Permit A CITY OF TIGARD
PLUMBING PERMIT
�I �
1 DEVELOPMENT SERVICES PERMIT #: PLM2003 -00298
c� I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/4/03
SITE ADDRESS: 15750 SW 98TH AVE ADM. BLDG. PARCEL: 2S111CD -00300
SUBDIVISION: ALDERBROOK FARM ZONING: R -7
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 1
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: 465 ft
Remarks: Site utilities for new administration building. Other fixtures are (3) rain drain connectors and 30' of footing
drain.
FEES
Owner:
Description Date Amount
TIGARD CHURCH OF GOD
15670 SW 98TH AVENUE [PLUMB] Permit Fee 9/4/03 $417.00
TIGARD, OR 97223 [PLMPLN] Plan Review 9/4/03 $104.25
[TAX] 8% State Tax 9/4/03 $17.36
Phone : Total $538.61
Contractor:
PETE'S QUALITY PLUMBING
20985 S. SWEETBRIAR RD.
WEST LINN, OR 97068 •
REQUIRED INSPECTIONS
Phone : 503 Storm Drain Insp
Storm Drain Insp
Reg #: LIC 122359 Storm Drain Insp
PLM 3 - 344PB Final Inspection
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
Issued ;. ,' Irk / � : � � Permittee Signature: f �„� �, ,4.--,..---
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed th next business day
i
+ � Site Utilities /7,-25 D3
/ Plum P erml t A lll cation FOR OFFICE USE ONLY : . ,
R ece i ve d // Plumbing
.-, • D a t e / B y � i f 1- �- Permit No.: J f )I a O 3 O 4 " - a
Planning Approval Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other . .. -
Tigard, Oregon 97223 Date /By: Permit No.:W , �� `a v3i
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 -4 � ' � r ' Post- Review Land Use
i�i�� (+ Contact Case No.:
Internet: www.ci.tigard.or.us,�,. �.' � I : Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639- 4175UN 2 3 no Name/Method: Supplemental Information.
CITY OF TIGARD
i , s °e :.�;:; ,,:t a.<.,`Ss.,.."%r;+ s, . "a" _r j .. *• - .- :r::,r>..«�: .,E ��;�.:,r.a 'h:` 4ia '+�
s „ , . , z.; t v ',T;-v ttorxwORIC,n .1_, :niei j :n.. ,,t FEE, :{SCHEDULE (for s peciwi fo u s e che ,:>„
y5 New construction ❑ Demolition ` v Description I Qty. I Fee(ea) I Total
_' ,1 New 1 & 2 1 f0 d s $ `
El Addition/alteration/replacement El Other: e . . ; � ,., a M € � i g n
CATEGORY OF CONSTRUCT1ON ° (includes 100 f t: ,fo °ea utilit conneetion) __ ,,
SFR (1) bath 49.20
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial
_ SFR (2) bath 350.00
['Accessory Building ❑ Multi- Family SFR (3) bat 399.00
❑ Master Builder 24 Other: C )(2C4 Each addit ath/kitchen 45.00
F s1:4 0B1SITE' �INF .ORIVIATION•anii ;L'OCATI'ONF
;,�, M ,a, F' rmkler - sq. ft Page 2
Job site address: / 5 7.52 S w 96 0 AVOI 0 '` ' e r : t g w 4 m r i A ' -' / i i S A I re's,3. 4 =':'leilBsSr?PwF" 16= € _ } ..,`"'
Suite #: --' Bidg. /Apt. #: Catch basin /area drain ,m9,/ 16.60 / I✓ 62
Project Name: 7 ithie C!/URL// Q� 10.0 Drywell /leach line /trench drain �� 16.60
Footing drain (no. linear ft.) 3o Page 2 _ -5•0'_
_
Cross street/Directions to job site: /- OM /Al /STEAT /6Al Manufactured home utilities 0 110.00
ROAD � BU /4b//1(b Manholes 0 16.60
Rain drain connector tail. 16.60 /9/, Yo
9r ( 4V0Af (f Sanitary sewer (no. linear f . /r - 1 Page 2
i s
Subdivision: Lot #: Storm sewer no. linear ft. - "rf' Pa:e 2 ,7�
0
Water service (no. linear ft.) /00 Page 2 3 .
Tax map /parcel #: 251II 00300 :,,
Ai x` t..., Xr DES.CRIPTION OF:`WORI{, ` �` .,4.; : ,. ;. .�, 1 .
�� • bsorption valve 16.60
,r /4i/ ' Ti rvV0 .2 f. Ba• ow preventer Page 2
�ipM i,Jr 1�V0 Of ice- 1 Bac • .ter valve 16.60
/CPC 1119. C4uRal OF boa Clothes • .sher () 16.60
Dishwasher 0 16.60 17 _
Drinking founta' q 0 16 0 d
PROPERTY.OWNER l lt:`1 ti 'T = ENANrM' _.: r` Ejectors /sump 0 6.60 Q
Name: T(b Ckt)1Qoi oF bop Expansion tank 16.60
Address: P9070 5L4) qey Ave. Fixture /sewer cap 16.60
City /State /Zip: T(IshRv Ole i ` Floor drain /floor sink/hub 16.60 I
1 Garbage disposal 6 16.60 0
Phone: 50 3 439- 4ts.o Fax:5o3 ' 1 31 -/ 35 Hose bib L 16.60 y
AP.PLICANT,f. r ° °i , CONTACT PERSQN'° - Ice maker 0 16.60 f
Name: JA ) O0r ZIk1K/4 1u.Ol'Z /5544, , Interceptor /grease trap i 16:60 0
Address: Zap )414) ?F{U/E,i4 i 5in-ro - 20I Medical gas - value: $ Page 2
City /State /Zip: pdypri,/f9U0 OA q7�p Primer �/ 16.60
/ Roof drain (commerp l) & e 60 to
Phone: 503- 22.z- yl5g Fax: 50 3- 212- / Sink/basin/lavato 16. E e - =3
E -mail: jetait re, 2,I.IkI14iII2f. aim Tub /shower /sho er pan 16.60 0 •
e rEaioa, + ^ ?v sav0;0N,Mt,____ Urinal
0 16.60
Water clot 1'i 16.60
Business Name: 1-5 LCttLt f Water hater j 16.60 2.
Address: 8"5 -3. Scd�� / 7 ,Ep -
O the
, Q • •9'o
City/State/Zip: l!1 GAT .�- T II 11/0.1 o e r
.;�. � f 'c?:.5'. a } .� ^ -,p:�. e � , yam; �-�; ,a :�a�- * �, . rfir;ar °'..s, �
Phone:53 • S3 7- SS `t6.) i Fax: 1 . ter. .: � ���'Iumtiing :,.� i ;.. �. ��,_ � :
CCB Lic. #: /,Q i5`, Plumb. Lic. #:3 - 39i PS Subtotal $ 4/1.
Authorized 3U _0 l Backflow Minimum Fee $36.25
Minimum Permit Fee $72.50 $
�,- Residential
Signature: /$ . � Date: l/' ,?.3.-o..3 Plan Review (25% of Permit Fee) $ e ?. "
d , k/E. 'COOT State Surcharge (8% of Permit Fee) $ / 7. 3(4:7
(Please print name) TOTAL PERMIT FEE $ ,S; -Q. /o/
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.
is \Dsts\Permit Forms\PlmPermitApp.doc 01/03
1
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
- ... A
. ,..
Fee Schedule: Residential Fire Suppression Systems:
PIW'j4.,,A"'v 81iniilifi 1 am ''''''Z'°: 1 ; ' , '. 1- QtY -' ' F(� °Tr)iilY'''• '$j:44iWcillit4i0i,:;:: " -,;':,:.'; 5_ lierhfifeFee:
, 41 '!:•=:i zt' ! l',4::.',
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 .
Valiiition ;,': ,Teilinit fee: • . .
Storm & Rain Drain - 1st 100' / 55.00 ,--------- $1.00 to $5,000.00 Minimum fee $72.50 -
Storm & Rain Drain - each additional 100' 4 46.40 /,'6 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
Nrldiatmti .119 :,'Fii.,. kT4411', 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 $25,001.00to $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 $ for
Subtotal: each additional $100.00 or fraction thei ...
• •
. •'
. .
• ..
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*.
:7 ,y,i,iy,i0N14- fftliiiiiiiipiMii4iiiiiYViiWtiaViliirellill Comments regarding fixture work:
Viktiiiiiei4i5;:0% ! ''',.k7 1 .NT:;; WE'!",?::';'W nitePige,6i IL LL • .t• • •• .
. • •• -• V ••• * .
W:li 4 ;F ,1 * - k13 7 . '' • ' ;AA`=;2 S'afi4i !='!44giti !Tfilkiiiit •Valteili .
Baptistry/Font •
Bath -Tub/Shower . '
.
• -Jacuzzi/Whirlpool ,
Car Wash -Each Stall
-Drive Thru
, •
. .
. .
.
Cuspidor/Water Aspirator . - •
. •
Dishwasher -Commercial '
• - .. ' • - •
-Domestic ' . ,
•
,
Drinking Fountain - .
-,-
Eye-Wash • . . .
- , . .
Flodi Drain/sink - 2" ,
' • .. .
- , .
, • . . . . • . , .
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
c.„'..„,
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit FormaImPermitAppPg2.doc 01/03