Permit CITY TIGARD PLUMBING PERMIT
1 l DEVELOPMENT SERVICES PERMIT #: PLM2003 -00407
,' 1 DATE ISSUED: 8/7/03
.4 ,' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15757 SW 74TH AVE BLD D PARCEL: 2S112DC
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: 006 JURISDICTION: TIG
CLASS OF WORK: OTR 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: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Adding (1) lav, (1) water closet and (1) water heater for new restroom.
FEES
Owner:
Description Date Amount
74TH AVENUE INDUSTRIAL PARK LL
8100 SW DURHAM RD [PLUMB] Permit Fee 8/7/03 $72.50
TIGARD, OR 97224 [TAX] 8% State Tax 8/7/03 $5.80
Total $78.30
Phone :
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone : Rough -in Insp
Top -out Insp
Reg #: LIC 81837 Final Inspection
PLM 26 -445PB
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 _.,,
Issu d By 1 / ' 4 .: I Permittee Signature: ou .- 17.) '
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed th next business day
•
Building Fixtures
11Ca FOR OFFICE USE ONLY Plul bins Permit App R eceived Plumbing I /�
Date/By: Permit No.: cf 7e) 7
Planning Approval Sewer �- 2
City of Tigard
Date/By: Permit No.:orvRd09J d 17
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use .
ho � Iryl o ° � Date/By: Case No.:
Internet: www.ci.tigard.or.us A I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 �"""-" Name /Method: Supplemental Information.
, ; r Are TM.0ENW.ORK i .. ' FEE* SCI EDULE (foKspccialinformation: use checklist) : i
❑ New construction ❑ Demolition Description Qty Fee(ea) � Total
N ew 1 , & fa dw ellings $ 4 �.
111 Addition/alteration/replacement 11 Other: CATEGOR SFR (1) bath (includes�100 ft #. for e connection) ,�
YnOF „CONSTRUCTION , 249.20
❑ 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00
❑Accessory Building ❑ Multi- Family SFR (3) bath 399.00
111 Master Builder El Other: Each additional bath/kitchen 45.00
74 , tYMOB SI =TE ±INFORM1tTION Airit 0,0t8VIOGItt TRA Fire sprinkler sq. ft Page 2
i I x�, Site Utilit `� 0
Job site address: /S�7�5� � �..� � �`t°� W M
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
�
/ Drywell /leach line /trench drain 16.60
Project Name: 1 7/7 1 /h .2 -
r/S ' a L 0,a('/ Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no linear ft.) Page 2
Tax map /parcel
E
DES,CRIRTIONk,O£ WORK_ ` ' "a "`°' a iWture or Item , , , .��
��.o�.a. ` =Z " Absorption valve 16.60
Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher • 16.60
Drinking fountain 16.60
iPROPtittI'OOWNER .,' "' .' ..;$ T NANT, ., .r. . Ejectors /sump 16.60
.z 1 �� �
Name: h7 e3 Ca 5 7 Expansion tank 16.60
Address: 9-/00 SLID /U.(JIdm a9 Fixture /sewer cap 16.60
City /State /Zip: - - - J e fe 9'7a2 / Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: 4 ► 9 -etsTi -1 Z / 2 Fax: 502 6217-1r2cr0 Hose bib 16.60
APPLICANT i Mari' to :1:CONSAVUOt8ONICTI Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Roof drain siaf 16.60
Phone: Fax: Sink/ba( avatory J of 16.60 / .o0
E -mail: Tub /shower7shower. pan 16.60
F� ` - �`: i # r r P4 Urinal 16.60
r:a �CO,NTRACT ORS x u< .
Business Name: 46rd» �, ,O/ .4/ Al Water closet / 16.60 /( •6c)
Water heater / 16.60 /6 bd
Address: d'a A/ 3 ! �5 Other
City /State /Zip: 7 ed 7 ?.7S/ Other:
.., ermitF.,,ees *'T i
Phone: Fax: �._ Plum bingP.
Subtotal $
CCB Lic. #: - ►c- 3 '7 Plumb. Licit: 24 - fly5 P.3 Minimum Permit Fee $72.50 $ Q
Authorized Residential Backflow Minimum Fee $36.25 7,,
Signature: Date: Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ b e V
(Please print name) TOTAL PERMIT FEE $ 7 •, 36
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
• 180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Dsts\Permit Forms \PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
'' OSiteUtili'ttes a °, t )S`` " uare,Foota e. ;Perini<tFee '
.1 Qt ee ea Total
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
a luat ion , � �� � ;PermtfwFee_ , ;--t
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
additional $100.00 or fraction thereof, to and
F , ,F ur
te 4 ;N Qty F ee e a Tot f '
- ��.ufl� � .� „ _� ��. >y.,�:..� ,.... 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 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: 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 *.
' Quant►tyby(F�xte) WorkPerformed Comments regarding fixture work:
tFiitta aType11010 y Replaeeg {€
A
4 . ` New t az Moved ., Exish g € _.�Capped.7
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 *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice Mach. /Refrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water- Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is \Dsts\Permit Forms\P1mPermitAppPg2.doc 01/03
FROM : BRUNER1PLUMBING FAX NO. : 6242173 Aug. 12 2003 02:01PM P1
CITY OF TIGARD
13125 S.W. HALL BLVD. � 003-60(-16
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281
Plumbing Signature Form
Permit #: PLM2003 -00407
-Date Issued: -8/7/03 ._ - ...__...
Parcel: 2S112DC -01500
Site Address: 15757 SW 74TH AVE BLD 0
Subdivision: FANNO CREEK ACRE TRACTS
Block: Lot: 006
Jurisdiction: l -P
Zoning: TIG
Remarks: Adding (1) Iav, (1) water closet and (1) water heater for new restroom.
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and retum
this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
74TH AVENUE INDUSTRIAL PAR BRUNER PLUMBING
8100 SW DURHAM RD PO BOX 23985
TIGARD, OR 97224 TIGARD, OR 97281
Phone #: Phone #:
Reg #: LTC 81837
PLM 26- 4451
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Signature of Authorized Plumber
If you have any questions, please call 503.7182433.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested AM PM BUP
Location 5 7 ? L I ' Suite MEC
Contact Person J w`^ Ph ( ) I -7 1- 721 LM' Y 7
Contractor 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
Firewallo0119- =% i / � II mil I 0 12115401.... iM Fire Sprinkler i
Fire Alarm 41/
Susp'd Ceiling — -
Roof /; .
Other:
Final
PASS PART FAIL
CPLUMBING
Post & Beam
Under Slab
Rough -In
Water Service j
Sanitary Sewer 1FP° .�
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
-Final
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 0 Please call for reinspection RE: 111 Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Dote .. / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL