Permit C ITY - OF TIGARD PLUMBING PERMIT
°. COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00086
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/4/2008
PARCEL: 1S 133AD -02200
SITE ADDRESS: 12930 SW SCHOLLS FERRY RD ZONING: R - 7
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: WESTGATE BAPTIST
Project Description: Installation of backflow preventer for irrigation system.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: NONE FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WESTGATE BAPTIST CHURCH Description Date Amount
12930 SW SCHOLLS FERRY RD
TIGARD, OR 97223 [PLUMB] Permit Fee 3/4/2008 $72.50
[TAX] 8% State Surcha 3/4/2008 $8.70
Phone : . Total $81.20
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -691 -6166
FAX 503- 691 -6771
Reg #: LIC 87906
PLM 34 -250PB
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 dirart uestions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued y: k i �� ��.a�i .4
Permittee Signature: ' il- A■ ..
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.
Pins, miing Permit Application
Received 6
FOR OFFICE USE ONLY
4/ �r '
� � /l /� g - n
City of Tigard Date/By: ' (/� / Permit No.: �+ ( Q jj fC/
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
III . Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Read /B s: RI See Page 2 for
Internet: www.tl
T I G n R D ardor. ov Ready /By: �� 5, B
g g Notified/Method: � (� Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
E l 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 ❑ 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: / ' 'r 3 0 51.3 .5c/1 CL S Catch basin or area drain 16.60
City/State /ZIP: T. C- A 0 e c 7 Z z 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: /3 �,�A-Ls 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
n DESCRIPTION OF WORK Backflow preventer Page 2
R ,'TN opt�8tl.: tl'� P z eutG G (Ay %Ol3 gca C ( -ci- Backwater valve 16.60
Clothes washer 16.60
XPROPERTY Dishwasher 16.60
OWNER I ❑ TENS Drinking fountain 16.60
Ejectors /sump 16.60
Name: &) OSrZ/ -r grp ns r CI-km.4 Expansion tank 16.60
Address: IZ 1 3 0 S c,.I nC HOU FL-12e et. Fixture /sewer cap 16.60
City /State /ZIP:- UG,frjZo QA.) 22 Floor drain/floor sink/hub 16.60
Phone: (S 03) sz c( 3g d2 Fax: ( ) 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: / Pe. )r44/ Water heater 16.60
Address: Other:
City/State/ZIP: Subtotal
Minimum permit fee: $72.50 S[)
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 7� -
CCB Lic.: p ?CC, Plumbing Lic. no.: 3 q z o QZ, Plan review (25% of permit fee) r•$
State surcharge (12% of permit fee) '8, 70
Authorized signature: R14 44:^..)1 bt, TOTAL PERMIT FEE g' .
Print name: (/ - /J7 V . Date: 3 - t( - a ? This permit application expires if a permit is not obtained within
/��' I ` 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\ Building \Permits\PLM- PermitApp.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
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
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
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
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, 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 ❑ 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
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918 780 - 0040.
- Jacuzzi/Whirlpool
Car Wash - Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Stall ❑ 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.
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
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 \Prnnits\PLM- PermitApp.doc 12/27/06
•
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008- 00036
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3!'1/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .�
INSPECTION WORKSHEET FOR DATE: 3/20/2008 TIME: 7:02AM PAGE: 4
SITE ADDRESS: 12930 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WESTGATE BAPTIST
DESCRIPTION: Installation of bad-dicta prnventer for irrigation system.
OWNER: WESTGATE BAPTIST CHURCH, PHONE #:
CONTRACTOR: MODERN PLUMBING PHONE #: 503-691
I Inspection Request Scheduled For: Date: 3/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 0670530/ 503-572-7392 N
Corrections /Comments /Instructions:
Ca,r c1L-4
KPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: fl'n' \ \ \ Date: �a j �� Phone #: (503) 718-