Permit CITY TIGARD PLUMBING PERMIT
' r�,I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00639
mta c � Jll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/1/2004
SITE ADDRESS: 14650 SW 97TH AVE PARCEL: 2S111AC 02700
SUBDIVISION: TIGARDVILLE HEIGHTS ZONING: R -4.5
BLOCK: LOT: 037 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAINS; 10 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 8 URINALS: GREASE TRAPS: 1
LAVATORIES: OTHER FIXTURES: 11
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Building fixtures for new addition of multi -use student commons & kitchen remodel.
Other fixtures: (2) backwater valves, (1)drinking fountain, (1) hose bibb, (2) primers, (5) commercial roof drains,
FEES
Owner:
Description Date Amount
TIGARD TUALATIN SCHOOL DISTRICT J
6960 SW SANDBURG ST [PLUMB] Permit Fee 7/1/2004 / $610.80
TIGARD, OR 97223 [PLMPLN] Plan Review 7/1/2004 - $152.70
[TAX] 8% State Surcharl 7/1/2004 $48.87
Phone : Total $812.37
Contractor:
PARFITT PLUMBING
12172 SE 222ND DR
BORING, OR 97009 REQUIRED INSPECTIONS
Phone : 658 Sewer Inspection
Water Line Insp
Reg #: LIC 85121 Top -out Insp
PLM 3 - 274PB Storm Drain Insp
Storm Drain Insp
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
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 b •.fling (503)
246 -6699.
� � o
Issued By: - Permittee Signature: ,
Y
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t e next business day
• Accumulative Sewer Tally Parcel # 2S111AC -02700
Tenant Nam: Twality Middle School This SWR #2004 -00014
Site Address: 14650 SW 97th Ave , -, This PLM# 2003 -00639
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 h 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 0 1; = 1 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 4 20 .. 9 ...4v. 45 5 25
- 4 inch 6 0 0 „ , , 0 0 0
- Car Wash Drn 6 0 0 k r. • ; ., i 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 , 4 16 1 16
- Commercial (to 5 HP) 32 _, ` 0 0 0 0 0
- Industrial (over 5 HP) 48 :. 0 0 0 0 0
Q5
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 0 0 0 0
- Bradley 5 � 0 0 �,,�_,
0 0 0
- Commercial 3 ;. 0 1 3 4 12 3 9
- Service 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 4 ,` 0 0 1 6 1 6
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 ., ; , 0 0 0 0 0
Urinal 6 5 ' ” 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 5 23 17 83 12 60
Current Fixture Value 60 divided by 16 = 3.8 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 60 divided by 16 = 3.8 over (under) $ 9,120.00
Enter EDU Change Here4;8
Notes:
/ 7.---- 7 .
Sig lature: L _ , _k_; - A' ,,,/ 0 Date: 4 /Ad - 4'�`
Build' g Division j
Note: The property owner all 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 11/19/03
.Y
Accumulative Sewer Tally Parcel # 2.S) I I At-c - 02 700
Tenant Name 1 )m) I l i MI AlG..(cko,1 ,4 ki i ge•P` I This SWR# 200 L4 . -0001"
Site Address:) t.) 1,, £O . O 1 r Avg,: This PLM# . nr) 2. TO 6.3 q,
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
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4
Car Wash - Each Stall 6
- Drive through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1 I
Eye Wash 1
Floor Drain /Sink - 2 inch 2
-3inch 5 q 9 •
.
- 4 inch 6 .
- Car Wash Drn 6 .
Garbage Disposal
•
. - Domestic (to 3/4 HP) 16 , /
- Commercial (to 5 HP) 32 ►/
- Industrial (over 5 HP) 48
Ice Machine /Refrigerator Drain 1
Oil Sep (Gas Station) 6
Rec. Vehicle Dump station 16
Shower - Gang (per head) 1
- Stall 2
Sink - Bar /Lavatory 2 .
- Bradley 5
- Commercial 3
- Service 3
Swimming Pool Filter 1 .
Washer - Clothes 6 i ✓
Water Extractor 6
Water Closet - Toilet 6 "
Urinal 6
Previous EDU Count .
_ Capped EDU Credit
TOTALS
Current Fixture Value divided by 16 = Current EDU 1 EDU = $ 2,400
Previous Fixture Value divided by 16 = Previous EDU
Change divided by 16 = over (under) $ -
L f En er EDU Chan a Here
Notes: 1,4o a>-Y • ' tADCLO ■ , A L -3 VAX t a•rv� -O LA.) R.�
A.'4. II
Name: Date:
Building Division
Note: The property owner shall retain this record for sewer credit purposes. In the event of a credit, this
document stamped "ORIGINAL" shall serve as a credit voucher and must be submitted to the City of
Tigard Building Division to redeem credit towards future system development charges.
T�
Building Fixtures • ) ' 1 D
Plu Application FOR OFFICE USE ONLY
RE-/1;0v Received .a > A. Plumbing b
Date/By: �� D � J� V0 Permit No.: 1�`j 5 -* (�06 j?
�.
City o Planning Approval Sewer
Date/By: Permit No.: 3
13125 SW Hall Blvd. DEC th er (,���(� o
Tigard, Oregon 972 U 2 2003 Date /By: -4,
g g Y Permit No.: t7�I - oZbnD _66 70I
Phone: 503- 639 -4171 Fax: caywasARIli Post- Review land Use
Internet: www.ciaigard.or.uiw� DiVi$ a' J!
. Date /By: Case No.: MK� a g e for ] IA
s t „ ., Contact Juri ® See Page 2 for
24-hour Inspection Request: 3- 639 4175 Name /Method: / la'. Supplemental Information.
TYPE_OF;W.ORK- '. ; FEE* SCHEDULE (for special. information use: checklist). `t
❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
El Addition/alteration /replacement ❑ Other: •i'.:New .- i' ;& 2 - family dwellings ..
.CATEGORY'. CONSTRUCTION - - ".( includes . 100 =ft: for"'each.utili onnection). .'" 1 1-:.'0":.= : ,'' . :' , '._ 1
S U.CTION : '. -.' <.: ' ,' .: = h. c :...,,!..,-,=_.,.'
ill 1 & 2- Family dwelling g Commercial /Industrial SFR (1) bat 249.20
SFR (2) bath 350.00
❑Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath /kitchen 45.00
• JOB.'SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: t - 6:6 O ) 61-11 ANC, . _.., w ,,..',' , 4, .'Site ti i
U, 1 ties � .:,,- „ :; :;:i,4 Suite #: /V 13% Bldg. /Apt. #: (U, Catch basin /area drain 16.6 0 1x~
Project Name: TWAL1"C -( t-tzo A1'JOITi ot.i JI t•'ND O L. Drywell /leach line /trench drain 16.60
C
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site:
E-} ALL *Lyn To MG 1JDNArL:o Manufactured home utilities 1 10.00
Manholes 16.60
MGYJ ot..» a-v C 5 W g II' Avt Rain drain connector • 16.60
Sanitary sewer (no. linear ft.) . Page 2 -CD
Subdivision: Lot #: 2?Da Storm sewer (no. linear ft.) Page 2
t
Tax map /parcel #: 2 5 1 tl Water service (no. linear ft.) Page 2
:' „ ` DESCRIPTION :OF WORK - " =rt`' ' - " °F iztui
. . , ; - ;. i.' .. ,. e.or-Item. x= ::' : .,i.:. °;'.: °. r..:
Absorption valve 16.60
AnV) ITI o N 0 (`�I V(� - O S� . Backflow preventer 1 • Page 2 1.044 •
Gd MMVNS j O. t4cWC1.. ke1TC IC,A) Backwater valve 2 16.60 33.20
Clothes 16.60 ' / L , C 0
Dishwasher , I 16.60 1(, , 6t) • - `5..,
Drinking fountain r / I 16.60 /0,
•) i PROPERTY :OWNER . .., • .'I:' ® TENANT .1:1 • - E'ectors /sum• 0 16.60 •
Name: 116-NW W - To At-All A Sc Howl_ uts Trutt Expansion tank • 0 16.60 Oh
Address: 6`1 617 SI.W SAU17 rbOV 9 Fixture /sewer cap 0 16.60
City /State /Zip: Tt v A ..r, c( 2V5 Floor drain/floor sink/hub ✓ , i 0- 16.60 /(oa0
Garbage disposal t 16.60 )10.4t)
Phone: Sb3 - 431-40 Fax: I-i3 ( - zitoll Hose bib 16.60 l(0Q0
•,.0 APPLICANT - - , • '1S1 CONTACT PERSON.. Ice maker 0 16.60
Name: Kt TH 70i4/45V1i - OVu- OI.SDL) WAS 6L Interceptor /grease trap i X 16.60 /0.6p0
Address: - ,iq SW WASHINI&Tv►., g". $ZOO Medical gas - value: $ 0 Page 2
City /State /Zip: pDVLTI.Nur� 012, 4 2-D 4. Primer ' 2 16.60 • 3a 20
Roof drain (commercial) WI 16.60 - �j
Phone: 2Zly - eg50 Fax: Z ?-j- cI 1 r7 Z. Sink/basin/lavatory 61E • 16.60 / /30
E -mail: 1tik3l o e c4ow . Gem Tub /shower /shower. pan 0 16.60
r,- rnrirrR ec rpR Urinal 0 16.60
Business Name: � �7 1 ( r I Water closet ( 16.60 I b,L b
I
Address: /; .. - - e2,.-'a. O Other
O 16.60 •
City /State /Zip: c' 0 OR-. a - 7 coy Other:
Phone :gV3 ,5,jr- --,5 :, Fax: -�- - r` .; ' 4z :`Plumbing Per[iiit Fees "' . ' ,.'''' `
CCB Lic. #: Plumb. Li #: Subtotal $
Minimum Permit Fee $72.50 $
Authorized
Signature: 'L L ��a ,/ ~ l ate: 3 Residential Backflow Minimum Fee $36.25 �p / a Q, �v
Plan Review (25% of Permit Fee) S / , 7a
/k► 6 �� .... f/.. -l State Surcharge (8% of Permit Fee) S L-/g. g 1
(' ea e print name) TOTAL PERMIT FEE $ S /a, 31
Notice: This permit application expires if a permit is not obtained withi 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.
1: \Dsts \Permit Forms \PlmPermitApp.doc 01/03 n 6.,---12-4 / `JO
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: — SCA, 5t't»`, OT►L-tTi> AM, Residential Fire Suppression Systems:
`° >. ;, #R Site aUtilities. =; a ';' °,, .,.x Qty: y, . „Fee.(ea)" •,Total
Square Footage: -.
q ,:Permit Fee:
Footing drain - l' 100' 55.00 0 to 2,000 . $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $660.00
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
, -Eizture;o� Item' ,.r .:`•,..,;; r ;, , additional 3100.00 or fraction thereof, to and
including $10,000.00.
lot 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: — SEA '5t'tt. U"CtLT+(S Are
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 *.
°, r ;';t;. z s a QuantitYiby .'(Fixture) „Woik formed Comments regarding fixture work:
Fixture - ,Type:. _ »fi a .:,. x •.t ni >: :;', %rs { »Re'place'.;: ,.: .
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi /Whirlpool
Car Wash• -Each Stall
-Drive Thru
Cuspidor /Water Aspirator
Dishwasher - Commercial , •
- Domestic
Drinking Fountain I •
Eye Wash
Floor Drain/sink - 2” •
-3"
• 4"
Car Wash Drain
Garbage Domestic • *Note: If the fixture work under this permit results in an
Disposal -Commercial • / • increase of sewer EDUs, a sewer permit will be issued and
• P - 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 d •
Water Closet - Toilet / z
Urinal
Other Fixtures:
•
is \Dsts \Permit Forms \PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /.). — l5 AM PM BUP
Location ! `� .S � 7 Suite MEC
Contact Person . -6i1c .,t Ph ( ) 1 7( $/ -6337 PLM e90 03 "ea 6-31'
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT •
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling •
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
ANICAL
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 ❑ Please call for reinspection RE: CI Unable to inspect — no access
Fire Supply Line
ADA [
Approach/Sidewalk Date t%" / " 2 �
Inspector :0 Ext
Other: [[
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL