Permit u '..,
AI,
CITY OF TIGARD PLUMBING PERMIT
IA DEVELOPMENT SERVICES PERMIT #: PLM2003-00040
� fl -' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/21/03
SITE ADDRESS: 11365 SW TIGARD ST PARCEL: 1 S134DC 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: 1
OCCUPANCY GRP: A2.1 FLOOR DRAINS: 13 TRAPS: 0
STORIES: 3 WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: 1 GREASE TRAPS: 1
LAVATORIES: 9 OTHER FIXTURES: 28
TUB /SHOWERS: 4 SEWER LINE: ft
WATER CLOSETS: 7 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Building fixtures for new building. Other fixtures are: (2) drinking fountains, (1) expansion tank, (3) hose bibs,
(6) primers & (16) roof drains.
FEES
Owner:
Description Date Amount
BAPS TEMPLE
PO BOX 41160 [PLUMB] Permit Fee 11/21/03 $1,175.20
SAN JOSE, CA 95160 [PLMPLN] Plan Review 11/21/03 $293.80
[TAX] 8% State Tax 11/21/03 $94.02
Phone : 408 - 453 -6464
Total $1,563.02
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005
REQUIRED INSPECTIONS
Sewer Inspection
Phone : 643 - 7619 Water Line Insp
Reg #: LIC 12889 Water Service Insp
PLM 34 - 4PB Underfloor /Underslab
Top -out Insp
Rain Drain Insp
RP /Backflow Preventer
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) 46 -6699.
I
Issued By: C / <i -CL Permittee Signature: ..
l .,..
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
• Building Fixtures RECEIVED FOR OFFICE USE ONLY
Plumbing Permit Application Received pia Plumbing
. AN 3 1 2003' Date/By: / -" 3 - 05 DP Permit No. ,- 7, -0SO
Planning Approval Sewer
• City of Tigard CITY OF TIG • '',11. Date/By: Permit No a`uog 3- /?3
13125 SW Hall Blvd. BUILDING DIV ■ Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
/Gad to Date/By Case No.:
Internet: www.ci.tigard.or.us e!I 1 Contact tuns • IN 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 Fec(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
1 & 2 dwelling SFR` () bath 249.20
❑ y g ❑ Commercial/Industrlal SFR (2) bath 350 00
❑Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder El Other: relPLt" Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: // 3/,,5 /1) .7767,kp Site Utilities
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: R, �jv\ R_E Drywell /leach line /trench drain 16.60
Footing drain (no. linear ft) ___Pa e 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: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: /c5 /(Y/bC - 00700 Water service (no. linear ft.) Page 2
Fixture or Item _
DESCRIPTION OF WORK Absorption valve 16.60
/\16u) Co rvs7 Backflow preventer /7 / Page 2 5`e . 40
Backwater valve 16.60
Clothes washer 16.60
Dishwasher , /t/ / 16.60 /640
Drinking fountain ✓ o Z 16.60 33 . P.0
]:PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name: a'/-F'1: 7E - j'Y) ?L6 Expansion tank 7 /- 16.60 /4.4/0
Address: Pm 60 )( 1 41 / to ?) Fixture/sewer cap 16.60
City/State /Zip: SA-N . .1 E CA • q5/ LO 1) Floor drain/floor sink/hub 7 /3 16.60 A 6 50
i • Garbage disposal 16.60
Phone:L /O -453 - 6 I/1 Fax:ypg - / -O a3 Z- Hose bib ✓ 3 16.60 qq. 8'D
❑ APPLICANT [,CONTACT PERSON Ice maker 16.60
Name: " )�'"2 / � A - 'TEL In terceptor /grease trap ✓ / 16.60 /6.
Address: 1'0 0 h 4 7 1 / / 100 Medical gas - value: $ Page 2
City /State /Zip: s4N .506 c q , q 5 (op Roof drain / 4 16.60 99. toe
l Roof d (commercial) 1- /(p 16.60 Ais,5% 66
Phone: yo3 -y53 4„( Fax: Sink/basin/lavatory t / ./A 16.60 /99 -
E -mail: Tub /shower /shower pan 1/ 16.60 (p¢. 'l0
n CONTRACTOR V Urinal s./ / 16 60 /4,60 D
Business Name: 1 rJ LtAHbi 00 I t Water closet v 7 16.60 MI , AD
Water heater / / 16.60 //p 4,c)
Address: 1 b-/€0 6aJ T J, 144`1 Other
City /State /Zip: 16 OP q 7005 Other.
Phone: LO4 3 - 7 to i 9 Fax: Plumbing Permit Fees*
CCB Lie. #: Subtotal $
l o1a$ Plumb. Lic. #: 3e�- P� M inimum Permit Fee $72.50 $ ( 75,a o
Authorized Residential Backflow Minimum Fee $36.25 //
Signature Date: Plan Review (25% of Permit Fee) $ e -9..9 8C)
State Surcharge (8% of Permit Fee) $ 9 . D -
(Please print name) TOTAL PERMIT FEE $ 1/ 5 .O :
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.
is \Dsis \Permit Forms \PlmPermitApp doe 01/03
ti
•
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 - l 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 - I st 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 increase of sewer EDUs, a sewer permit will be issued and
Disposal - Commercial
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. 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:
is \Dsts\Permit Forms \P1mPermitAppPg2.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 4° AM PM BUP
Location 3 - / ! .4' Suite MEC
•
Contact Person Ph ( ) PLM d DO3 — DO
Contractor Ph ( ) 6 4-t3 - 7' ( l SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: g,',0 1 SIT
Post & Beam
Shear Anchors f)-7(
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm / /
Susp'd Ceiling /. _ /I /
Roof
Other:
Final
PASS PART FAIL
PLUMBING /
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer uJ - ff.
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
AS - 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 El Please call for reinspe tion RE: / Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL