Permit Il CITY OF TIGARD
4: PLUMBING PERMIT
m '• ` COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00141
DATE ISSUED: 4/10/2007
TIGARD; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
" "ti g PARCEL: 2S102AD -03450
SITE ADDRESS: 08777 SW BURNHAM ST ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: CITY OF TIGARD
Project Description: TI - Water District Building, Capping (2) drinking fountains, (1) lay, (2) water closets & (1) urinal.
Adding (1) drinking fountain & (1) sink. Replacing (3) lays, (2) sinks & (2) water closets.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: 1 WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: 1 GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 4 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CITY OF TIGARD
13125 SW HALL BLVD Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 4/10/2007 $265.60
[TAX] 8% State Surcha 4/10/2007 $21.25
Phone : 503 -639 -4171 Total $286.85
Contractor:
PARFITT PLUMBING
12172 SE 222ND DR
DAMASCUS, OR 97089 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 658 -5068
FAX 503- 658 -2497
Reg #: LIC 85121
PLM 3 -274PB
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 or 1.800.332.2344.
/ I
Issu d By: 1. / (`� ! „L tfak , Pe rmittee Signature: -�i. JO
•
i
Call 503.639.4175 by 7:00 a.m. for an inspection that • s' ess day.
This permit card shall be kept in a conspicuous place on the job site until completion of the projec .
Approved plans are required on the job site at the time of each inspection.
Building Fixtures
Plumbing "< „ ati r A ..' _ I i
r ibin Permit Application Vii ` ( )f, l l i : I t 1 J Sl � o ,NI. 1' ` ( ,,
City of Tigard Received /0 1 permit No` /�d'j -6�Lj
13125 SW Hall Blvd., Tigard, OR 97223 Date/By
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Oetv " I i \ Date/By. Other Permit No.:
24- Hour Inspection Line: 503.639.4175 n-
Internet: www.ci.tigard.or.us � = li Date Ready/By: lu " ® See Page 2 for
Notified/Method: 1(t, Supplemental Information
• . TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
❑ Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial 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: g 1 17 S (,(f ( 3 J 2k, 1 6.,_ Catch basin or area drain 16.60
City /State/ZIP: it CA D DK Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: j /t?A 6 » t� tvo't k§'
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
� / 0g fi - D - Fixture or item
pC
Tax map /parcel no.: 4F
Absorption valve 16.60
• D ESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60 Fie , k.) PROPERTY OWNER . ❑ TENANT
Ejectors/sump 16.60
Name: l -r-V n 11 b Expansion tank 16.60
Address: Fixture /sewer cap W 16.60 99, 66
City /State /ZIP: Floor drain/floor sink/hub I 16.60 1 4 •4a
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 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) ( ) Sink/basin/lavatory b 16.60 9.7.6C)
Fax::
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR . Water closet 16.60
Business name: / / L v alm/3 ;4/ /(f , Water heater 16.60
Address: /247 Z ‘5' 7 -Z2n /, Other:
City /State /ZIP: `�i �` _,��7 tax_ 9 7089 e4> Subtotal aCn�,�
I Minimum ermit fee: $72.50
Phone: (93) __co 6A Fax: (c03 ) 6 $J -2_6?1 _ Residential backflow minimum permit fee: $36.25
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CCB Lic.: p 511, Plumbing Lic. no.: 3 -2 714 Pa Plan review (25% of permit fee) C
' • State surcharge (8% of permit fee) eR 1.01 J -
Authorized signature: 1) TOTAL PERMIT FEE a$ 6, S
Pr name: P Date: 9 -07 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 \Permits\PLMF- PennitApp.doc 06/05 440-4616T(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 Feex,
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 - 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
Fi 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: ') Plan Review for Complex Structures
Are you capping, di ng or replacing fixtures? If "yes ", A "complex structure" is defined as an installation of a plumbing
please iodic ork performed by fixture. Failure to system that meets any of the following criteria
crarately report fixtures could result in increased sewer fees *. Please check all that apply.
. Quantity by (Fixture) ork Performed ❑ Any new commercial building.
Fixture Type:, � C Replace El Any new exterior plumbing site utilities.
Previous p d . Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
-Domestic dwelling units.
Drinking Fountain L 1 • ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" k Submit 2 sets of plans with any of the above.
-3"
— -4 „
Car Wash Drain Isometric or Riser Diagram .
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory 1
- Bradley
• - Commercial 'Z.
- Service /.
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor P
Water Closet - Toilet - •Z increase of sewer EDUs, a sewer permit will be issued and
• Urinal i , fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
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i:\ Building \Permits\PLM- PermitApp.doc 07/06/05
Accumulative Sewer Tally Parcel# 2S102AD -03450
Tenant Name: City of Tigard This SWR# N/A
Site Address: 8777 SW Burnham St This PLM# 2007 -00141
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off # s count # value # s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 2 2 1 1 - -
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Dm 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink- Bar /Lavatory 2 0 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 2 12 0 -2 -12
Urinal 6 0 1 6 0 -1 -6
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 6 22 2 4 -4 -18
Current Fixture Value -18 divided by 16 = -1.1 Current EDU 1 EDU = $ 2,700
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -18 divided by 16 = -1.1 over (under) $ (2,970.00)
Enter EDU Change Here - 1.1
Notes: *CREDITS"
Authorized Name /Signature: Debbie ' ., . ki . ,1, Date: 4/10/2007
Bui .on
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\ Building \Forms \SewerTallySheet.xls 02/02/07
CITY OF TIGARD
BUILDING DIVISION a - PERMIT #: PLM2007 -00141
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/10/2007
Phone: (503) 639 -4171 i l l
Inspection Requests (24 Hrs.): (503) 639 -4175 '
INSPECTION WORKSHEET FOR DATE: 6/13/2007 TIME: 7:01AM PAGE: 80
SITE ADDRESS: 08777 SW BURNHAM ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CITY OF TIGARD
DESCRIPTION: TI - Water District Building, Capping (2) drinking fountains, (1) Iav, (2) water closets & (1) urinal.
Adding (1) drinking fountain & (1) sink. Replacing (3) lays, (2) sinks & (2) water closets.
OWNER: CITY OF TIGARD, PHONE #: 503 - 630 -4171
CONTRACTOR: PARFITT PLUMBING PHONE #: 503-658-5068
•
Inspection Request Scheduled For: Date: 6113/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 050117 -01 503. 658 -5068 N
Corrections /Comments /Instructions:
; ,j
O
AI ,/,.. ,
, 7, , - or .
, 4 / , 4i
1 ,,
\ 1 S
V ] , lf_ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v Date: 0 Phone #: (503) 718-
CITY OF TIGAR®
BUILDING DIVISION PERMIT #: PLM2007- 00141
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 411012007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 "-
INSPECTION WORKSHEET FOR DATE: 4/23/2007 TIME: 7:00AM PAGE: 28
SITE ADDRESS: 013777 SW BURNHAM ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CITY OF TIGARD
DESCRIPTION: TI - Water District Building, Capping (2) drinking fountains, (1) Iav, (2) water closets & (1) urinal.
Adding (1) drinking fountain & (1) sink. Replacing (3) lays, (2) sinks & (2) water closets.
OWNER: CITY OF TIGARD, PHONE #: 503- 633 -4171
CONTRACTOR: PARFITT PLUMBING PHONE #: 503 - 6585068
Inspection Request Scheduled For: Date: 4/23/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 046964 -01 503 -307 -5605 Y
Corrections /Comments /Instructions:
[og, PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: C 4 (22 J0 7 Phone #: (503) 718-
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