Permit • 'CITY OF TIGARD PLUMBING PERMIT
... i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00213
11r DATE ISSUED: 6/7/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 133AD -02200
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE ZONING: R -7
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Building fixtures for north side of 1st fl.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: 3 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 10 OTHER FIXTURES: 1
TUB /SHOWERS: 4 SEWER LINE: ft
WATER CLOSETS: 8 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WESTGATE BAPTIST CHURCH Description Date Amount
12930 SW SCHOLLS FERRY RD
TIGARD, OR 97223 [PLUMB] Permit Fee 6/7/2005 $431.60
[PLMPLN] Plan Review 6/7/2005 $107.90
Phone : [TAX] 8% State Surcharl 6/7/2005 $34.53
Total $574.03
Contractor:
KEVIN SHARPE PLUMBING
7422 SW PAG PL REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97223
Phone : 503- 293 -1314
Reg #: LIC 112898
PLM 26 -593PB
Th is 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- 699 or 1-800-332-2344. /�
Issued By: e'» ,,_,« ,2171,( ,e) Permittee Signature: � //2/7 ,t a
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card 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.
10 _ IA) (3d'
Building Fixtures �; E C E II V E D 3 W2 -2 a) - aa /6
Plumbing Permit Application FOR OFFICE USE ; ONLY ;
MAY 2 5 2 005 �!
City of Tigard DateBy: S "p ✓/O" �1) Permit NIV 5 .- ( �
13125 SW HaII Blvd., Tigard, OR 9722
3/ OF ?IGARD Plan Review
Phone: 503.639.4171 Fax: 503r-59,8.1960 N v p 1 /141'di�y'NI aci I f\ si 2 7 / s' . ) Other Permit No t , I p
, LANG �� {/ IS�01�1 ""���°�" (I . Date/By: t7' V '^� ' �(UUI�t 0
24- Hour Inspection Line: 503.639.4'175 Date Ready Ready/By: j5: - H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: t_ i Supplemental Information
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P ` R :,' :tR 1.4 Y PF3 61,:. rO _ ; -"� a A: ,'°' . =�a�: CALV m SCI3ie
:. „, =x.za.i..^ .,+ #:.'� . Mityl , ypia ,� ..t +.li a'' w.-. :w .'..: 4 1✓ , ; :iI ' .: ;��t) :iy..yw ri, -team v'. A D ada.Y.- ..sr - s .tt. a.....,,ra:. .Y... - .., 1 •
' New construction ID Demolition For special information use checklist. J
Description 1 Qty. I Ea. I Total 1
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) w'
�::« �. ,�t,�,,a;° wt's _ �'v%' - a:;;:�^;�,r���.x� =as��-^ , „ �. q
n . r. ` e c Ti GOIt i"O COR,'STRiT.CTI®i ' , ' +1 `;::" E" 24
ry � 4 - s`� . Via SFR (1) bath 9.20
�. ,r�`�"�z'1'sa ..`..'' "� ,',,?'.e.,:�x.:•.,:�r:c �.�,,:,: .�.«..c_ » °�'+.¢:s :uY:�1 .rs "�'na";�amas .r:.:.'.�k, -+
❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00 CA
SFR (3) bath 399.00 rl
❑ Accessory building ❑ Multi- family 1
Each additional bath/kitchen - 45.00 x-'
❑ Master builder ❑ Other: /
sat t ; k .=ate v,,.: r :.,. ,€ .. ,w _.....,._ Fire sprinkler ( , sq. ft.) Page 2 ri
.
itv . ? sates � ORIYIATIOLV AND Li ke l fi N ° "• •� q,= Sit u tiliti es
Job site address: Io S i,J ,lot■ Catch basin or area drain 16.60 N
Ci ty /State /ZIP: "T I+sA►2 � O G �ZZ3 ry Dw l line or trench drain 16
' ''
Footing drain (no. linear ft.: !) Page 2 �'
Suite/bldg. /apt. no.: Project name: 0 eST <k'� -9
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
S C rtOLCS eI UtV TO 1I6 Rain drain connector 16.60
SOU 1 it O1J I -Ot1 Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Oz200 Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: k 5 i 33 A b
Absorption valve 16.60
ro lz bESCRI VIOLA OF WORD , -4 ;J
°. ` ..., 1. � u se ,.;,:,v,,� .,,,,, „,,, A.,,,,„:., ..,, : e .�..;,a;', Backflow preventer Page 2
lir tJO12K 0 N 13eno2'CNS&E OF ■ST Backwater valve 16.60
V LOO %2 Clothes washer 16.60
Dishwasher 16.60
a � '�` l �.� is W °� ' , , E Drinking fountain I 16.60 / I , 6 0
x TENANT � t�, � 1 � �:
a Ejectors /sump 16.60
Name: ' : i G -t�'. ,.:- riS '. C11 uiyc 14 Expansion tank 16.60
Address: i 2...R 3 c vl� 1tOGl '�"t�RQ.Y e Fixture /sewer cap 16.60
City/State /ZIP: T't << A rtn i a rin c Floor drain/floor sink/hub 14.3 16.60 e/ , ktl Phone: (so' ) S24 ls'err Fax: ($p3) s' 2lj - q s( b Garbage disposal 16.60
, ik,rar:.::,,y° . >, .,� �- Mx a =.4; Hose bib
Z 16.60 .3 ZU
;' r At' I:ICA.IYT, i je1 "` + CO1vT E S I `
�. �, -;" �_ . ;a_. F�:�r� �,. o f Ice maker 16.60
Business name: by V p
Vi t' 5 k 6 mebts _ i.3 G Interceptor /grease trap 16.60
Contact name: 11, 13-r Oe..1 Medical gas (value: $ ) Page 2
Address: i GI 7 S 5 (.- R K€ FOr� rC 6;-VD Primer I 16.60 /6, 6 0
City/State /ZIP: C. et K n $ >; Gt) ! 6K C C7 03 S Roof drain (commercial) 16.60
Phone: (c03) 5?�._ 731 Z- Fax: : (s 47 Ole Sink /basi /shows �� 16.60 /��
Tub /shower /shower pan 4 16.60
E -mail:
Urinal 16.60
� � , ,t + z� =TRA'C4TOR' w g , 4,, �,,' Water clos 16 7 U
iF :, -` ga. . r. x,�. z,a, w.xvXl'*' >:-:�ki4- 4t S4∎V, x. <..Wa, ?:? pi .:., L-
Business name: is eq i A S ti itQ P 6 PLO 4 emu; Water heater 16.60
Address: 7 'SO PA& PL Other:Y►t(P Si 0 / /6.0 / 6. 6 0
Subtotal
City/State /ZIP: Po 2T C AN .b t O R es Q 7 12 3 Minimum permit fee: $72.50 , /
Phone: (Cp'') 2,9 3 131 LI Fax: ( ) Residential backflow minimum permit fee: $36.25 % 3/ ` 6 0
CCB Lie.: 1 1 2 /IV L 1 ,, p c / /l)/ 7 Plumbing Lic. no.: Z ‘ 5 pp .. _ Plan review (25% of permit fee) / 5 7 .9 0
Authorized signatu e: 7 _� _ State surcharge (8% of permit fee) 3 9, s3
A TOTAL PERMIT FEE . -79.03
Print name: iii Date: 5_ 2s- og 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- 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:
Sie` tltrlities ` QtY oa Tf Sq Foo g Per>< t , „ Fee ..
Footing drain - 1s 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer 3,601 to 7,200 $220.00
ewer - 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
VMalu- at!n�x . -''.xx Permif;Fee:.:,
Storm & Rain Drain - 1st 100' 55.00
$1.00 $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
R s , yarvw,t r c r;' ri,•;¢ <u rTM - -a additional 100.00 or fraction thereof, to and
kt/OR IQ tenlItiN . _. "'.. mo F e3(P Tofal $
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 * .
1.3 quanttt ork e 'ored t,
m
Frxtuee 1y ¢�� t i R e p la c e '
n; i a T f . e a � v� tfitthk 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
Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
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
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
•
Other Fixtures:
is \ Building \Pemtits\PLM- PemvtApp.doc 3/03
Accumulative Sewer Tally Parcel # 1S133AD -02200
Tenant Name: • Westgate Baptist Church This SW R;; 2005 -00168
Site Address: 10730 SVU 00th; This PLM# 2005 -00213
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 4 16 4 16
- 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 w,' 0 0 0
Drinking Fountain 1 0 0 1:;:k$14:::''.,,,',:.? 1 1 1
Eye Wash 1 0 0,, 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 6 3 6
- 3 inch 5 0 0 31�.��x, 0 0 0
- 4 inch 6 0 0 ,s " - 0 0 0
- Car Wash Drn 6 0 x 0, r , 0 0 0
Garbage Disposal
, �.
- Domestic (to 3/4 HP) 16 , 0 0 . 0 0 0
- Commercial (to 5 HP) 32 0 0 v 0 0 0
- Industrial (over 5 HP) 42 0 0 , -x 0 0 0
Ice Machine /Refrigerator Drain 1
,� 0 0 �, � �i� k 0 0 0
74"
Oil Sep (Gas Station) 6 0 t5 0 .� 0 0 0
station 16 0 0 : 'e ` `'
Rec. Vehicle Dump � 0 0 0
0
x,.r 0 0 0
Shower - Gang (per head) I 0 ,� � � �������
Stall 2 0 . .< -� 0 �� .. 0 0 0
Sink Bar /Lavatory 2 k 0 0 :‘ 20 10 20
- Bradley 5 . 0 0 � r 0 0 0
- Commercial 3 ' 0 0 0 0 0 • - Service 3 0 x 0 a 3 1 3
Swimming Pool Filter 1 - " • 0 sx 0 g l � 0 0 0
" . a 0 0 0
Washer - Clothes 6 F , 0 3 , 0 n :0 4 : k x;.
Water Extractor 6 � ,�� 0 I. ;g ::" 0 ilit#Pet 0 0 0
Water Closet - Toilet 6 _ 0 04� �i 48 8 48
Urinal 6 0 0�; 0 0 0
Previous EDU Count .. .,,, 0 0
,
Capped EDU Credit 0
TOTALS 0 0 0 0 27 94 27 94
Current Fixture Value 94 divided by 16 = 5.9 Current EDU 1 EDU = $ 2,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 94 divided by 16 = 5.9 over (under) $ 14,750.00
Enter EDU Change Here "s9 'r °.w
Notes:
Signature: ,, ej Date:
Building Division
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\Sewer Tally \SewerTallySheet.xls 7/1/04
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM 200500213
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/7/20115
Phone: (503) 639 -4171 17 /11114 t i .t Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE:
TIME: 7:05m4 PAGE: ii
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: +STGATE BAPTIST CHURCH
DESCRIPTION: Building fixtures for north side of 1st H.
OWNER: WESTGATE BAPTIST CHURCH, PHONE #:
CONTRACTOR: KEVIN SHARPE PLUMBING PHONE #: 603-293-1314
Inspection Request Scheduled For: Date: 1/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3 9 Plumbing final 025083 -01 503-572-7392 N
Corrections/Comments/Instructions:
i
C ,..-/ --
'IkPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /9 7/ 4 -„ Date: Phone #: (503) 718-
CITY OF TIGARD ..:. __ ,- . -- . ..
BUILDING DIVISION PERMIT #: Pl M2005 002 i3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 61712005 •
Phone: (503) 639 -4171 udptWgprfQ
Inspection Requests (24 Hrs.): (503) 639 -4175 �' I�
INSPECTION WORKSHEET FOR DATE: 9128/2005 TIME: 7:08AM PAGE: 36
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WESTGATE BAPTIST CHURCH
DESCRIPTION: Building fixtures for north side of 1st fI.
OWNER: WESTGATE BAPTIST CHURCH, PHONE #:
CONTRACTOR: KEVIN SHARPE PLUMBING PHONE #: 503 - 293 -1314
Inspection Request Scheduled For: Date: 9/ 28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 016851 -01 503 - 572 -7392 N
Corrections/Comments/Instructions:
- j I i..1( . ..diel.. , i
Pt re,/ Ar i f
0 ,(.
*PASS PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector Date: V _1- Phone #: (503) 718 -
CITY OF TIGARD ., . ,
BUILDING DIVISION PERMIT #: PLM2005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5,7/2005
Phone: (503) 639 -4171 �. ::time igl�1 "�
Inspection Requests (24 Hrs.): (503) 639 -4175 ,.,,._.„....1* ,.,,._.„....1* `:
_..
INSPECTION WORKSHEET FOR DATE: 6/23/2005 TIME: 7 :10AM PAGE: 83
SITE ADDRESS: 10730 SW 130TH AVE MULTI - PURPOSE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: WESTGATE BAPTIST CHURCH
DESCRIPTION: Building fixtures for north side of 1st fI.
OWNER: WESTGATE BAPTIST CHURCH. PHONE #:
CONTRACTOR: KEVIN SHARPE PLUMBING PHONE #: 503- 293 -1314
Inspection Request Scheduled For: Date: 6/23/2005 Pour Time: -
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 009945.01 503-672-7392 N
Corrections /Comments /Instructions:
•
, _ ; /-.(- . 7 A/ Sim/
. -,:-,,
P. 11 ' ASS [PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: q - ) 4 Date: ' 0 Phone #: (503) 718- - --
1