Permit •,„ CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00214
'TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/14/2008
PARCEL: 25101 AB -01607
SITE ADDRESS: 07540 SW HERMOSO WAY ZONING: MUE
SUBDIVISION: HERMOSO PARK LOT: 009 JURISDICTION: TIG
PROJECT: LUBY BUILDING
Project Description: Plumbing site utilities.
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: 2
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 65 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 200 ft
Owner: FEES
• LUBY BUILDING LLC
7360 SW HUNZIKER ST Description Date Amount
SUITE 206 [PLUMB] Permit Fee 5/14/2008 $189.60
TIGARD, OR 97223
[TAX] 12% State Surch 5/14/2008 $22.75
Phone : Total $212.35
Contractor:
BRUNER PLUMBING
PO BOX 23985
TIGARD, OR 97281 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 624 -4880
FAX 503- 624 -2173
Reg #: LIC 81837
PLM 26 -445PB
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 by calling 503.246.6699 or 1.800.332.2344.
Issued Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that 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.
•
Plumbing Permit Applicatio
Building Fixtures �� FOR OFFICE USE ONLY
1111 . City of Tigard MAY 1 4 2008 D c/V a / 0 0 4 .74 do d' -W //
13125 SW Hall Blvd., Tigard, OR 97223 w
y
Plan Revie
- Permi No
Phone: 503.639.4171 Fax: 503.598196p D . Other Permit No.� _ 8 goo S6
Inspection Line: 503.639.4175 1 I u 9 i GARD :
Td G A R D �. „ Date Ready/By: Jura: ® See Page 2 for
Internet: www.tigard- or.gov BUILDING DI 'ISIOR Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ID Demolition For special information use checklist
Description Qty. Ea. 1 Total
2* Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ I- and 2- family dwelling Qtommercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: • ,Y..o_s i W ' Catch basin or area drain Z 16.60 33 , 20
City /State /ZIP: / U Z (37 2- ? /
� Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 7 Project name: Z__6,‘ y 1....e2.6,4--e Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
7 2_ Qom- Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: r03 Page 2 _53 (77)
Storm sewer (no. linear ft.: Page 2 /el/, yip
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
A Fixture or item
Tax map /parcel no.:
,p , ^,W Absorption valve 16.60
�
DESCRIPTION OF WORK f ' Backflow preventer Page 2
rI.12J1-'�, C> e . , ‘..1 Backwater valve 16.60
/ ( r � s � Clothes washer 16.60
.S. +C) _ v -�, vx r ��� C / Dishwasher 16.60
V� t'e-i'✓A Drinking fountain 16.60
❑ PROPERTY OWNER TENANT Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floorsink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E - mail: Urinal 16.60
CONTRACTOR Water closet 16.60
7
Business name: ()N�� ��, r i b. ` Water heater 16.60
Address: /2 U ,,� Z 301 g S 7 "� Other.
1 Subtotal
City /State /ZIP: ( �) f2 7 1 - 3' IN
Minimum permit fee: $72.50
Phone: (96-3 6 S p Fax: (5 3 ) 60 v z( 7 3 Residential backflow minimum permit fee: $36.25 d 1, �4
CCB Lic.: 8-I 83 7 Plumbing Lic. no.: 24, -% 5 Plan review (25% of permit fee)
State surcharge (12% of permit fee) a 7.6
Authorized signature: _�� l TOTAL PERMIT FEE „Q/ 3 '
Print name: � .(fa,(..--7,( t � � yLg Date: 6 C L d This permit application expires if a permit is not obtained within
in J
/� 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I'\ Buildin g\Permits\PLMF- Permi1App.doe 12/27/06 440- 4616T(10 /02 /COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: - Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: 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
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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
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: Plan Review for Plumbing Installations
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
Quantity, by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ 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 Isometric or Riser Diagram
Drinking Fountain g
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-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:
is \Building\Permits\PLM- PermttApp doc 12/27/06
CITY OF TIGARD
„.
\ k fr i 206e- d o z 11
BUILDING DIVISION
A 5'1/ PERMIT l SSU E D :• 101; 8 00 2
13125'SW Hall Blvd., Tigard, OR 97223
Phone: (503) 639-4171 1;Vil
Inspection Requests (24 Hrs.): (503) 639-4175 -14- --,
INSPECTION WORKSHEET FOR DATE: 6/12/2008 TIME: 7:02AM PAGE: 38
SITE ADDRESS: 07540 SW HERMOSO WAY CLASS OF WORK:
SUBDIVISION: HERMOSO PARK LOT #: 009 TYPE OF USE:
PROJECT NAME: WY
DESCRIPTION: Replumb all fixture. Currently on septic. For residential use only. 5/12/08 ADDED 80 ft. of water
service and changed type of use to commercial.
OWNER: LUBY, K.EVIN PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503-6244880
Inspection Request Scheduled For: Date: 6/12/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Me- ag
3.15 Culvert/catch basin 071276-01 503-624-4880 Y ?4
■.
Corrections/Comments/I structions: c _.ir, Q Q.,PNINi—t.j t 70
/
, X
, .. 6"
or
SS PARTIAL APPROVAL CANCEL fl NO ACCESS
—
I I FAIL 1 CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
IPA P hone 1 br
Inspector: VW/ Date: / #: (503) 718-
. .
CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2008.00214
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 51147200E
Phone: (503) 639 -4171 747k Nei ` L pltjO
Inspection Requests (24 Hrs.): (503) 639 -4175 � �.A d
INSPECTION WORKSHEET FOR DATE: 5/19/2008 TIME: 7:00AM PAGE: 21
SITE ADDRESS: 07540 SW HERMOSO WAY CLASS OF WORK:
SUBDIVISION: HERMOSO PARK LOT #: 009 TYPE OF USE:
PROJECT NAME: L,UBY BUILDING .
DESCRIPTION: Plumbing site utilities.
OWNER: LUBY BUILDING LLC, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503-6244880
Inspection Request Scheduled For: Date: 5/19/2008 Pour Time: •
Code # Inspection Description Confirm # Contact # Message
335 Rain drain 070075 -01 503 -524 -4880 N
Corrections /Comments/ Instructions:
Z 6, v w L s, ud ✓J P O O \) C J o-d tSuJ 1 6
e4.ati Ov i. •
.0,e--‘ t- C L.. CctA . , v .
■
PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL Il CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t4 -∎- -A AV ^'/ Date: (c11 Phone #: (503) 718-
•
CITY OF TIGARD i
BUILDING DIVISION PERMIT #: PLM2006 -00214
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/14/2008
Phone: (503) 639 -4171 bast 1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/4/2008 TIME: 7:01AM PAGE: 41
SITE ADDRESS: 07540 SW HERMOSO WAY CLASS OF WORK:
SUBDIVISION: HERMOSO PARK LOT #: 009 TYPE OF USE:
PROJECT NAME: LUBY BUILDING
DESCRIPTION: Plumbing site utilities.
OWNER: LUBY BUILDING LLC, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503 - 624 -4880
Inspection Request Scheduled For: Date: 6/4/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
336 Rain drain 070600.01 503-2098172 N
Corrections /Comment /Instructions: �,- 2-r-- Pilfr '''
U■ - V . 0— '- k dAr6L- (4 ° r .
0
SS PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
(l FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector:
It ‘("jZ--___----. Date: ` b Phon #: 5 03 718- 2 P (503)
.
CITY OF TIGARDK
BUILDING DIVISION ' PERMIT #: PLM2008.00214
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/14/2008
Phone: (503) 639-4171 N "�NPNA ° � i 1 �
Inspection Requests (24 Hrs.): (503) 639 -4175 „III-
INSPECTION WORKSHEET FOR DATE: 5/20/2008 TIME: 6:59AM PAGE: 16
SITE ADDRESS: 07540 SW HERMOSO WAY CLASS OF WORK:
SUBDIVISION: HERMOSO PARK LOT #: 009 TYPE OF USE:
PROJECT NAME: LUBY BUILDING
DESCRIPTION: Plumbing sito utilities.
' OWNER: LUBY BUILDING LLC, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503-6244880
Inspection Request Scheduled For: Date: 5/20/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
335 Rain drain 070159 -01 503 - 624 -4800 N
Corrections /Comments /Instructions:
P a j 03,, 0 v0 <C0 ��, s At,
S-}3 � w C
® r G 'C� cYG� ds✓ � L't
n PASS 11,.PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector:\ \51, Date: 51/),/b 1,o 6) Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PL1v12008-002
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/14/2001
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/16/2008 TIME: 7:00AM PAGE: 28
SITE ADDRESS: 07540 SW HERMOSO WAY CLASS OF WORK:
SUBDIVISION: HERMOSO PARK LOT #: 008 TYPE OF USE:
PROJECT NAME: LUBY BUILDING
DESCRIPTION: Plumbing site utilities.
OWNER: LUBY BUILDING LLB', PHONE #:
CONTRACTOR: EIRUNER PLUMBING PHONE #: 603-624-4880
Inspection Request Scheduled For: Date: 5/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 07000001 503 - 624.4880 Y
Corrections /Comments/ Instructions:
Sx ilee w. e.d1. P .ro s A, A. C°-101 s-y -t , Put , -_ 1 0.1,/
t o (-
Ce, 4-1-c-c-L--7/1 a c
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION p ADDITIONAL FEES ASSESSED
Inspector: Date: ( I ko Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION
1 PERMIT #: PLM2008-00214
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED 5/14/2008
Phone: (503) 639-4171 _ 1 1
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE 7/24/2008 TIME: 7:00AM PAGE: 32
SITE ADDRESS: 07E40 SW HERMOSO WAY CLASS OF WORK:
SUBDIVISION: HERMOSO PARK LOT #: 009 TYPE OF USE:
PROJECT NAME: LUBY BUILDING
DESCRIPTION: Plumbing site utilities.
OWNER: LUBY BUILDING LLC, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503-614-4880
Inspection Request Scheduled For: Date: 7/24/2008 Pour Time:
Code # Inspection Description Confirm. # Contact # Message
399 Plumbing final 073146.02 503-620-3342 N
Corrections/Comments/Instructions:
ickip4 c "rat.L.A& AA.,,A 4- Pi ‘ \--A. ,S1,_e_ A-4-1--.L-A
• cA,r,c. 4 --i\--X , --- A
4 PASS PARTIAL APPROVAL Ell CANCEL n NO ACCESS
7 FAIL 7 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: '
frn " Date: 7 /2..4 /or) . Phone #: (503) 718-
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RECEIVED BY
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TOTAL r9
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ZO 39Vd 'ONI ONL1OVa1NO0 SAO 6Z868ESEO9 EE:80 800Z/TI/S0
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A-Affordable
Septic Service L.L.C. (INVOICE)/ Proposal
DEQ #37918(503)-682-1929 CCB #158246
P.O. BOX 1130 • WILSONVILLE, OR 97070
Date: 5- 5.
Name/Company (''( V 'c :) (On (t (MO 111(. • Job Address:
Street 1 U C - /t5L1 C Si kftLi
1104 v c,
City N('NrVC . ) State ( )V.■ Zip .91 ;I)
Phone (H) (w) DIM& D. 0 . 5 I -
DESCRIPTION UNIT PRICE TOTAL
70S1/4Li_ErLc — e L.
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GRAND TOTAL
Balance Is due by the 10th of the following month. Service charge of 1.5%, 14444 *clai
18% per annum, added on all accounts thirty days or more past due.
CO 39Vd 'DNI ONI1OVellN00 SAO EZ868C9COS CC:80 800Z/9T/S0 " —