Permit „gt
CITY TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: P 281200 -00291
��' I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/28/2004
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 350 PARCEL: 1S126BC -01506
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 1 sink relocation.
FEES
Owner: -
Description Date Amount
WYSE INVESTMENT SERVICES CO. [PLUMB] Permit Fee 6/28/2004 $72.50
PORTLAND, ORR 97204 111 5TH AVE. 1100 [TAX] 8% State Surcharl 6/28/2004 $5.80
Total $78.30
Phone : 503 294 - 0400
Contractor:
DP PLUMBING
904 S. CHEHALEM
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone : 503 Top -out Insp
Final Inspection
Reg #: PLM 110612
LIC 36 -70PB
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
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.
/ L�O� 14/
Issued By: 0 /111.- _ � � _ � �� Permittee Signature: � ��,�,�
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Buil 'Wg Fixtures
•
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard EZ N 4 ermi o / Pt N 13125 SW Hall Blvd ,Tigard, OR 97223 ti 'I l
Phone: 503.6394171 Fax: 503 598 1960 k_ ,, y I y (�
1 ,; r Other Permit No
24- Hour Inspection Line: 503 639.4175 I CI I, Date/B Jura
W Date Ready/By ® See Page 2 for
Internet: www ci tigard.or.us Notified/Method: Supplemental Information
- +a >
FE * . =SCHEDUL
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty I Ea I Total
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 ukCommercial/mdustrlal 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
x ' , ; JOB SITE INFORMATION : AND 'LOCATION'', ' - • Site utilities
Job site address: 90 Za S (A) Ulus t l► ° . � t Catch basin or area drain 16.60
City/State /ZIP: Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: 3tc I Project name: 5 F 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
, DESC OF WORK - '.
• � . � - � .. , - Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16 60
Dishwasher 16 60
- Dnnking fountain 16 60
_ ` . .PROPERTY, OWNER, I` ; .❑ TENANT__ , — . m
/-_ Ejectors /sup 16 60
Name: nue t dre�i� C�e a Expansion tank 16 60
Address: l I ( S -) S'ick s U Q 'le (00 Fixture /sewer cap 16 60
City/State/ZIP: f ION iiiLb44 02 cl -7Z 2 q Floor drain/floor sink/hub 16.60
Phone: ( ) 2 { L(„ 0(00 Fax: ( ) Garbage disposal 16.60
Hose bib 16 60
'k ' N' APPLICANT '" ,❑ CONTACT PERSON ._
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 1 16 60
Tub /shower /shower pan 16 60
E - mail:
Unnal 16.60
. ' CONTRACTOR
Water closet 16.60
Business name: op P i U 10 N La-, Water heater 16.60
Address: CIO N S c """
k ( w 9-, Other -
l Subtota
�
City/ State/ZIP: h (� �� n/ � V Minimum permit fee $72.50
Phone: ( ) S Z 7 _ q f _t j Fax: ( ) s g . (f ?0 6 Residential backflow minimum permit fee $36 25 7 ,—
a
CCB Lic.: I r , Z Plumbing Lic. no : 36.10 /01:9 Plan review (25% of permit fee)
State surcharge (8% of permit fee) s, EfO
Authorized signature:
d/" , �l/l,c ft j' /�/ TOTAL PERMIT FEE 1Y, 30
Print name: air P f (4 Date. 6/Zoa This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board
i \ Building\Perrtuts\PLMF- PemutApp doc 12/03 440.4616T(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 t 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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:
$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, 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
•
Fixture Type: Replace
• New Moved Existing Capped Comments regarding fixture work:
Baptistr
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
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
-Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach. /Refng. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
- Commercial , Isometric or riser diagram is required if fixture quantity
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Unnal
Other Fixtures -
\Building\Pcmuts\PLM•PemutApp doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
g) I BUP
/U - Na P m Date , Req ° AM PM BUP
Location �oZ t/4'• c S'6 • Suite Ca-S MEC
Contact Person Ph ( ) PLM 4200 e a` I
Contractor Ph ( ) 57 - 7 7 `C 0 SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
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
PASS PART FAIL
972.g
PLUMBING
Post & Beam •
Under Slab •
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date �I y Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL