Permit 4 - " CITY OF TIGARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2002 -00005
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/18/02
SITE ADDRESS: 11515 SW HALL BLVD PARCEL: 1S135DA
SUBDIVISION: ZONING: C -
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: A3 FLOOR DRAINS; TRAPS:
STORIES: 2 WATER HEATERS: CATCH BASINS: 3
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: 3
SINKS: URINALS: GREASE TRAPS: 1
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 210 ft
WATER CLOSETS: WATER LINE: 175 ft
DISHWASHERS: RAIN DRAIN: 635 ft
Remarks: Site utlities for construction of new temple and addition to a SF residence for a congregate residence.
FEES
Owner:
Type By Date Amount Receipt
BRAHMAPREMANANDA ASHRAM/TEMPLE PRMT CTR 9/18/02 $649.00 27200200000
11515 SW HALL BLVD PLCK CTR 9/18/02 $162.25 27200200000
TIGARD, OR 97223 5PCT CTR 9/18/02 $51.92 27200200000
Phone 1: Total $863.17
Contractor:
D & A GENERAL CONTRACTOR INC
3100 TURNER RD SE #204
SALEM, OR 97302 REQUIRED INSPECTIONS
Phone 1: 503-581-8036 Sewer Inspection
Water Line Insp
Reg #: LIC 145089
PLM 24 -396PB Fire Supply Line -FPS
Storm Drain Insp
Rain 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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
C / i
Issued r + /' I Permittee Signature:
Call (503) 63• -4175 by 7:00 P.M. for an inspection needed the next business day
Plumbing Permit Application
Date received: 4 ' , - Permit no.:/2/y?pp4 •
14i � ; City of Tigaard
/4 4',- . � b Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City ofTigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: Rece.iptno.:
. Land use approval: (P D R) 2001-00003 Case file no.: Payment type:
uiTuii)W1111J Q1I111111
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory • Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
' JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) `
Job address: l l S 1 5 S. W .HALL BLVD, T I G A R D, OR Description Qty. Fee (ea.) Total
New I- and 2- family dwellings only:
Bldg. no.: j Suite no.: includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: 151 5 D A 1 4 U U , 1 5 U U & 3 S U U SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath _
Project name: BRAHMA PREMANANDA ASHRAM SFR(3)bath
City /county: T I G A R D/ WAS H I NI ZIP: 9/223 Each additional bath/kitchen
Description and location of work on premises: S F F PLANS Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
1 Manufactured home utilities
A Business nam(D ar Ql ,& )Q !''I/"5r% � Manholes
,
Address: / pp J �2iva2 XD it , Dc1 Rain drain connector
City: Statei I ZIP: P7,5= Sanitary sewer (no. lin. ft.)
Phone: Fax: E -mail: Storm sewer (no. lin. ft.)
CCB no.: • ( Plumb. bus. reg. no: Water service (no. lin. ft.)
City /metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer'
Print name: Date: Backwater valve
CONTACT PERSON ' Basins/lavatory •
Name: SAM ADD I T I WAR Clothes washer
Dishwasher
1 225 N .W. MURRAY ROAD #1UL
Address: Drinking fountain(s)
City: PORTLAND I State: OR I ZIP: 9/229 Ejectors/sump '
Phone: 646-9069 Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap
Name (print): Floor drains /floor sinks/hub
Mailing address: 11515 S .W . HALL BLVD Garbage disposal
Hose bibb
City: T I G A R D I State: OR I ZIP: 97223 Ice maker
Phone: 598_3073 I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: / / State surcharge (8 %) .... $
Expires within 180 days after it has been
p TOTAL, $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6/00/COM)
r .
PLUMBING PERMIT FEES:
1 u " . ,r t .° ,+ XeRICE ,':: „;New 1 artit family'dwellings only:•r , w
FIXTURES (indi - ry° . , :, ! z QTY `m(ea), -, 1:$AMOUNT (inclu plum bing fiztures, z i, PRICE . 'TO
Sink 16.60 the dwellingand�the fi'rst;100-ft: _, , ; " QTTYa, ;(ea) " ° A '
Lavato 16.60 for: eah -uy
ctilitconnectiort) '„ -' _., . __. •••,, - •
ry One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL `
Urinal 16.60 8% STATE SURCHARGE ,
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL .
TOTAL
i
a
eDs osal 16.60
Garbage p
9
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/
Floor Sink 2" 16.60 - •
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 --•,,,,-.7-:- °" > � -- '' Quantity<byuWork Performed '
Gas piping requires a separate mechanical tFixture 'Ty;pe r 1' ' -' ^-Mowed. Replaced. - ,Removed/
permit. .
MFG Home New Water Service 46.40 Sink
MFG Home New San /Storm Sewer 46.40 Lavatory
•
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) • 16.60 Dishwasher
• • Garbage Disposal • .
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' / 55.00 6K6-6 3„
Sewer - each additional 100' Rf 46.40 qz , „F D 4
Water Service - 1st 100' if 55.00 snit) Water Heater
Other Fixtures
Water Service each additional 200' / 46.40 ,i/6, vd (Specify)
Storm & Rain Drain - 1st 100' / 55.00 5 -t
Storm & Rain Drain - each additional 100' & 46.40 2 7&,(10 _
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device* 27.55
Catch Basin 3 16.60 s/9, �✓D
Inspection of Existing Plumbing or Specially - 62.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps / 16.60 / rito
QUANTITY TOTAL ., ". =' ," „ ` , V„ i
Isome or riser diagram is required if u * _a,. „y, �'i,,- - -`3 d:
Quantity Total is > 9 ,, „ _' S
*SUBTOTAL .r : ' , ` t' °`�,
X14 ,
8% STATE SURCHARGE ;:::' ,2- ::::'',-°''''' -iz -
**PLAN REVIEW 25% OF SUBTOTAL `::° y:'' /,� r 25
Required only if fixture qty. total is > 9 ., ' ' a - ° � „
TOTAL ... y" rt 7°: -,g, = $01 2 � f
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
is \dsts \forms \plm- fees.doc 12/26/01
CITY OF TIGARD 24 -Hour . "
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /0 — 3/ AM PM BUP
Location 1/ 5/ 5 �Ct 1/ Blvd Suite MEC
Contact Person MiGA.e_G%-- Ph ( ) . c9 — 66053 aro 2-00o05
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
A ccess:.
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam .
Shear Anchors
Ext Sheath /Shear ,
Int Sheath/Shear
Framing
Insulation
Drywall Nailing r..
Firewall J. - G -r r l
Fire Sprinkler
Fire Alarm V '� ����� = � P A
S usp'd Ceiling .
Roof .
Other:
Final
T FAIL .
PLUMBI
-ost & Beam d -
Under Slab
Rough -In f 't3 Water Service r
Sanitary Sewer `�� -
Rain Drains
Catch Basin / Manhole r
• Storm Drain
Shower Pan /fir- J /�� Orr 0•" AV -
f
PART FAIL
00-, ANICAL
Post "& Beam d
Rough -In / ,/ <
Gas Line ir
Smoke Dampers
Final %" .
PASS PART FAIL
ELECTRIC AL'
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 0 "Please call for r- inspection RE: ❑ Unable to inspect - no access
Fire Supply Line ; D ADA )7/17/ Approach /Sidewalk Date I Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL