Permit CITY OF F TIGARD PLUMBING PERMIT
IN ` COMMUNITY DEVELOPMENT PE
COMMUNITY PLM2007 -00358
TIGARD - 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/9/2007
PARCEL: 2S110DB -01200
SITE ADDRESS: 15280 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: PP1996 - 010 LOT: 001 JURISDICTION: TIG
PROJECT: DEZFULLI USED AUTO SALES
Project Description: Install (2) backflow preventers (1) for plumbing and (1) irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: M 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: ft
Owner: FEES
DEZFULLI, SHAHIN + EBRAHIM
12587 SW 133RD Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/9/2007 $92.80
[TAX] 8% State Surcha 8/9/2007 $7.42
Phone : Total $100.22
Contractor:
CAMPBELL PLUMBING + HEATING
14755 SE 232ND DR.
BORING, OR 97009 REQUIRED ITEMS AND REPORTS
Contact # : PRI 658 -3137
FAX 503- 658 -5167
Reg #: LIC 154148 .
PLM 3 -426PB
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
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or •' ect questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued -- i , viii/ J,.. / Permittee Signature /N � '
, :
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 1
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applica J C E I �! E
lv� FOR OFFICE USE ONLY
City Received
ty of Tigard ('`` L PermitNo.:pL _/_I # ��i.i
• 13125 SW Hall Blvd., Tigard, OR 972 AUG 0 9 2001 Plan Re
C Plan Review
Phone: 503.639.4171 Fax: 503.5 Other Permit No.:
�:IOF TIGARD Date/By:
Inspection Line: 503.639.4175 Date Ready/By: Juris: ® See Page 2 for
T I G A Ii D B Internet: www.tigard - or.gov BUILDING DIVISION Notified/Method: 77(..," Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ 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 ID Multi-family SFR (3) bath 399.00
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: /5 7_s/0 5A) PQrU ci C. Hwy Catch basin or area drain 16.60
City/State /ZIP: J Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: i �>°-&A.c,l I' us Footing drain (no. linear ft.: ) Page 2
�+ Manufactured home utilities 110.00
Cross street/directions to job site:
QAA,+0 Sa t2,S Manholes 16.60
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 Backflow preventer 01 Page 2 92 . VQ
(2- i pee t I4 -P14 Iz u) ci P, V i G2S , (1) . plumb, Backwater valve 16.60
(� ^) 0) for ) r r i gLj' -/ � Clothes washer 16.60
0) (Jr ! /" Dishwasher 16.60
04 PROPERTY OWNER I ❑TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Frb nv i m De...:�[ � 1 Expansion tank 16.60
Address: /7s e- U SA) / 2 rd Fixture/sewer cap 16.60
City/State /ZIP: -7- rd, Ore_ G 7 3 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( )
v ,} ' _ Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: an/ bat p l u m10.1 ' j H 1 t,'t l ( Water heater 16.60
Address: 14 5 r � 232 l�. D Other:
Cit /State/ZIP: O ia Subtota
"� �� �� �f^J a -1 Minimum permit fee: $72.50 Az . 8'b
Phone: (503) ( < 4- Fax: (G (05 9' fpI CO- Residential backflow minimum permit fee: $36.25
CCB Lic.: / 54./ 4 ' Plumbing Lic. no.: 3-424° p Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee) 742_,
TOTAL PERMIT FEE /00 - Z2
Print name: I Date: This permit application expires if a permit is not obtaibed within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I: Building \ Permits \PLM- PemtitApp.doc 12 /27/06 440.4616T(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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$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
Qt 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 92. 8o I $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 • I, " 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, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
' please indicate work performed by fixture. Failure to Plan review is required for any of the following,
accurately report fixtures could result in increased sewer fees * . ' Please check all that apply. .
Quantity by (Fixture) Work Performed El Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Tub /S ❑ New exterior plumbing site utilities for any complex structure
Bath - hower
Tub/S ower rlpool as defined in OAR918- 780 -0040. ,
Car Wash Each Stall ❑ Medical gas and vacuum systems for health are facilities.
Drive tall ❑ Any multipurpose fire sprinkler system.' •
Cuspidor/Water Aspirator • ❑ Any complex structure as defined in OAR918 780 - 0040.
Dishwasher - Commercial '
•
- Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 ' that meet the qualifications above.
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
i Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall • .
Sink Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley
- Commercial . increase of sewer EDUs, a sewer permit will be issued and
•
• - Service • • . - fees assessed for the sewer increase, must be paid before the
Swimming Pool Filter . plumbing permit can be issued.
Washer - Clothes .
Water Extractor
- Water Closet - Toilet
Urinal
Other Fixtures: •
i:\Building\Permits\PLM- PermitApp.doc 17!27/06 .
08/08/2007 14:28 658 -5167 CAMPBELLS PLUMBING PAGE 01
08/09/2007 13:10 FAX 5435981980 CITY OF TIGARD :"': '"
CITY OF TIGARD
COMMUNITY DEVELOPMENT
13123 SW Hall Blvd., Tigard, OR 97223 503.639.4171
•
•
Plumbing Signature Form
•
IMPORTANT PERMIT NOTICE
CAMPBELL PLUMBING + HEATING
14755 SE 232ND DR.
BORING, OR 97009
Permit #: PLM2007- 00358
Date issued:
Parcel: 2S110DB -01200
Site Address: 15280 SW PACIFIC HWY
Subdivision: PP1996 -010
Lot: 001
Jurisdiction: C -G
Zoning: TIG
Project Name: DEZFULLI USED AUTO SALES --t
Description: Install (2) backflow preventers (1) for plumbing and (1) irrigation.
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return th,
Plumbing Signature Form prior to the start of the work Please mail the form to: City of Tigard, Building Dons.-
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.;681.
If you have any questions please call 503.718.2433.
No plumbing inspections will be authorized until this completed form is re Delved
OWNER: PLUMBING CONTRACTOR:
DEZFULLI, SHAHIN + EBRAHIM CAMPBELL PLUMBING + HEATING
12587 SW 133RD 14755 SE :!32ND DR.
TIGARD, OR 97223 BORING, OR 87009
•
Phone #: Phone #P 658 -3137 ' •
Reg #: • IC 154148
3-426P151
•
•
•
INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Authorized if •er Name (printed)
•
•
1/
\ r ' 1 i �.
CITY OF TIGARD .
BUILDING DIVISION PERMIT #:pLM 2a07- 003
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: gl al 12,0x'7
Phone: (503) 639 -4171 4 " " 'x , � i� 4
Inspection Requests (24 Hrs.): (503) 639 -4175 `__l.
INSPECTION WORKSHEET FOR DATE: ° j 2107 TIME: PAGE:
SITE ADDRESS: 152 80 S(,J -PAL ;- • CLASS OF WORK:
SUBDIVISION: PP lq, `— 0 l 0 LOT #: TYPE OF USE:
PROJECT NAME: D.c.2 IcA L.A. u (ciA Ca,,,/ 5C.. k/'
DESCRIPTION: T'r-.r Aft (2) 134,,,k frl,w Pile,.,t —It4. (1) fa✓ PIw..1.i., a C) ) i'vi^lg -'-
OWNER: rat 2 R4.1 1' Ch 1, i ✓+ t 64+ RI w•, PHONE #:
CONTRACTOR: Camp bz, i I Q 1 w,...b PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Ins ection Des ription Confirm # Contact # Message
17,4T' 04)(d P 1 145
Corrections /Comments / Instructions:
1 ire-cc it r ee 14- k-t 4 ' 1 5. Ng N y.2 1-J•
(PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (T3' »A...A \l\ -,'- _ Date: el 1'7. 10 SS Phone #: (503) 718-