Permit CITY TIGARD PLUMBING PERMIT
t'Yr. i:� DEVELOPMENT SERVICES PERMIT #: PLM2001 -00178
,,� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/30/01
SITE ADDRESS: 16290 SW 72ND AVE B -02 PARCEL: 2S113AA -00400
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 018 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 1 GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replacement of existing fixtures. No change to EDU count.
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT CTR 4/30/01 $116.20 27200100000
15350 SW SEQUOIA PKWY #300 -WMI SPOT CTR 4/30/01 $9.30 27200100000
PORTLAND, OR 97224
Total $125.50
Phone 1:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 236 -4152 Rough -in Insp
Final Inspection
Reg #: LIC 172
PLM 26 -83PB
E XPIR
Magi &dr
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: / Permittee Signature:
CaII (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
Date received: y /_u /d/ Permitno.:PLf/o2Qn/ - Doi
.
City o f Tigard Sewer rnut no.: Building permit no.:
r1 J.''" 11' - Address: 13125 SW Hall Blvd, Tigard, OR 97223 g
City of Tigard Phone: (503) 639 4171 Project/appl.no.: Expire date:
Fax: (503) 598 -1960 Date issued: By ?!:1 no.:
Land use approval: Case file no.: Payment type:
71 PE OF PERM IT
0 1 & 2 family dwelling or accessory ',‘ Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction ' Addition/alteratio - placement 0 Food service 0 Other:
.1011 SITE INF0Ri19AT10N FEE SCHEDULE (for special information use check ist)
Job address: / b R 9 0 S w - 7a / Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
map/tax lot/account no.: (includes 100 ft. for each utility connection)
Tax ma
P/ SFR (1) bath
Lot: Block: Subdivision: SFR (2) bath
Project name: ; L-b 6 g_ FiA../2 L4,12e SFR (3) bath
City /county: 7 7 irA R I ZIP: c t -7 a a 4 Each additional bath/kitchen
r n lion and locatiorj of wojk on remises: Site utilities:
ta E g_X t STiM(r )C r ,Pip Ga,r/, >vaty Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench dram
Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: n EA ,✓ A f�} F� L.. & Manholes
Addres : 3 if se 3 ......
Rain drain connector
City: PO ,,�- I_A - I State0, Z ( ZIP: 9'7 ao a Sanitary sewer (no. lin. ft.)
Phonea3 ,— ti I 5--a Fax -) 7 74 E -mail: Storm sewer (no. lin. ft.)
CCB no.: Q 1 7Z Plumb. bus. reg. no: at, g 3 PB Water service (no. lin. ft.)
-
City /metro lic. no.: /9 8 , Fixture or item:
Contractor's representative signature: �� q - i .1(/‘ Absorption valve
Back flow preventer
Print name: L. N E _.• Date: 3. • Backwater valve •
CON1'AEI PERSON Basins/lavatory
Name: j-�,Ej✓/v p oce.S Clothes washer
Dishwasher
Address: Drinking fountain(s)
City: 'State: 'ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
Fixture/sewer cap
G! S Floor drains/floor sinks/hub
Name (print): /'t S' 7 Garbage disposal
Mailing address: / 5 $p w Eq
S Suc iPkwy. 0340 Hose bibb
City: Ti (9- m- Stated f 2 ' ZIP: 9 - zaal_/ ` Ice maker
Phone(p,* t.y —3 0 o I Fax: (E-mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
[NC 1 N E1. It Tubs/shower /shower pan
Urinal
Name: Water closet 3
Address: Water heater r
City: 'State: ( ZIP: Other:
Phone: 'Fax: (E -mail: Total
Minimum fee $ )I
Not all jurisdictions accept credit cords. Please call jurisdiction for more information. Notice: This permit application
O Visa 0 MasterCard Plan review (at _ %) $
expires if a permit is not obtained .--
Credit card number: / / within 180 days after it has been State surcharge (8 %) $
Expires -?o
Exp accepted as complete. TOTAL $ h-2..5 --
Name of cardholder as shown on credit card ��..srr
Cardholder signature $ Amount ds �' 440 -4616 (6/00/COM)
PLUMBING PERMIT FEES: • , ,
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES (Individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE . • TOTAL
Sink 16.60 the dwelling and the firsti00 ft. QTY (ea) AMOUN'
Lavatory 16
aci for each utility connection)
One (1) bath $249.20
Tub or Tub/Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 3 16.60 SUBTOTAL
•
Urinal ' 16.60 ilb C. C2,,P,- 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE:
3" 16.60 COMPLETE:
16.60
Water Heater 0 conversion X like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical 6 Fixture Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink -<"--). MFG Home New San/Storm Sewer 46.40 Lavatory
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
16.60 Urinal
Other Fixtures (Specify) Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3" ill .:
Sewer - each additional 100' 46.40 4°
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Speafy)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL ) I / 9-g-_
8% STATE SURCHARGE 3=
"PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $ lass'
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $38.25 + 8% state surcharge.
* 'All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i:1dstslforms\plm- fees.doc 10/10/00