Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00187
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/13/2007
PARCEL: 2S 102 DA -00400
SITE ADDRESS: 13125 SW HALL BLVD ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: TIGARD SKATE PARK
Project Description: Site utilities for new skate park.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 4
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 342 ft
Owner: FEES
TIGARD, CITY OF
13125 SW HALL Description Date Amount
TIGARD, OR 97223 [TAX] 8% State Surcharl 6/4/2007 $20.85
[PLUMB] Permit Fee 6/4/2007 $260.60
Phone : Total $281.45
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # :
Reg #:
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. T. e - - . - : - set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions
to OW by calling 503.24...699. .:00.332.2344.
I-sued By: r I / y � Permittee •ignature: ` i , /� I� /✓ l�
Call 503.639.4175 by 7:00 a.m. for an inspectio - .t business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
„� Plumbin P rmit Application / .', a ,4�.L /A /b
Site Utilities ° �� ' , ;1011 -OFF Icy. , usl IONI i F
i�
City of Tigard -.
D l
Permit
Y !�' 1 7 L �Q'�'z7 -6610
714
v 13125 SW Hall Blvd., Tigard, OR 97223 IA { �t v�//�u��
' :;,; Phone: 503.639.4171 Fax: 503.598.1960 9 200 Plan Review Other Permit No.:
Inspection Line: 503.639.4175 D Ready/By: T 1 G A R D; ReBy: . ' .
Internet: www.tigard- or.gov � ` Q` �� a t ^ ^t�fl�e� Non / la See Page 2 for
a Supplemental Information
Vi 161 6.. DA VISION i` , • „�_ - i ,
M: : 4. , �. SCHE DULE:':' - r , .s.` .`
Tl 'PE.:OF WORK. ' c. � .- p , i _:; -, ' � .4 i ,� . F E E. * -' �•:� .
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ® Other: S k. 4'tTE PRale New 1- 2- family dwellings (includes 100 ft. for each utility connection)
'. ' ` CATEGORY' OF, kCONSTRUCTION " : L �K • SFR (l) bath 249.20
❑ 1- and 2- family dwelling (fit] Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
ID Master builder Each additional bath/kitchen 45.00
❑ Other:
, ;., _., ..., __ - -. - •.. ; .:4.1`.-%'. Fire sprinkler ( sq. ft.) Page t
-
;.'" ,r * . , i ' „', t ` ``: UBiSITE°; IIVFOR11TN''rUD.;LUTN+ K';, ri4
b• AlO� V� CAIO �' •.gym Site utilities
Job site address: 1 3 12 S S t..1 t.4 A. Lk - C3\ va Catch basin or area drain L' f 16.60 t m
City /State/ZIP: - F, Ag , f .,A t O 9_ �7 �� 3 Drywell, leach line, or trench drain 16.60 '
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: _) Page 2
�trt~ car1cc.1}# Meth. S(tsaie
Cross street/directions to job site: Pac lL Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear R: 142.) ?„,..1.2_ Page 2 11 t4 , Z ,.
Subdivision: I Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
:s ,,,,r ...DES IPTIONOF, WORK ` ; - ; � • ° t . ,._:. °, ,, .;t , . e �
�,, '� ...9,; "� „� _ �� , . . .: • �. k �'. *., ', �'��� • r "� :� " s .■: Back Sow preventer Page 2
4Id.--a }e- P Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
r t' I r, Drinking fountain
s 16.60
:,.......1":";:.1:',P, ;s''' II rPRUPERTit.OWNIER` 4;,' .: i _ '. 's` ti .. ;ti *, P>
. - . - . - . - _. _ ., t , , ,, .. t• R, Ejectors/sump
16.60
Name:
CAA - 1 c Ti 9o,rA Expansion tank 16.60
Address: 1 3 1'2.5 S t.J 1-kakk Q\ VC1 cap 16.60
Fixture/sewer ca
City / State/ZIP: - 1 - 1 0kc‘ f a t c . 3 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( )
Garbage disposal 16.60
••- PERSO Hose bib 16.60
16.60 1
is » [` wa. APPL1CAIVT�' t - , - ;0 CONTACT - N,:'; y - °`
` Ice maker
Business name: t��,1 Oc "r a , t .A
'j Interceptor /grease trap 16.60
Contact name: -n..0 y in eq , f S . Medical gas (value: $
`` ) Page 2
Address: 13 1 2.s �t J ‘,4 411 (3\ uc , Primer 16.60
Cit / State/ZIP: T�c: ca t C 2- ql 2 -Z3 Roof drain (commercial) 16.60
Phone: ( ) Fax: ; ( ) Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
Urinal 16.60
a;n - � - -..;p, i_w.. o7;. 'el .. :q „A:.. �•lY - . e - k =J. -. _ . ,- .w...�1- t , .. r.
,,.. 4 ±4? t .; : CONT ;
� ' r, , ., y- ' , . `,=.. Water closet 16.60
Business name: 0LCl )X12 Water heater 16.60
Address: Other:
Subtotal
City / State/ZIP: Minimum permit fee: $72.50 60
Phone: ( ;) °. / / Fax: ( ) Residential backflow minimum permit fee: $36.25 •
CCB Lic.: lumbing Lic. no.: Plan review (25% of permit fee)
C / State surcharge (8% of permit fee) ODD . � 8 / S
Authorized signature: /��/i TOTAL PERMIT FEE p2 91„ vs
J
Print name: 'TQ 0 7 A ME 4:012 S Date: 51 / 7 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:\ Building \Permits\PLMU- PermitApp.doc 06/26/06 440A616Tt 10/02/COM/WEB)
Plumbing Permit Application - City of Tigard -..
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site ITtilitles, ,'ss. r ''Q=3 e,:(ee); ,,.Toi ",
,.. ...... �. ry..•.- ���.,�z nt ��,,,�,�. =` fit` ^w��. -. 1 _r ��,�s<�., •� ildl'e'',�!t)
q � .. .at'�`:_•,K .a,r:= Via, °�,.�'�',,.
Footing drain - 1. 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
Storm & Rain Drain - 1st 100' l 55.00 55.0..t $ 1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 5 46.40 13q, 20 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
"'e i _'� _ '\ "?,' 'y ota additional $100.00 or fraction they of to and
�' Future 'Or' e
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
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 $100.00 or fraction thereof.
Fixture Work:
�„ �... I' u ting`Iustallahons4Y�,�;
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
greater, systems stamped licensed
;µ�,;. '; - F,� •;�,r.:��, �Qu' a` nYitY= tiy(Fiztu "i•e)rwo�knPerfti�roed =� l� , exce t P Ys tem s estgn and b Y
Replace:*, engineer.
,g1v:; 411 *. A . :" 4.,; 4 , 41 '.'Previous , = ;:tifO tiZ; ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918 780 - 0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic :14.70.61: ,c$,a3xts �„ y ,�� s P a _.�u; ,a
Drinking Fountain ` `s : ::.M? y.„ I30 r. 0Y ; R ser..Ai.'agra_m «yo-. ^; ,'' `
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink -2" - that meet the qualifications above.
-3"
-4 ,,
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
-Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor •
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PertnitApp.doc 09/22/06
CITY OF TIGARD f co l e7
BUILDING DIVISION 1 PERMIT #: c k
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 u��1�11 t0
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: , (),/[)'—/ a 7 TIME: PAGE:
SITE ADDRESS: 4 3 1 2– t Nk- `' ` VA CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # ( nn \ k-A-/v.--- t•";.- t Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
y4
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c
, \ / 77-----------
` PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
El FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: \ D ( �� / U Phone #: (503) 718 - e-2—k1 Z
CITY OF TIGARD
BUILDING DIVISION PERMIT #: 1 2617 2O /g.?
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 mir �i�� rV'
Inspection Requests (24 Hrs.): (503) 639-4175
WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: 0 1 2.c �J "" /01 CLASS OF WORK:
SUBDIVISION: n LOT #: TYPE OF USE:
PROJECT NAME:7 / GAP Sg fri 7
DESCRIPTION: �i
OWNER: C. /T y OF T 7�j PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
3LO $7 j i pm/A) •
Corrections /Comments /Instructions:
4
X PASS Li PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
I I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ]1 7 f./ Date: _ _ i Phone #: (503) 718-
CITY OF TIGARD "z_ rn Q
BUILDING DIVISION PERMIT #: a00 7 " 0 / v 7
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 �°" '44��iiq o � l � ,
Inspection Requests (24 Hrs.): (503) 639 -4175 :�' : _..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / 3/ dZS_ Al '? CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT TI O :
N „4.......A (A. �`.
DESCRIPTION: d�
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: (p - a 7 - 0 7 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3'v
Corrections /Comments/ Instructions:
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o l
0 i 4I 7 -
•
i ai
0
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fey
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X 74 PASS $ - ARTIAL APPROVAL El CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
O
Inspector: / Date: I Phone #: (503) 718- .)- '.3/*