Permit CITY TIGARD PLUMBING PERMIT
gin' I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00598
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/18/03
SITE ADDRESS: 09095 SW BURNHAM ST PARCEL: 2S102AD 01300
SUBDIVISION: ZONING: CBD
BLOCK: LOT: 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: 0 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install 100ft. or less sewer line, 1 hose bib, 2 lays relocated, 2 water closets relocated and 1 water heater. No
sewer tally required.
FEES
Owner:
Description Date Amount
GDW PROPERTIES
9115 SW BURNHAM [PLUMB] Permit Fee 11/18/03 $212.40
TIGARD, OR 97223 [TAX] 8% State Surchari 11/18/03 $16.99
Total $229.39
Phone : 503 - 799 -0010
Contractor:
NELSON PLUMBING
PO BOX 818
BATTLE GROUND, WA 98604 REQUIRED INSPECTIONS
Sewer Inspection
Phone : 360 - 696 -0876 Rough - Insp
Reg #: L1C 125759 Top - out Insp
MET 00003463 Final Inspection
PLM 37 -171PB
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 adopte / d'b`y the Oregon
�' ; �L "4 Permittee Signature: X
Issued By: � � -�z�` �
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed tfie next business day
Building Fixtures
:FOR OFFICE USE ONLY 4 '-
Plumbing Permit Application Received . Plumbing
' DateBy: / ///.2 fil- Permit No -00 f �/
D
R ECE li/E ® Planning Approva a Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 NOV 1 8 2003 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
/�ufil�i I Date/By: Case No.:
Internet: www.ci.tigard.or.us CITY OF TIGA" 4,1P Contact Juris: ® See Page 2 for
f ' W I Su
24 -hour Inspection Request: 5 �. ���t°.; �j►VI' Name /Method: I Supplemental Information.
.f,; 2;��� �;`�a,.4i: €:,, tr 75:4tr 562a M noEE* `SCHEDULE,(for's ectal info us,e ch m
Description Qty. I Fee(ea) Total
❑ New construction ❑ Demolition P I � �
Addition/alteration /replacement ❑ Other: i * ( d w & f w' lung ,r , L
:?„ as <, . ,.. . li 'include 100 fY for each ut li „co o ), ,. .; sd . ",
t , .,, <,', CATEGok8 OFOO.NSTRUCTION_;` ' lg.gae
SFR (1) bath 249.20
❑ 1 & 2- Family dwelling Commercial /Industrial SFR (2) bath 350.00
❑Accessory Building Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
it r JO1110trE INFORMATION andTE,00 - TION M u Fire sprinkler sq. ft Page 2
' "- x ...�S1tC iiiitles . „ea. _a ze- , � , r;:,,'�,. �"'e°"
Job site address: �t�S l�/tiNl7x� /lam,.��.� �. �_•N
Suite #: Bldg. /Apt. #: Catch basin /area drain 16.60
U Project Name: , /,4E Footing l /leach line /trench drain Page 2
Y �i�� Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
�G7kN Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) / Page 2 �/(
• S ubdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Water Tax map /parcel #: .. . , service
``..... . xtu_ a o'r I . m ,.x., 2 � "�; l 4"
linear ft.) Page
IMAk tit$MPT'IONI,OP: OWit y,�. - - Absorption valve v 16.60
' / DL&-' A/174 4/2i1/ /T4T /f `f-- Backflow preventer Page 2
y� /t Zay�40 / yams Backwater valve 16.60
/ Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
I ', " itiotipuzieloNnIVALMIg 0 UNOTIEUMEMICA Ejectors /sump 16.60
(S me. 4.7 J ,17fs Expansion tank 16.60
Address: '// h ivihme� Fixture /sewer cap 16.60
� ✓i C i/State /Zi f , ajc, y Floor ge disposal sink/hub 16.60
City/State/Zip: p
' 7 Garbage disposal 16.60
Phone: j - a9/0 Fax: /I/// Hose bib / 16.60 /(�. /ad
1 - s <:,;
rn � APPLICAIVT�, '�E,I.;., � :'- ,CONTRACT' =PERSON, ,�:�. Ice maker 16.60
O Name " ,n,-,,C, ,frU hvc, Interceptor /grease trap 16.60
(f) Address: /7.� 44i0.- Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: 7 / � /yteGv� Roof drain (commercial) 16.60 � �, _ • ; �(5
Phone: j3 -66 �7 < „S Fax: ,03 -06.-52/ Sink/basin/lavatory C.(14) yj 16.60 A 3 , a 0
E -mail Tub /shower /shower, pan 16.60
� '.c 3 Urinal 16.60 tea, /0
Business Name: � . y)h Water closet 16.60 33 . 0)/)
�� �/ Water heater / 16.60 f( w)
Address: ' 4 z 6/6 Other:
City /State /Zi.: Aid! , htgr; • /A.,,,,! - 'b �,*- Other:
Phone: / -2 -mil'% -087 Fax: c? 3/ L ` .za :IM A ; ?Phf m biii Permit Fees*. r r .el Dili
Plumb. Lic. #: 7
Subtotal $
CCB Lic. #: /��7!;- 37 /7 p Minimum Permit Fee $72.50 $
Authorized ' ( p .'?-t) -0 4 Residential Backflow Minimum Fee $36.25 v La .40
Signature: Date: / 4_1 Plan Review (25% of Permit Fee) $
l /..aM114-= State Surcharge (8% of Permit Fee) $ ./(A r
(Please print name) TOTAL PERMIT FEE $ ,.� _,c) ..) 9
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:
t r Fee ea Total
� SiteIItilltles� � � - Q Y ( ) , �� z Square Footage:..,. _ �. n � Permit „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
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40 *HO
HQ
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 ,Va1uat1011 <'Per Fee; _ t` r
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
1 Flxture'oc- lteltl , ,, QtY ,,reToi)` _Total 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 *.
z,q0 -4a t AI Quanaty by ( rxure) WorI/ Performed Comments regarding fixture work:
Frxtu e'Type ` geplace £
temv - - st-txmiatti __ = New `.. gved Existing Gapped�z
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
increase of sewer EDUs, a sewer permit will be issued and
Disposal - Commercial
- 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 ,1
Urinal
Other Fixtures:
i:\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 � Z%0ea Requested 2 / 2 Vey AM PM BUP
Location F09-5 A Suite MEC
Contact Person ,&c- Ph ( v3) 5/ 9 scr PLM ,3 -OD 59'c
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
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer r \
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Osz.
F' .
AM 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: Unable to inspect — no access
Fire Supply Line
ADA � 7s0 C
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL