Permit CITY TIGARD PLUMBING PERMIT
* t' I Nttitl'�' l DEVELOPMENT SERVICES PERMIT #: PLM2003 -00039
'�' r � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/21/03
SITE ADDRESS: 11365 SW TIGARD ST PARCEL: 1S134DC-00700
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: A2.1 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 5
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 120 ft
WATER CLOSETS: WATER LINE: 170 ft
DISHWASHERS: RAIN DRAIN: 640 ft
Remarks: Site plumbing work for new building. Includes (4) rain drain connectors.
FEES
Owner:
Description Date Amount
BAPS TEMPLE
PO BOX 41160 [PLUMB] Permit Fee 11/21/03 $685.60
SAN JOSE, CA 95160 [PLMPLN] Plan Review 11/21/03 $171.40
[TAX] 8% State Tax 11/21/03 $54.85
Phone : 408 - 453 - 6464 Total $911.85
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005
REQUIRED INSPECTIONS
Phone : 643 7619 Sewer Inspection
Water Service Insp
Reg #: LIC 12889 Storm Drain Insp
PLM 34 - 4PB Storm Drain Insp
Storm Drain Insp
Rain Drain Insp
RP /Backflow Preventer
Final Inspection
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.
(
Issued By: �lvr.G2� Lti Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
- Site Utilities! 5/-/6 -(63 - Phip `brag Permit Application I v() Y FOR OFFICE USE ONLY
Received Plumbing
. • . Sewer
J Date /By: � - �/ -03 O Permit No : 1-- M x 003 - 00(�
City of Tigard., Planning Approval `
C E
E I ` V / E® Date /By Permit No -�
13125 SW Hall Blv C C Plan Review Other Q
Tigard, Oregon 97223 Date/By Permit No.:
Phone: 503- 639 -4171 IAN 58315920U330 ° ' I Post - Review Land � n
/ 4,, Date/By Case No.: o.: r v )
Internet: www.ci.tigard.or.us e . iI Contact Juns • ® See Page 2 for
P �0310L3 N
24 -hour Inspection Re Contact
thod • Supplemental Information.
BUILDING
i 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
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial SFR ( bath 350.00 4
❑ Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder g Other: -T g Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq ft.. Page 2
Job site address: 1 t.,5 4.-vi THAN!) S7 • Site Utilit ps
Suite #: I Bldg. /Apt. #: Catch basin /area drain ` S 16.60 83 3.a/
Project Name: ? -S 'T
- Drywell /leach line /trench drain 16.60
1 �• Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
I IS T I4 A✓ Manholes 16.6
Rain drain connector / 16.6 [yC .9 6 /rG y
Sancta sewer no. linear ft. • , • Pare 2 I► a /0 /'
S torm sewer (no. linear ft) -� /' T,( Page 2 2 7 35 /6/. Subdivision: Lot #:7o�p �v
I St3 4 0�- 6C7 Water service (no. linear ft.) \ /7 Page 2 ,, �, 'O/6/• 90
Tax map/parcel #: 0D Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
NEVI CONS 01.4C- /i w G,( A 7 4PLG Backflow preventer Page 2 'I
Backwater valve 16.60 1'4..
Clothes washer 16.60 _
Dishwasher 16.60
Drinking fountain 16.60 _ �ti _.
X PROPERTY OWNER I 0 TENANT Ejectors/sump 16.60
Name: B. A • p• S 7 P 1PLE Expansion tank 16.60 r
Address: P. Q • 9t 0( 1.411/.. Fixture /sewer cap 16.60
City /State /Zip: SA,. 3 c A 9,6( Lb Floor drain/floor sink/hub 16.60
Garbage disposal 16.60 ��
Phone: L}og -y53 - 6464 Fax:' 9. 4.S3 - o L Hose bib 16.60
❑ APPLICANT RCONTACT PERSON Ice maker 16.60 a'
Name: pAn c,K PA7'6e. Interceptor /grease trap 16.60 ,
Address: Q. o . pa 41166 Medical gas - value: $ Page 2 1 ,
Primer 16 60
City /State /Zip: SAN 3'0 4 , C4 9.51 66 Roof drain (commercial) 16.60 ` L
Phone:44M- 64 /,‘, I Fax: lfbii -4s-3-.123i. Sink/basin/lavatory_ _ 16.60
E -mail: PAAi ."H 42 Aurusfou- riN' • C bt►h Tub /shower /shower past _ 16.60 .
CONTRACTOR Urinal __ 16.60
Business Name: � €P, - oe P t.tut4Pait / ' Water closet 16.60
Water heater 16.60
Address: 39 $® 61.0 TJ , 1 tii3 Other:
City /State /Zip: P& S ti - 1 D 3 aP._ '7O0 J Other:
Phone: C944. ° ?(21 q Fax:
Plumbing Permit Fees*
CCB Lic. #: /A�Z' Plumb. Lic.#: 3 - ii p b Subtotal $
Minimum Permit Fee $72.50 $
Authorized - / Residential Backflow Minimum Fee $36.25 / y! S ion
Signature: fs.�.•� Date: Plan Review (25% of Permit Fee) S / 7/ , •iD
PA& FJII f frf . State Surcharge (8% of Permit Fee) $ 54. S'S
(Please print name) TOTAL PERMIT FEE $ Q //, 8
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. Or (
lr (,
is \ Dsu\Permit Forms \P1mPermitApp.doc 01/03
•
iI
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain /Floor Sink 2" 16.60 PLEASE COMPLETE:
3" 16.60
4" 16 60
Water Heater 0 conversion 0 like kind 16 60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46 40 Sink
MFG Home New San/Storm Sewer 46 40 Lavatory
Tub or Tub /Shower
Hose Bibs 16.60 Combination
•
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16 60 Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer- 1st 100' 4. 55.00 56 .- - 3"
Sewer - each additional 100' 46.40 i i vo 4"
Water Service - 1st 100' 55.00 Water Heater
00
Water Service - each additional 200' 46.40 Other Fixtures
� / `�O (Specify)
Storm & Rain Drain - 1st 100' • I o 55.00 SS 09
Storm & Rain Drain - each additional 100' 46.40 , - .1Ib
Commercial Back Flow Prevention Device 46 40
Residential Backflow Prevention Device' 27.55
Catch Basin [ 16.60 3i00
Inspection of Existing Plumbing or Specially ✓ 72 50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL #IQ cO
8% STATE SURCHARGE
* *PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty total is > 9
TOTAL $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
i:\dsts \forms\plm- fees.doc 08/29/01
I .
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223 NOV`2 5 2003
IMPORTANT PERMIT NOTICE •
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005
Plumbing Signature Form
Permit #: PLM2003 -00039
Date Issued:
Parcel: 1 S134DC -00700
Site Address: 11365 SW TIGARD ST
Subdivision:
Block: Lot: •
Jurisdiction: R-4.5
Zoning: TIG
Remarks: Site plumbing work for new building. Includes (4) rain drain connectors.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
BAPS TEMPLE BEAVERTON PLUMBING INC
PO BOX 41160 13980 SW TUALATIN VALLEY HWY
SAN JOSE, CA 95160 BEAVERTON, OR 97005
Phone #:408- 453 -6464 Phone #: 643 -7619
Req #: LIC - 12889
PLM 34 -4PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Authorized PI •:•er
If you have any questions. please call 503.718.2433.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7— /..0 AM PM BUP
/
Location l / 3 (p .S �c ���,� Suite MEC
Contact Person PJ), Ph ( ) c(‘' a /!'' T PLM 49603 X63
Contractor Ph ( ) SWR
BUILDING Tenant/Owner G f( �� ELC
Footing /
Foundation ELC
Ftg Drain Access: 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
.101.a�.Irda
II rain -►
a c :asin / Manhole
rai
Shower Pan
Other:
• ` 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: ❑ Unable to inspect — no access
Fire Supply Line
ADA /
Approach/Sidewalk Date ! _ � Inspector \' l/ Ext
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL