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Permit (86) A CITY OF TIGARD PLUMBING PERMIT rlAr DEVELOPMENT SERVICES PERMIT #: PLM2005 -00031 �'�" �.� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/25/2005 SITE ADDRESS: 16200 SW PACIFIC HWY W PARCEL: 2S115BA -02500 SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G BLOCK: LOT: 001 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: TI Plumbing Owner: FEES SN INVESTMENT PROPERTIES Description Date Amount 1121 SW SALMON STE 400 PORTLAND, OR 97205 [PLUMB] Permit Fee 2/25/2005 $72.50 [TAX] 8% State Surcharl 2/25/2005 $5.80 Phone : 503 242 - 2900 Total $78.30 Contractor: NORTHWEST WATER WORKS 40110 SE MEADOWSONG RD REQUIRED ITEMS AND REPORTS SANDY, OR 97055 Phone : 668 - 0375 Reg #: LIC 113197 PLM 3 - 333PB 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 ( 246- 9. Issued y: � Permittee Signature: / C Call (503) 639 -4175 by 7:00 P.M. for an inspection the next business day. This permit cans shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. Building Fixtures / I S 1 5 64 - O. 5 Plumbing Permit Ap PE IVE® _, FOR OFFICE USE ONLY City of Tigard IJNIV 26 2005 Date/By: / -....6, -05- �(m Permit No.: �/ ` - 6 � 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review / /x "' Phone: 503.639.4171 Fax: 503.598.1960 �.1 \ . '1 Date/By: Othe Permit No. S (,tl �O� -Da ©r.2 24- Hour Inspection Line: 503.639.41' ITY OF TIG `� il.1- r. I Date Ready/By: ' Tans 10 See Page 2 for Internet: www.ci.tigard.or.us • Notified/Method: Supplemental Information OF WORK FEE* SC ULE ❑ 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 CommerciaUindustrial 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 . , JOB SITE INFORMATION AND LOCATION Site utilities Job site address: ( („200 S \v PA e 1e..._ HWY Catch basin or area drain 16.60 City/State/ZIP: -1-Te 0-0 , C) cy a23 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project nameT ca. Footing drain (no. linear ft.: ) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: e14 awl (app 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.: l 01 Water service (no. linear ft.: ) Page 2 Fixture or item Tax map /parcel no.: 25 1, 1 5 eds. Absorption valve 1 6.60 D ESCRIPTION- OF WORK Backflow preventer Page 2 C_Ir lS a a44c3'' N Ew Te9 t 1 ` lEtktILY1 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 PROPERTY OWNER ., 0 TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: SK I Ky S r l'•=o- p€A - rES (_c_-L Expansion tank 16.60 Address: 1 (`_f S \\/ 5a0.Y10Nt 1 S4 ti... el...41;Q Fixture/sewer cap 16.60 City/State/ZIP: 1::=:,„ as. rte. Kp 7 cp,e c3•7 20 Floor drain/floor sink/hub 16.60 Phone: ( 4c 's) 21 - 2 - rae Fax: (6 2'14 --- 30, 9 Garbage disposal 16.60 - ., APPLICANT • • CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: "'"1"1,)/k, \ -/ A ar-14 l7 . I'S Interceptor /grease trap 16.60 Contact name: go e:„4 ,� Medical gas (value: $ ) Page 2 Address: 6''� Sw (( 4\ VC, Primer 16.60 City/ State/ZIP: �smQ.�.�,� Roof drain (commercial) 16.60 Phone: (r X4 4 Fax: : ( ) � _ (o�j( T in/1 tory j 16.60 ( �1 Tubs ower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR Water closet 16.60 1C0 4:5: Business name: -r yam. &i 10 41 - f 11--14)044.5 Water heater . 16.60 • • Address: Other: City/ State/ZIP: Subtotal g.5 !0 Minimum permit fee: $72.50 Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 '-'? Z 6 5 CCB Lic.: Plumbing c no.: Plan review (25% of permit fee) 1 *, la Gi .W % / State surcharge (8% of permit fee) /j 40 Authorized signature: - TOTAL PERMIT FEE -,`:,._ Print name: � 1 / Date: V 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 \Pemtits\PLMF- PermitApp.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:F ee:.: , : 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 • - . . . 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof, to specially requested inspections - per hour 72.50 and including $50,000.00. 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 -Ba&vatoryD ) Quantity Total Bra Isometric or riser diagram is required if fixture quantity - Commercial - Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet I Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: i :\ Building \Permits\PLM- PermitApp.doc 3/03 if a CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005 00031 4i0 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 2/25/2005 Phone: (503) 639 -4171 ii t1 t Inspection Requests (24 Hrs.): (503) 639 -4175 _ INSPECTION WORKSHEET FOR DATE: 4/7/2005 TIME: 7:14AM PAGE: 119 SITE ADDRESS: 16200 SW PACIFIC HWY W CLASS OF WORK: SUBDIVISION: TIGARD TOWNE SQUARE LOT #: 001 TYPE OF USE: PROJECT NAME: PARTY MART DESCRIPTION: TI Plumbing OWNER: SN INVESTMENT PROPERTIES, PHONE #: 503-242-2900 CONTRACTOR: NORTHWEST WATER WORKS PHONE #: 66B 0375 Inspection Request Scheduled For: Date: 4/7/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 003864 -01 503. 314 -1471 N Corrections/Comments/Instructions: e/ M -PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED i j/ Inspector: Date: 7 Phone #: (503) 718 -