Permit V . • if II
C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PE
DEVELOPMENT P -00219
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 5/27/20027/200 5
PARCEL: 1 S134BC -00200
SITE ADDRESS: 12180 SW SCHOLLS FERRY RD ZONING: C - G
SUBDIVISION: GREENWAY TOWN CENTER LOT: JURISDICTION: TIG
Project Description: Installation of backflow device.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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
SAUNDERS, WILLIAM W TRUSTEE Description Date Amount
2155 KALAKAUA AVE STE 500
HONOLULU, HI 96815 [PLUMB] Permit Fee 5/27/2005 $46.40
[TAX] 8% State Surcha 5/27/2005 $3.71
Phone : Total $50.11
Contractor:
WOLCOTT PLUMBING CONTRACTORS
1075 W HISTORIC COLUMBIA RIVER
TROUTDALE, OR 97060 REQUIRED ITEMS AND REPORTS
Phone : 503- 667 -1781
Reg #: LIC 23847
PLM 26 -208PB
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 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: A1,c
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.
05/27/2005 10:37 5034912932 JACK HOWK PAGE 01
gip • la I ''' .
Plumbing Permit A4lication FOR OFFICE u.i•: ONLY
r
City of Tigard I "G EIV' R t e -Z 7 �C� Permit No.: \ \ / ,o,ZJ A
13125 SW Hall Blvd., Tigard, OR 9723.. Plan Review
Fax
Phone: 503.639.4171 503.598.IL960 ; r te ,., , Other Permit No.:
715 � � �"' °. I �'� "�
24 Hour Inspection Line: 503.639.41 M A�/ � fi l 4 , bue/BY: B ali I Date Readytay: T lee'�: / El See Page 2 for
Internet: www,ci,tigard.or.us � Notified/method; .J Supplemental information
TV'EE B. tTW R T IG A In: FEE SCHEDULE
❑ New construction U I n -
molition For special information use checklist
Description j Qty. I Ea, I Total
e dition /altcration/replaecnicnt ❑Other: New 1- 2- family dwellings (includes 100 ft. for each utility cxtnncetion)
l:'_ATEC=OIIt1i OF CONSTRUCTION SFR (1)bath 24920
1 2- family dwelling ❑ Commercial /industrial SFR (2) bath A 50.00
❑ Accessory building ❑ Multifamily SFR (3) bath • MT41 it l_' 399.00
Each additi • . InF W,. t�/W t t
❑ Master builder ❑ Other Fire aprinkl t I Ci 11•1411111MM1
JOB SITE INFO : L #TION AND LOCATION Site utilities 1
Job site address: � �� j � � � � . [" Catch basin or • drain 1 r 6.60
• Drywctt, latch line, ,
City /Statc/Z I': "/) / / 1 16.60
& P 1 . ',J' k .. Fo ot ing drain r , I , Page 2
Suitc/bld /a no.: Proj�� name:
Manufactured ! 110.00
Cross street/directions to job site;
Manholes 16.60
Rain drain cow 16.60
)�
*. Sanitary sewer (no. linear 0.: ) 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.:
&5-5-- Absorption valve 16.60 f
DE3C'R f TiON OF \ \'CtRI, lack flow preventer I Page 2 II ■ , ai S
. I Backwater valve 16.60
] e ' /,a.,,-, Clothes washer 16.60
Dishwasher 16.60
11=111=711111111 ❑ TENANT Drinking fountain 16.60
Ejectors/sump
Name: P1j1f ifffr ���. �.. �/` Expansion tank 1 6.60
Address' ff joriewn f ,i � Fixture/sewer cap 16.60
City/State/7_1P. ,.r - ore , /� e ,A Floor drain/floor sink/hub 16.60
M , .� � Il
Phone; ( / Fax: ( ) Garbage disposal 16.60
aa PPLTC',1NT I ❑ C. ONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Wolcott Phi Bing dha Jack Hewk Plumbing it,terapror /Rre„se app 16.60
Contact name: J 1 Medical gas (valuesS ) Page 2
Address: 1075 W Historic ColumbialRIver Hwy Prima 16.60
y
City/State/ZIP: Troutdale, OR 97060 Roof drain (commercial) 16.60
Phone: (503) 235 -8784 I I Fax: : (503) 491 -2932 Sink /basin /lavatory 16.60
Tub/shower /shower pan 16.60
E-mail: Urinal 16.60
COFITRaC.TOR Water closet 16.60
Business name: Wolcott Plumbing dim Jack Howk Plumbing Water heater 16.60
Address: 1075 W Historic ColombialRiver Hwy Other I � r /
C Troutdale, OR 970611 - Subtotal o
Minimum permit fee: 572.50 , Aso
Phone: (503) 235 -8784 Fax: (503) 491 -2932 Residential backiow minimum permit fee: $3625 i:i ' . 1
CCB Lie.: 23847 Phtmbpig Lio. no.; 26-208 PR Plan review (25% of permit fce)
State surcharge (8% of permit fee) /0
Authorized sigrtature: TOTAL PERMIT FEE
I •
T-
Print name: ✓/ . 4 A i vied Date- III This permit application expires if a permit Is not o , ,,. t . a. Aw .. — . 180 days after it has been accepted as complete.
*Fee methodoloav set Iw Td- County Btrildine Industry Service Board.
05/27/2005 10:37 5034912932 JACK HOWK PAGE 02
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Plumbing Permit An - City of Tigard
Page 2 - Supplemental Iiiformation
•
Fee Schedule: • Residential Fire Suppression Systems:
Site Utilities Qrs. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1" 100' 55.00 0 ro 2.000 $115.00
-
Footing drain - each additional 100' I 46.40 2001 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 ton' I 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water 9ervicc- 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 Dram - 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
Fixture or Item 1 QIv. Fee tea) Total additional $100.00 or fraction thereof, to and
�fj� .'�� including $10.000.00.
Commercial Back Flow Prevention Dcivicc I. 46.40„ $10,001.00 to $25.000.00 $148.50 for the first $10,000,00 and $1.54 for
Residential Backflow Prevention Devito iY�� each additional $100.00 or fraction thereof, to
(minimum permit fcc $36.25) ; 27.55 and including $2S,000.00.
Drain. ain, 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 h¢ttr 72.50 ---- - �y�}� $50,001,00 and up $742.00 Ibr the first $50,000.00 and $1.20 for
Soh'fotal: ,( ,j� each additional $100.00 or fraction thereof
i '��/
Fixture Work:
Are you capping, moving or replacing existing fixtures? If
"yes", please indicate work performed by fixture. Failure to
accurately report fixtures cot4ld result in increased sewer fees * .
QnAgtlty lw (Fixture) Work Performed
Fixture Type: Replace
A-,I,. t,faced itsictitat , capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub/Shower
- Jacum/Whirlpool
Car Wash -Each Stall _
-Drive Thru
Cuspidor/Water Aspirator i .
Dishwasher - Commercial j
- Domestic ;
Drinking Fountain
Eye Wash
Floor Drain/sink - 2" _
-3"
4, '
Car Wash Drain
Crarhagc - Domestic
Disposal - Commercial ; *Note: If the fixture work under this permit results in an
- linl
!cc MachJRefrig. increase of sewer EDUs, a sewer permit will be issued and
s. Drains ,
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rea 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.
- Ser vice i
Swimming Pool Filter i
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet _ . Plan review is required if fixture quantity total is ?9.
Urinal
Other Fixtures:
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00219
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/27/2005
Phone: (503) 639 -4171 it o ,a y � ilb ii
Inspection Requests (24 Hrs.): (503) 639 -4175 � - fi I .
INSPECTION WORKSHEET FOR DATE: 5/31/2005 TIME: 7:11AM PAGE: 31
SITE ADDRESS: 12180 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: GREENWAY TOWN CENTER LOT #: TYPE OF USE:
PROJECT NAME: WU'S OPEN KITCHEN
DESCRIPTION: Installation of backflow device.
OWNER: SAUNDERS, WILLIAM W TRUSTEE, PHONE #:
CONTRACTOR: WOLCOTT PLUMBING CONTRACTORS PHONE #: 503-667 -1781
Inspection Request Scheduled For: Date: 5/31/2005 Pour Time: /-•-
Code # Inspection Description Confirm # Contact # Message �
325 RP/backflow preventer 008009 -01 503235 -8784 Y '
Corrections /Comments/ Instructions: •
.--- i
14 ... ..
i
ninl ,
ASS ❑ PARTIAL APPROVAL ffj CANCEL ❑ NO ACCESS
FAIL O9ALL FOR INSPECTION % ADDITIONAL FEES ASSESSED
Inspector: fr kr\O Date: 1 Phone #: (503) 718 -