEN �A�
166 SF. Q -=
p- 205 SF a
3068
8040 3042 X ---j —t J T I ) 0 9
p
CITY OF TIGARD 24 -Hour
• BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION" Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /1 I AM PM BUP
Location 35,5 (5 I � _ Suite , !G MEC
Contact Person • Al .4L . Ph ( ) & S 7 `� 17 PLM — 1 d Yd 7
Contractor Ph ( ) ( q7 -14010 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ` ELR
Crawl Drain G (/
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
• - -
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fi
ASS PART FAIL
HANICAL
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 El Please call for reins • ection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
CITY O ''rARD 24 -Hour
BUILD_ Inspection Lirte: (503) 639 -4175
INSPECTION DIVISI,.. Business Line: (503)439 -4171 MST /L
BUP as 7
/ Received Date Requested /I AM PM BUP
Location / 3 s 6 Suite MEC
Contact Person M Ph ( ) 6 t / 4' 62-6 PLM O — 6° 7 d 7
Contractor Ph ( ) g ` Td / D SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain e- C Yti 3 0 ELR
Crawl Drain
Slab Inspection N tes: „ l SIT
S & Beam ��`�
Ext Sr Sheath/Shear
h /
Ext eah/hear
Int Sheath/Shear
Framing
Insulation LOG f% C u �n/I 6v 13)(
Drywall Nailing I` 1 1
Firewall I J - -1 Q - 0 D ,p — %/37
Fire Sprinkler �6 !!
Fire Alarm
Susp'd Ceiling
Roof
Other:
=ART FAIL
Pos � i
Under S -b r � IMM�r
Rough -In &W iK I_
Water Service
Sanitary Sewer
Rain
Catch / Manhole MMIICOMMIKIIPILW/mr •
Shower Pan LW FAW MAWS
Other: NI— W - N'W
1a PART FAIL
ANICAL
Post & Beam -
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final i Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Ei Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line / '7
ADA D // / / 0 < 0 ( / inspector Ext
Approach/Sidewalk (( /27
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL