Permit CITY TIGARD PLUMBING PERMIT
4.� DEVELOPMENT SERVICES PERMIT #: PLM2003 -00360
�,j�l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/14/03
SITE ADDRESS: 11565 SW DURHAM RD PARCEL: 2S110DC 02400
SUBDIVISION: SDR1999 -00022 WILLOWBROOK II ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS: TRAPS:
STORIES: 1 WATER HEATERS: CATCH BASINS: 2
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 5
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 85 ft
DISHWASHERS: RAIN DRAIN: 315 ft
Remarks: Site utility work for new 5,700 square foot office building. Other fixtures are (5) rain drain connectors.
FEES
Owner:
Description Date Amount
DOUG FRY
[PLUMB] Permit Fee 10/14/03 $365.40
2423 REMI NGTON CT MI
WEST LINN, OR 97068 [PLMPLN] Plan Review 10/14/03 $91.35
[TAX] 8% State Tax 10/14/03 $29.24
Phone : 503 348 - 2237 Total $485.99
Contractor:
CENTURY PLUMBING
2710 E HANCOCK
NEWBERG, OR 97132
REQUIRED INSPECTIONS
Phone : 538 2388 Water Service Insp
Storm Drain Insp
Reg #: MET 00003257 Storm Drain Insp
LIC 19085 Storm Drain Insp
PLM 36 - 24pb Rain Drain Insp
Rain Drain Insp
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 By: 4110 f� � j Permittee Signature: � / / . I • AV
Call (503) 639 -4175 by 7:00 P.M. for an inspection need-d the next business day
-Side Utilities q /7_,6 fs s!
�.� - :F OR OFFICE USE ONLY
Received Plumbing Plumbing Permit- l &t t� Ri / r� � p •
r) \\ * rlIc. Date/By: 7 /; ✓ s y.% Permit No.: ] 5 74'o
City of Tigard 1UL 23 2003 Planning Approval Sewer
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 (`,1TY OF TIGARD Date /By:8 - /f - 03�Jc Permit No.: /r��� 5 W € '
Phone: 503- 639 -4171 Fax: 50 59 .66 IS Post - Review Land Use
4�16.1�i .)IV �r��� �" � +� DateB Case No.: OP494495 �e�a✓ �
Internet: www.ci.tigard.or.us , ' � I Contact J IE See Page 2 for \
24 -hour Inspection Request: 503- 639 -4175 -- � -W Name /Method: / cr... Supplemental Information.
tea - oo 4/ S "
,, ; w. x , , , ,'4TYPE OF_WORK? ,'z , ,. 14.z -- '.'. � : « f; FEE
s *`SCHEDiJIsE,(for pet al` information, u se,heckli s t)' �s ,�,
W . New construction ❑ Demolition Description I Qty. [ Fee(ea) 1 Total
] Addition/alteration/replacement ❑ Other: ,- 2e a h ut ► vet gs z
s� .1Nerv'1 f Ln r;
=g a : CATEGORI' OF CONSTRUCTION LL ?`;'' ,,,,,t ' `'' ~ ' ' °' (i n c lud e e's '100;ft, -one i y conne ion) ,� ,;�,,,�,,,„ , ,?
�' SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 F
['Accessory Building ❑ Multi - Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 N
' Fire sprinkler - s ft.: a
_ xrt
���`m•:,'^.,.��. JOB SITE :`INFORIyIATION�andLOCATIONL„b. ;. ''E p Q• Page g 2
Job site address: I( 5605 IOu -Lt a - =„ ll . 'g.. ,.,:... , ; Site =>rttifities, w ; • ,. . �x� �.
1.
Suite #: Bldg. /Apt. #: 1 F Catch basin /area drain 2 16.60 - , Po i
Drywell /leach line /trench drain 16.60
Project Name: la' I! o rbob. 14.A d.4,41 F r
Footing drain (no. linear ft.) Page 2 I
Cross street/Directions to job site: Manufactured home utilities 110.00 ! �'
eti GO SIN) Ott► -k a„,. Manholes 16.60 I
A' ((otai/. rtst L Connitte - 0 G eri J"+" Rain drain connector / 5 16.60 g5. °b
Sanitary sewer (no. linear fL) )ti r f 0 Page 2 _
Subdivision: Lot #: Storm sewer (no. linear ft.) i Page 2 /9l/. c
Water service (no linear ft) g5 Page 2 66
Tax map /parcel #: ...,�,, it S ,FK �
r ..�:._ �..�<,. Fixtureoraitem,. _. N,•..,.� .,._,..
4 OESCRIP_T'ION OF WORK " .: .,a.. �.... °n ,. t
�° P•° .4 Absorption valve 16.60
t\J e W 4,1/i of -elf # S( W 0 1'44 • Backflow preventer Page 2
* Fvi DtS(el f+e - 3Ac Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
iRTY6OWNER; '.;ACA ® TENAN 1 T 4
s�PI2OPE� � Ejectors /sump 16.60
Name: DoT. -i Fil Expansion tank 16.60
Address: 2q-34 ae../n rti - f c i. CI • Fixture /sewer cap 16.60
City /State /Zip: (arts{- (,,'Kd "CO- 'Pr/C: riS Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phone: .►, • 2237 Fax: *72 • Coo 4- Hose bib 16.60
[ }APPLICANT : ": , " WONTACT�PERSON:
�. �. Ice maker 16.60
Name: KadLi-.ek (), IA C „ _ , Sethi "1 1 Interceptor /grease trap 16.60
� w , ewe l ari-A
Address:lcPso S•f . S-(-c !20 • Medical gas - value: $ Page 2
Cit City/State/Zip: - T1 ar/\ CAI 4 11 ZZ3 Primer 16.60
Y p I Roof drain (commercial) ' 16.60
Phone: 24- '-.o5Sz Fax: 2_q-4 -. Sink/basin/lavatory 16.60
E-mail: 6e4-j, (? mart p c • c-c.Yb Tub /shower /shower pan 16.60 •
stttr }'i ` ., ' . , -t CONtT CTORV ./ /. \\ . ,= Urinal 16.60
Business Name: C e, N" rt %/ t I P3 ec. Water closet 16.60 riAAM 16.60
W ater heater
Address: A7 E E. t CDC1e O ther:
City /State /Zip: � L,,J Q > Q Q�jL g9„, Other
Phone: 63$.a a3 gg Fax:
:. '''''" iumbtn Feesi 1 ;: -, � `
Dn Subtotal $ 417W '
CCB Lic. #: l'je 5 Plumb. Lic. #: 'e-a411� Minimum Permit Fee $72.50 $ 22 // [�
Authorized Residential Backflow Minimum Fee $36.25 c�(SI �' `
Signature: . Date: l • 2-3 • o 3 Plan Review (25% of Permit Fee) $ 9 / • 35"
F).C# -+11 uet State Surcharge (8% of Permit Fee) $ 9 • aq
(Please print name) TOTAL PERMIT FEE $ 'y R 5 - 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.
is \Dsts \Permit Forms \PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information .
N)
Fee Schedule: Residential Fire Suppression Systems:
MACtagi*Viiiiiii:WrIM'A ii9iSA Fee i:094.1 Square Footage = „ . - f.' ' '-: ',Peritiit 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 $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 7=V410ilifiii.ilil: , : , f., , ',Y:', 3■„eiiiiiito':- - '!-,: - :-., - ;;; :; ,':,!,ki, ::
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
N : IP V00 Tt4 additional $100.00 or fraction thereof, to and
::EVECARTOWIfelif, 17 kfjeel(4):4 St 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" ••• • •"-• • $742.0 the firk $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*.
f wo3F,VINf. Mil'aiinty100fie-u"Kmiiiiel,eigiiiieWs: Comments regarding fixture work:
Fili
,.,-iigio ..,•.:x.,-,'
otl,'el'oio.,.=:::::" EV, N e i M (
- mpi.'4r-i? 4,14yea :.., atigariti ,,,:kieilt
. - :• • !
Baptistry/Font - - .• ,
Bath -Tub/Shower
-Jacuzzi/Whirlpool -
Car Wash -Each Stall
-Drive Thru , .
Cuspidor/Water Aspirator - 3 i . . • ,
Dishwasher -Commercial - .
• • - • , • ,
-Domestic - • -
Drinking Fountain
Eye Wash . . • , ..
Floor Drain/sink - 2"
' „. '
„. ,
Car Wash Drain * , Note: " Irthe'tixtuie W'ork'under this permit results in an
Garbage -Domestic ,
- increase oeseWer EDUs, a sewe
D isposal -Commercial . .
sewer perniii,Will be issued and
?
-Industrial ' fees assessed fdr the sewer increase mustbe paid-before the
Ice Mach./Refrig. Drains plumbing permit can-be issued., . ,
Oil Separator (Gas Station)
Rec. Vehicle Dump Station , • .
-,
Shower -Gang :, 1, „•'%; ' i•C'i S '•,,•••••- , ..::; ,:: .-,... •
-Stall 0
Si
: 1 ., l':=. • • ' • : - .. „N
Sink -Bar/Lavatory '
• v tt,
-Bradley
-Commercial , --•.:,..„ 7C' 0,'',.: .'
-Service , . .: ' . '
Swimming Pool Filter • '• ••■• „e , s• -0,
Washer - Clothes .
. „
• • „ -
Water Extractor - -
Water Closet - Toilet
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 ° Date Requested. / .f/i PM BUP
Location 11 5 Co Suite MEC
Contact Person 7 rA-L Ph (- ) 5 Z — 7453 PLM d 3 Co
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation j
ELC
Ftg Drain Access: / ELR
Crawl Drain '`!
Slab Inspection) otes:
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
, 01#
Post & Beam
Under Slab
Rough-In yr% ����
Water Service
Sanit.. - er
'ain Drains
.sin / Manhole
form Drain
Show an
• -. -r:
•
S PART FAIL
ECHANICAL
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 E Please call for reinspection RE: ❑ Unable to inspect - no access
Fire Supply Line
ADA
I Approach/Sidewalk Date • - In8pecto� Ext
Other:
Final D • NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•