Permit I
C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2004 -00278
� , DEVELOPMENT SERVICES D ATE ISSUED: 6/21/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12240 SW SCHOLLS FERRY RD PARCEL: IS134BC -00300
SUBDIVISION: GREENWAY TOWN CENTER ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 0 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace water heater, hand sink & drinking fountain.
FEES
Owner:
Description Date Amount
BPP RETAIL LLC
BY BURNHAM PACIFIC PROPERTIES [PLUMB] Permit Fee 6/21/2004 $72.50
ATTN: JOHN WATERS [TAX] 8% State Surchari 6/21/2004 $5.80
SAN DIEGO, CA 92101 Total $78.30
Phone:
Contractor:
DP PLUMBING .
904 S. CHEHALEM
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone : 503 - 537 - 9492 Rough -in Insp
Final Inspection
Reg #: PLM 110612
LIC 36 -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
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 -6
Issue By: _�� ,'A _ / ,, 1 Permittee Signature:2( i( (UUi.OM P
- Call (503) • 39 -4175 by 7:00 P.M. for an inspection needed the next business day
Buildiw Fixtures
,r
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Da /. al de( Permit No.: Lt./ 2�(r� OOa
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review v`
Phone: 503.639.4171 Fax: 503.598.1960 i il � i \ DateBy: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 ■ �, I J
Internet: www.ci.tigard.or.us Date ed /Me S y: See Page 2 for
g Notified/Method: Supplemental Information
- TYPE OF WORK . . . - . FEE *, SCHEDULE , :.;r -- :, ' - .� . ` , .. - <. • :.
❑ 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 pa Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
E] Master builder ❑Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB. SITE INFORMATION AND LOCATION Site utilities
Job site address: 1' 22_ y( &u) 6v(9`` f� 1, Lo hay '�[ , Catch basin or area drain 16.60
City/ State/ZIP: � Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: 1 - fd Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: -
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 Page 2
It2 (or SnAk / Lt/ e( Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain r 16.60 /-/ . G d
❑ PROPERTY.. OWNER , ❑ TENANT
Ejectors /sump 16.60
Name: i p p CL -ril 1 L. ��
L. Expansion tank 16.60
Address: �u(Lti ) p,,l 1 1"QOPikfi S Fixture/sewercap 16.60
City/State/ZIP: bR>J�) l if i�, r t ( t e ?-/Q / Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) I 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 co 'al 16.60
Phone: ( ) Fax:: ( ) Sink n/lavato' i 16.60 ��o , /o 0
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR - Water closet 16.60
Business name: Op 60 ( hi - Water heater i 1 6.60 /6,
Address: 9 S CC, � , t tr,,,, / S Other:
City/ State/ZIP: l Z Subtotal
- Minimum permit fee: $72.50
Phone: ( S3) cg - 2 _ q cpqZ Fax: ( ) Residential backflow minimum permit fee: $36.25 ?a , SO
/ P Plan review (25% of permit fee) _
CCB Lic.: 111 f,.. Plumbin 'c. no.: 3t3 -�D
Authorized signature: gilt' S tate surcharge (8% of permit fee) j , rU Q/U(�(Au� TOTAL PERMIT FEE 7 q x C)
Print name: del r PIQc Date: 6 ZV 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 B ' Industry Service Board.
is\ Bui !ding \PamitsTt.MF•PemutApp.doc 12/03 440- 4616T(10/02/COM/WEB)
J
Plumbing Permit Application - City of Tigard F _
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
Fixture or-Item • • Qty. Fee (ea) Total. additional $100.00 or fraction thereof, to and
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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
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" 1
-3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice MachiRefrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
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
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:lBuilding\ Permits \PLM- PermitApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
p BUP
Received Date Requested o 11 AM PM BUP
Location - - 4. .: � / ii-L-1 ii-L-1 uite MEC
Contact Person Ph ( / ) St7- 7446S PLMa0 y- -007SI
Contractor Ph ( ) SWR
BUILDING Tenant/Owner /?J:2 a A A ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
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
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
�
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 III Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE 0 Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line ��
ADA / // t Approach/Sidewalk D L ` Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL