Permit C ITY OF TIGARD PLUMBING PERMIT
P ERMIT #: PLM2006 -00045
j DEVELOPMENT SERVICES DATE ISSUED: 2/22/2006
131 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S110DC -00300
SITE ADDRESS: 15700 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: WILLOW BROOK FARM LOT: 016 JURISDICTION: TIG
Project Description: Interior plumbing: other fixtures, one primer & 1 hose bib
CLASS. OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: M FLOOR DRAINS: 2 TRAPS:
• STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 0 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SHURGARD STORAGE Description Date Amount
1155 VALLEY ST SUITE 400
SEATTLE, WA 98109 [PLUMB] Permit Fee 2/22/2006 $162.60
[PLMPLN] Plan Review 2/22/2006 $40.65
Phone : 206 652 - 3877 [TAX] 8% State Surcharl 2/22/2006 $13.01
Total $216.26
Contractor:
M B PLUMBING
7112 NE 65TH PLACE REQUIRED ITEMS AND REPORTS
VANCOUVER, WA 98661
Contact # : FAX 360 - 696 -3330
PRI 360- 608 -9521
Reg #: LIC 159285
PLM 37 -548PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 0001 -0010 through OAR 952 -0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 -246 B9 or -800- 332 -2344.
Issued By: Permittee Signatureil-
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Fixtures ��JJ��
PlumbinE PermitRi��X roll oFFICF tisr oNl
City of Tigard 2 7 2 00 6 Received ��M�'
13125 SW Hall Blvd., Tigard, OR 9 Oat �� ��
Phone: 503.639.4171 Fax: 503.598.1960 5 '
Plan ew Other Permit No.: ��,. '.16192:2 •
I i
24- Hour Inspection Line: 503.639.9 7 O F TIGARD _, J ` ' •I .. Date ReadyBy. �� Q� ®See Page 2 for
Internet: www.ci.tigard.or.us fa pN�$IO1v Noti6 eb l /�d!f/ ' / 1(p Supplemental Information
BUiLD%N
TYPE OF WORK 404k. w/ 4� ( FEE* SCHEDULE
grNew construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2 -family dwelling N Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi -family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1 5 0 S W PAc j •4i 1N Catch basin or area drain 16.60
City /State/ZIP: .- r l G fie 0 0 & 1/22 if !! Drywell, leach line, or trench drain 16.60
/a t. no.: (Project name: of J � e- Footing drain (no. linear ft : ) Page 2
1�ar jots-
//J`
.1 n� • Manufactured home utilities 110.00
Cross street/directions to job site: 9NrA - /L 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
n/�
Fixture or item
Tax map /parcel no.: 01 5 1/0 - 0C - 06300
Absorption valve I 16.60
e L
DESCRIPTION OF WORK Back flow preventer / Page 2 �4 d
/f G� T/"a 0 /)s t S IV t`0 ... frrevil . Backwater valve 16.60
Clothes washer 16.60
•
Alt me 0 c ite S l dp Dishwasher 16.60
yy PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: 5111 a rt'9 i r I C r 4 J ,s,..; L Expansion tank 16.60
Address: /15 4 1 -t. 4-c. 1 1 0 0 Fixture /sewer cap 16.60
• City /State/ZIP: S' . ' e . W4 C9/ 0 J Floor drain/floor sink/hub /flit) 2.. 16.60 33
Phone: (206) 65'2 - 397 7 Fax: (lob) 652- 3 82 0 Garbage disposal - 16.60
PI APPLICANT ❑ CONTACT PERSON Hose bib / , 16.60 / 6' /' v .
Ice major • 16.60
Business name: ERIC, GA , 't' , 8 EE Co vs T'R KC -r o/t/ Interceptor /grease trap 16.60
Contact name:
R 1 i I Dub. /C Medical gas (value: $ ) Page 2
Address: p0 Box 13g 5 Po,- #104,44 O,e Primer / 16.60 r
City /State/ZIP: 0/-41 4 A d - 0g. 77213 Roof drain (commercial) 16.60 11-- ��
Sink/basin/lavatory.. / j I f 16.60 , U! •
Phone: (5 690 .. 9 6 Q 0 I Fax:: (503 ) 63 8_ 0 1 - 7 O Tub/shower/shower pan 16.60
E -mail: 0LDu6ENk0 & Horm* L • COm Urinal 16.60
CONTRACTOR _ Water closet / I. 16.60 /C 66 •
Business name: M g PiN 4 e r n Water heater f 16.60 16. /� a
Address: .7 1 NE 4 5 S A P/ c e, Other: I to
City /State/ZIP: Van < O k l e i p•---- wA 2 g,4 4 /
Subtotal. . - -
Minimum permit fee: $713.0
Phone: (360) 60 B.- i 5 . 2 / Fax: (36 0) 6 y 6 - 333 O Residential backflow minimum permit fee: $36.25 _ �
CCB Lic.: /5 7 2 0 S' Plumbing Lic. no.: 3 ?i y 6(s ?p, Plan review (25% of permit fee 70 • �Ob ,
. r t VV State surcharge (8% of permit fee) / 3 • 0/ 1
Authorized signature: i, / ,,, /G TOTAL PERMIT FEE Al ( a(p
Print name / K y 4. f L I/e %//DIAAl41-AwI Date: /2/04 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:\ Building Wennits\PLMF- PermiWpp.doc 06/05 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard .
Page 2 - Supplemental Information
Fee Scheduler Residential Fire Suppression Systems:
• ,. Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l 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 Fixture or Item Qty. Fee (ea) Total f to and
Commercial Back Flow Prevention Device 1 46.40
including
148. i0g for the first $10,000.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Back flow 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $ I.20 for
each additional $100.00 or fraction thereof.
•
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing .
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixture s could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed Any new commercial building.
DI
Future Type: Replace Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower I ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall _ ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
'
- Domestic _ I dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain /sink - 2" - ,� Submit 2 sets of plans with any of the above.
-3" _
-4"
Car Wash Drain - Isometric or Riser Diagram
Garbage - Domestic - _/ ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial _ three (3) or more stories in height.
-Industrial
Ice Mach./Refrig. Drains •
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang _
-Stall _
Sink - Bar/Lavatory ' d`- I
- Bradley _ ,
- Commercial _
• - Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor , ,
Water Closet - Toilet : X -l- increase of sewer EDUs, a sewer permit will be issued and
Urinal - _ fees assessed for the sewer increase must be paid before the
Other Fixtures: _ _ plumbing permit can be issued.
i:\ Building \PetmitAPLM- PertnitApp.doc 07/06
Accumulative Sewer Tally Parcel # 2S110DC 00300
g I ° ThisSWR#N , ,A Ala` x ^ �:?
Xe[�,aA���,��S Storage � � r �, 4^f 4' ;
Sit4 A d gS4 „` 5700 SW PacifiW ,05t r, rkf..Z2 This PLM# 2006- 0070, 0,,,,:',4",,,,f,
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 1 4 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
r
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 1 2 0 - 1 - 2
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0
0 0
Floor Drain /Sink - 2 inch 2 0 1 2 2 4 1 2
3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drr 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 1 16 0 - - 16
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 42 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 1 2 - -
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- 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 2 12 1 6 - -
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 8 40 4 12 - 4 - 28
Current Fixture Value -28 divided by 16 = -1.8 Current EDU 1 EDU = $ 2,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -28 divided by 16 = -1.8 over (under) $ (4,680.00)
Enter EDU Change Here ;, -1.8;
Notes: ** *CREDITS * **
i
Authorized Name /Signature: I1 bbie Ada m kr Ali °` „Y t^ 1"44 Date: ' Otfaf b66' '
But . r g Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
i:\ Building \Sewer Tally \SewerTallySheet.xls 7/1/05
CITY OF TIGARD D OCR r0 ?�o // ttr
BUILDING DIVISION PERMIT #: CD 9 J
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639- 4171o����
Inspection Requests (24 Hrs.): (503) 639 -4175 � ..
INSPECTION WORKSHEET FOR ' DATE: `3 /3 V6,_ TIME: PAGE:
SITE ADDRESS: / S ? 0 c) A 4 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #: 6 O V_ 516 q0
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
q 01 et, i.v,./c., „.:
,_ .______ _
Corrections/Comments/Instructions:
#2 MILM - A'ar ‘-----,
/ f
Le
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0 1 Date: Y/ - , Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: I;I M2006 00046
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ?_/; 2/
Phone: (503) 639 -4171 ,�� !1 �I
Inspection Requests (24 Hrs.): (503) 639 -4175 _ "'I —
INSPECTION WORKSHEET FOR ' DATE 2/24/2006 TIME 7:03AM PAGE: 43
SITE ADDRESS: 16700 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #• 016 TYPE OF USE:
PROJECT NAME: SI.IURGARD STORAGE
DESCRIPTION: Interior plumbing: other fixtures, one primer & 1 hose bib
OWNER: SI- IURGARD STORAGE, PHONE #: 206 -662 -3877
CONTRACTOR: M B PLUMBING PHONE #: 3(0 -60P -957. i
Inspection Request Scheduled For: Date 7124/20(16 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3211 Plumbing rough -in 027620-02 503 - 680.9690 N .
Corrections /Comments /Instructions:
2 :..9 //
�f / ,
f , •Ft y . . .- _-.--
-1 -- 3/f o
'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
NI . FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4/ 1 1 �' Date:) ) 211 i C Phone #: (503) 718 -
L ___ . .
CITY OF TIGARD
BUILDING DIVISION A PERMIT #• PI M20l)c�•CS 045
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2D2/200G Phone: (503) 639 -4171 /tin�jjticiii
Inspection Requests (24 Hrs.): (503) 639 -4175 ..:..Iii•
INSPECTION WORKSHEET FOR DATE: 2/74/2006 TIME: 7 :03AM PAGE: 44
SITE ADDRESS: 16700 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 010 TYPE OF USE:
PROJECT NAME: SHURGARD STORAGE
DESCRIPTION: Interior plumbing: other fixtures, one primer & 1 hose bib
OWNER: SHURGARD STORAGE, PHONE #: 205 -652 -3877
CONTRACTOR: M B PLUMBING PHONE #: 360 9Q1
Inspection Request Scheduled For: Date: 2/24/7006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing undefslab 027520 -01 503-680- 0691) N
Corrections /Comments /Instructions:
t - _PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Vi I Inspector: l / Date: Phone #: (503) 718 -