Permit 1*
C ITY OF TIGARD PLUMBING PERMIT
IA DEVELOPMENT SERVICES PERMIT #: PLM2004 -00212
`�' I° 13125 SW Hall Blvd., Tigard, OR 9 (503) 639 -4171 DATE ISSUED: 5/19/2004
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 500 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: 1 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Add building fixtures. Other fixtures include water heater and primer.
FEES
Owner:
Description Date Amount
PORTLAND OFFICE ASSOCIATES
BY TC PORTLAND, INC [PLUMB] Permit Fee 5/13/2004 $83.00
8930 SW GEMINI DR [TAX] 8% State Surcharl 5/13/2004 $6.64
BEAVERTON, OR 97008 Total $89.64
Phone:
Contractor:
DP PLUMBING
904 S. CHEHALEM
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Top -out Insp
Reg #: PLM 110612 Final Inspection
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 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: ! Permittee Signature: J/ L � _�
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next bus ne s day
�'c'' Bop wog-00
Building Fixtures ASi .:),(p -► /
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received i3 00 Permit No /O /f .��p�{ d�
13125 SW Hall Blvd , Tigard, OR 97223 Plan Rorie i
Other Permit No :, '�-� _� ��pp ..�� M�
Phone: 503.639.4171 Fax: 503.598 1960 GH��NI� `� Date/By ateW ����
24- Hour Inspection Line. 503.639.4175 CO Date Ready/By -runs El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
TYPE OF WORK _ - FEE* SCHEDULE •
IN New construction ❑ Demolition For special information use checklist.
Descnptton I Qty Ea 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 MiCommerciaUtndustnal SFR (2) bath 350 00
El 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: Om a-0 SW 14_ SQ tra 5-co Catch basin or area drain 16 60
City/State/ZIP: . f G _p Drywell, leach line, or trench drain 16 60
Suite/bldg. /apt. no.: I Project name: 1 7 C ( � 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
. - DESCRIPTION OF WORK + . Backflow preventer Page 2
J-iMl ll Sing i I" '� Le Cder healtr, Backwater valve 16 60
Clothes washer 16 60
Dishwasher / 16 60 /6,690
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16 60
Name: Expansion tank 16 60
Address: Fixture/sewer cap 16.60
City/State /ZIP: Floor drain/floor sink/hub c7 if ( 16.60 /( , 4,6
Phone: ( ) 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 1 16 60 l tp, 100
City/ State/ZIP: / Roof drain (commercial) 16 60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory f 16.60 i V .
Tub /shower /shower pan 16 60
E -mail:
Unnal 16 60
, CONTRACTOR Water closet 16.60
Business name: Op p [ u Tw ( , Water heater ' 16.60 I to 1o0
Address: cio o S. r ke, Other.
City/State/ZIP: g -2 /3z, 13 Subtotal
Minimum permit fee $72 50
Phone: ( ) J 71 4( q Z Fax: ( ) ,fig - 13o6 Residential backflow minimum permit fee $36 25 ` 1?3'a
CCB Lic.: 1 t O i + Plumbing Lic ao.: 3 6, 70 pQ Plan review (25% of permit fee)
p&thi,, State surcharge (8% of permit fee) ,(p af{ Authorized signature: ^ TOTAL PERMIT FEE - , (p
Print name: 11) a Pre I4 / l e ( Date: S'/r3 /Ol( This permit application expires if a permit is not obtained within
J l 180 days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board
I \Building\Pcmuts\PLMF- PerrttitApp 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:
Sile 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, 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:
Baptistry/Font
Bath - Tub /Shower • J
- Jacuzzi/Whirlpool S I ia�C f3 rP IO ca { to � ' �J ' Dm S UiTc
Car Wash -Each Stall
-Drive Thru �_ •
Cuspidor /Water Aspirator !7 '(-
0 40 1 �s H eU1 suite � Soo,
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
Ice Mach. /Refrig Drains increase of sewer EDUs, a sewer permit will be issued and
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 t ( 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.
Urinal
Other Fixtures:
t \ Buildmg\Pernuts\PLM- PerntitApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
(e(g BUP
Received Date Requested AM PM BUP
Location 0 6 1 O� Ski LAk Sk �w � KAY Suite SZTO MEC
Contact Person Ph (. _) 9 — PLM SL/— calms
Contractor 2P l� /) 1 IA. wkivjv Ph ( ) 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 t%
Roof a 1 ,
Other: ,
Final
PASS PART FAIL
P MBI
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot - •
PART FAIL
CHANICAL
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 / Y Inspector Ext
Other:
Final DO NOT R MOVE this inspection record from the job site.
PASS PART FAIL