Permit C ITY OF TIGARD PLUMBING PERMIT
I& DEVELOPMENT SERVICES PERMIT #: PLM2002 -00502
L
AL 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/30/02
SITE ADDRESS:. 12442 S W SCHOLLS FERRY RD * * ** PARCEL: 1SI346C -00401
SUBDIVISION: ZONING: C -N
BLOCK: LOT: JURISDICTION: TIG
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: URINALS: GREASE TRAPS:
LAVATORIES: 3 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing tenant improvement, adding (3) lays and (1) water closet.
FEES
Owner:
Description Date Amount
SISTERS OF PROVIDENCE IN OR
BY STEVE FOSTER [PLUMB] Permit Fee 12/27/02 $72.50
PO BOX 13993 [TAX] 8% State Tax 12/27/02 $5.80
PORTLAND, OR 97213 Total $78.30
Phone :
Contractor:
KSM PLUMBING INC
DBA SUNSET PLUMBING
PO BOX 23263
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone : 503 - 657 - 0010 Rough -in Insp
Top -out Insp
Reg #: LIC 141154 Final Inspection
PLM 34 -366PB
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
Issue By: �I -� , �// " Permittee Signature: �,�
Y � . L . � �- IL_�. 9 � ��2 /r/I
Call (503) 63 • -4175 by 7:00 P.M. for an inspection needed the next business day
Pluming Permit Application FOR OFFICE USE ONLY
.Q Received Plumbing `
Date/By: /A a 7 6' y �LKa�
Permit No.: ✓
Planning Approval Sewer A � 2 J (J ��
City of Tigard Date/By: Permit No.: /5
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 kit Post - Review Land Use
_d� l Contact Case No.:
Internet: www.ci.tigard.or.us ,.•I I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings Y
(includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (l) bath 249.20
❑ I & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00
❑Accessory Building ❑ Multi- Family SFR (3) bath 399.00 9
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: / 2... W2. sec) _Lo//j .,---.frieL4 Site Utilities ' P
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Drywell /leach line/trench drain 16.60
Project Name: S c 4 o// 5 a e_I-L.' Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
DESCRIPTION OF WORK Fi xture or Item `ti
Absorption valve 16.60 (t.
/(4 g 72- 1 I 4 `J /try,11 -, S Fitt il(XF) ` 1 44 /C- Backflow preventer Page 2
i 1-,z,/ Backwater valve 16.60
(E XAM mss) 2-54A-3 Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER I U TENANT Ejectors/sump 16.60 v,
Name: ,- ,ST�,e.S O ` *tit - D Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/Zip: Floor drain/floor sink/hub 16.60
Garbage disposal . 16.60
Phone: Fax: Hose bib 16.60
0 APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60 S
Address: Medical gas - value: $ Page 2 `�
Primer 16.60
City /State /Zip: Roo • o rci�� 16.60
Phone: I Fax: Siiik/b sin lavatory / 3 16.60
E -mail: Tub /shower wer pan 16.60
CONTRACTOR Urinal 16.60
Water closet • i 16.60
Business Name: /6 AA p,,,,.,4,,i Water heater 16.60
Address: flo- (3 0 4- 23ZC' 3 Other:
77
City /State /Zip. ar o 2 3 ? o r / Other:
Phone: 43-64 -oa(a Fax:
Plumbing Permit Fees*
CCB Lic. #: /I !!5 Plumuf ic.#: 3 - 3(6Q Minimum Permit Fee $72.50 •
Authorized l q Residentia : • �� �b •
Signature: , ,.: / � Date: { 0� -d--7-° 2 Plan Review (25% of Permit Fee) $
9(' 1 1 2 /(/ State Surcharge (8% of Permit Fee) $ 5 • €
l (Please print name) TOTAL PERMIT FEE _ $ 7 S i J 0 v
Notice: This permit application expires if a permit is not obtained within MI new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri- County Building Industry Service Board.
i:'Dsts\Permit Forms\PlmPermitApp.doc 01/03
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 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, to and
Fixture or Item Qty. Fee (ea) Total 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or 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, 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 Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
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"
- 3"
-4"
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice MachiRefrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
•
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
BUP
Received ,1 I Date RIN s ted AM PM BUP
Location . I �'f `1 Z p.00 J Suite MEC
Contact Person Ph ( ) PLM a — eo SG
Contractor s Ph ( ) G S 7 6 1 b SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation 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 L, qvur
PASS PART FAIL l
PLUMBING
Post & Beam
Under Slab
Rough -In L.-at> l rO
Water Service
Sanitary Sewer
Rain Drains ' ■••••I '' • A -
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot. : r:
•4
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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date ` 7 _ Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL