Permit CITY TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00354
Ai' SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/3/2004
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 570 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: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: 1 SF RAIN DRAINS:
SINKS: 5 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 3
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI. Other fixtures: 1 backflow and 1 med gas 1 primer.
FEES
Owner:
Description Date Amount
PORTLAND OFFICE ASSOCIATES [PLUMB] Permit Fee 9/3/2004 $367.90
BY TC PORTLAND, INC [PLMPLN] Plan Review 9/3/2004 $91.98
8930 SW GEMINI DR
BEAVERTON, OR 97008 [TAX] 8% State Surchari 9/3/2004 $29.44
Phone : • Total $489.32
Contractor:
DP PLUMBING
904 S. CHEHALEM
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone : 503 - 537 - 9492 Rough -in Insp
Underfloor /Underslab
Reg #: PLM 110612 Top -out Insp
LIC 36 - 70PB 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: A �� / Permittee Signature:(
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures o( �, �cr,... Y -00e gy / �!a( '0 /Sow
Plumbing Permit Applico�h����� FOR OFFICE USE ONLY •
City of Ti g and Received
`J JUL '' �O Date/By: , d ti. u Permit No.: IL, i i // -t003 /
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.639.4171 Fax: 503.598.1960 • /y+c D �l „ 5 -- - 0...
)
Other Permit No.�ROb4 oQ
24- Hour Inspection Line: 503.639.4175 CITY OF TIG � j � l � e
Internet: www.ci.tigard.or.us BUILDING DI - . - - `' 1- Date ed /Me y: �° S See Page 2 for
g Notified/Method: Supplemental Information `S
°: - 4 =" ' ". ` TYPE OE ;WORK -:" _: � , 2, ':,, �? " .F SCH , , , . -
■
0 New construction 0 Demolition For special information use checklist.
Description I Qty. I Ea. I Total -O
❑ Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
r'; .'CATEGORY,, CONSTRUCTION;; '-c.'".: . v.,< - " 1 ` . SFR(1)bath 249.20 •
❑ 1- and 2-family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
C.
ID Accessory building ❑ Multi - family SFR (3) bath 399.00 `\
Each additional bath/kitchen 45.00
❑ Master builder 0 Other: Fire sprinkler ( sq. ft.) Page 2
' ? ;JOB, SITE' INFORMATION, AND..LOCATIONF., ?-1-,-
', : � ., ; '::' • `�:. �'' ' ... .. .. -- _:.. .. . _ ' '= %I " Site utilities
Job site address: C O 0') 5 As/ JJ N 5 v t I' E _Catch basin or area drain 16.60
City / State/ZIP: (Z Drywell, ell, leach line, or trench drain 16.60 • Suite/bldg. /apt. no.: Project name: y Footing drain (no. linear ft.: ) Page 2
�� S `�� � Manufactured home utilities 110.00 "■„...'
Cross street/directions to job site:
Mans 16.60
/\.
J / V Rain d draain 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 1 I Paget ` p,4,
R ■.-V;.A.,% U Backwater valve 16.60
Clothes washer
/ 16.60 Flo (
Dishwasher 16.60
Drinking fountain 16.60
- • RI; PROPERTY: OWNER , -„ 11 : ❑' ,TENANT <. .,.=: .,
Ejectors /sump 16.60
Name: P 'lD Cr.% le-6 W-0,00e, • Fay i1. Nivi -L -P b I rx., Expansion tank 16.60
Address: 9 , J G E l N 1 - D Q . , Fixture/sewer cap 16.60
City/ State/ZIP: �� l 7 ? Ca
OD Floor drain /floor sink/hub AB / 16.60 i j, 40
Phone: (_ ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
❑;:APPLICANT,.:• . . . ■• CONTACT` PERSON . • Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $3,06 I Page 2 7A,
Address: Primer I 16.60 J/0 Zoo
City/State/ZIP: Roof drain (commercial) •• ll 16.60
Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 3 / _ £Arh 7 16.60 /1(o ,
Tub /shower /shower pan , 16.60 d 0
E -mail:
Urinal 16.60
'CONTRACTOR , +i:. , : %• Water closet at 16.60 3 3 x
Business name: o ii )1....V t .-. �‘. N1 Water heater / 16.60 / ( ipO
Address: ° OH S- (t-I &Hilt -P� Other: /tAui IRA/ I ,.
/ State/ZIP: N \'\ Subtotal
Ci
ty w d �R '� oit 57 2- M permit fee: $72.50
Phone: (303 )5-7- 9141,' Fax: ( ) Residential backflow minimum permit fee: $36.25 3101, go
CCB Lic.: ‘ i o 1 Plumbing Lic. no.: ..6---) 0 8 Plan review (25% of permit fee) G) � �
L State surcharge (8% of permit fee) 0 19 . 4g
Authorized signatureyc2
Qiy , �r �� TOTAL PERMIT FEE C/ pq . 30-
Print name: .49,2/Zcy1i "l4l6k Date: 7/2 r This permit application expires if a permit is not obtained within
/ 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Pemuts\PLMF- PennitApp.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" 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
- 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./Refrig. 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 Q
Quantity Total
- Bradley
- Commercial t6- Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes L--
Water Extractor Plan Review
Water Closet - Toilet r? Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures: „.4){l,r /
y
i:\ Building \Permits\PLM•PennitApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line:. (503) 639 -4171 MST
p
4 V D ate Requested /,;\ r l AM �PM BUP
Location 9 n Z- (2-) DPI' SQ Suite ,S 7 MEC
Contact Person Ph ( )-- — 7 4' o p PLM c .240 ( / 6035 �(-
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain f N 6--L._ ELR
Crawl Drain
Slab Inspection Notes: c SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing /
Firewall
Fire Sprinkler — _ / AIM"
Alarm /
Susp'd Ceiling traria
Roof ,
Other: - Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Ma. ole
Storm Drain
Shower Pa
Other:
dre 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 //
/; "?7/7-
Approach/Sidewalk Date u Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site. .
PASS PART FAIL