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Permit _ IF A CITY OF TIGARD PLUMBING PERMIT i DEVELOPMENT SERVICES PERMIT #: PLM2003 -00241 Al- 6 'I I - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/4/03 SITE ADDRESS: 12930 SW SCHOLLS FERRY RD PARCEL: 1S133AD -02200 SUBDIVISION: ZONING: R -7 BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: E2 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 2 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of (2) outside drinking fountains. 1 located near portable classroom and 1 located near classroom building. FEES Owner: Description Date Amount WESTGATE BAPTIST CHURCH 12930 SW SCHOLLS FERRY RD [PLUMB] Permit Fee 6/4/03 $72.50 TIGARD, OR 97223 [TAX] 8% State Tax 6/4/03 $5.80 Total $78.30 Phone : Contractor: KEVIN SHARPE PLUMBING 3851 SW CULLEN BLVD PORTLAND, OR 97221 REQUIRED INSPECTIONS Phone : Top -out lnsp Final Inspection Reg #: LIC 112898 MET 00004632 PLM 26 -593PB 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 - / r Issued y: �t _ , /�L Permittee Signature: d � v • Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day liuticiing + txtures PlumbiaMrermit Application FOR OFFICE USE ONLY Received d Plumbing D ikogt A // Date/By: � l � j if 0 3 Permit No.: City of Tigard Planning Approval Sewer G, City g Date/By: Permit No.:OY.()1. 5r00/7 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 DatcLBy: Permit No.: Post - Review Land Use Phone: 503 - 639 -4171 Fax: 503 - 598 -1960 / /arr „ 0..,� DateB : Case No.: Internet: www.ci.tigard.or.us li� Contact Juri .: ® 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 . Qty I Fee(ea.) I Total ❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings CATEGORY OF CONSTRUCTION (includes 100 ft for each utility connection) ❑ 1 & 2- Family dwelling ..Commercial/Industrial SFR (1) bath 249.20 SFR (2) bath 350.00 DAccessory Building ❑ Multi - Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2 Job site address: L Z I Lo w 5 c stocks - ttv R tN Site Utilities Suite #: 1 Bldg. /Apt. #: Catch basin/area drain 16.60 Project Name: t TC- Cs CAP TA g t" Drywell/leach line/trench drain _ 16.60 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: 1 Lot #: Storm sewer (no. linear ft.) Page 2 Tax map /parcel #: Water service (no. linear ft.) Page 2 DESCRIPTION OF WORK Fixture or Item Absorption valve 16.60 T tvSC KLL fw o vTS to Backflow preventer Page 2 - DvLurieg,A , C- 00A�Trk S Backwater valve 16.60 b Clothes washer 16.60 Dishwasher 16.60 4 .I ROPERTY OWNER I ❑ TENANT Drinking fountain j 16.60 p Ejectors/sump / 16.60 Name: i,3‹:,-;T t� AA9TvS -c CN i,o_c IN Expansion tank 16.60 Address: I zi 3o S,,J Sc ttou.S �l fQ(1. , / (Z.o Fixture/sewer cap ! 16.60 City /State /Zip: ice,' Gk& p 6 rL C�61J S'7 ZZ 3 Floor ge disposal sink/hub 16.60 r Garbage disposal 16.60 Phone: $o3 5z 3S 60 Fax: spa szcl L1 SL(.) Hose bib 16.60 J APPLICANT [CONTACT PERSON Ice maker 16.60 Name: Z go,, k3 4 ) 0 ccn,v interceptor /grease trap 16.60 Address: 1 C,,`71 S S L,..) c it-Kg ,crrCIeS - SZ V p Medical gas - value: $ Page 2 City /State /Zip: °T ( a2b Oet q )O gS P o mer 16.60 r Roof drain (commercial) 16.60 Phone: $6 3 n 72 ? 3 °i Z I Fax: Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower. pan 16.60 CONTRACTOR Urinal 16.60 • Business Name: i [ vtr,l ? SHrtP� Pr A;w�� ►tJCr Water closet 16.60 Water heater 16.60 Address: Other: City /State /Zip: Other: • Phone: ' Fax: Plumbing Permit Fees* Subtotal $ CCB Lic. #: I 12.'35'15 Plumb. Lic. #: , (6 - 513 kg Minimum Permit Fee $72.50 $ Authorized Residential Backflow Minimum Fee $36.25 7p? 5-0 Signature: � 4/a.ri ki- 5 -,Z 7- 03 Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) $ 6 • so (Please print name) TOTAL PERMIT FEE $ 78 • 30 Notice: This permit application expires if a permit is not obtained within All 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 - I" 100' 55.00 0 to $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" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic p 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 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested 7 G f AM PM BUP Location __ 7 )� f MEC Contact Person Ph ( S 7 a — 7 W.3---PLM 3 - oc) Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ,gyp ELC g Access: /e ELR Ft Dr Crawl Drain Slab Inspection Note . SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler e „i t 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 Other:�� PART FAIL HANICAL 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: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Other: Date , /,0- Inspector Ext / Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL