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Permit ..: CITY OF TIGARD PLUMBING PERMIT II , DEVELOPMENT SERVICES PERMIT #: PLM2000-00444 - I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/7/00 SITE ADDRESS: 09225 SW HALL BLVD E PARCEL: 1S126C0 -00100 SUBDIVISION: ZONING: 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; 1 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 4 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing tenant improvement. Added (4) new lays, (1) 2" floor drain and relocating (1) existing sink. FEES Owner: Type By Date Amount Receipt MENASHE, R BARRY PRMT CTR 12/7/00 $83.00 27200000000 621 SW ALDER, STE 605 5PCT CTR 12/7/00 $6.64 27200000000 PORTLAND, OR 97205 Total ' $89.64 Phone 1: Contractor: MAREK PLUMBING 3229 SE 160TH AVE PORTLAND, OR 97236 REQUIRED INSPECTIONS Phone 1: 761 -0105 Top -out Insp Reg #: LIC 75624 Final Inspection PLM 34 -229PB • 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 Ca t in copies of these. rules or direct questions to OUNC by calling (503) 246 -1987. Issue a tf . deC Permittee Signature: I� d . i Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day ■ • • =, . , • Plumbing Permit. Application Date received: /2 -7 - a 0 Permit no.: /?ij1�0 - luol,/rf a > , City of Tigard i s Sewer permit no:: Building permit no.: - - - -° Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire da Fax: (503) 598 -1960 6 u p — Od a-7 Da te issued: By: Receiptno.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory Cl Commercial /industrial ❑ Multi- family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist) Job address: 9'2 z 5 i4/ Mr/A /3 /tom c/ Description Qty. Fee(ea.) Total Bldg. no.: I Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: IBlock: I Subdivision: SFR (2) bath Project name: /eCt' .3 � i D e lv A-L. SFR (3) bath City /county: 7- on,/ , I ZIP: 772 2 3 . Each additional bath/kitchen Description and location of work on premises: Site utilities: Catch basin/area drain Est. date of completion/inspection: Drywells / leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: //' RE it Plat 2./ 14 - Manholes Address: `3 2 29 -•.S'. /6'9 -11 f,,, , p, _ Rain drain connector City: P � -f / cwt rV • I State: 2/ I ZIP: 77 ' 3 u6 _ Sanitary sewer (no. lin. ft.) Phone: 7 / 7 Z I Fax: 76'/ - 0/0.1-E-mail: Storm sewer (no. lin. ft.) CCB no.: t9 .5 6' 2. c /. I Plumb. bus. reg. no: 3 e ? Water service (no. lin. ft.) City /metro lic. no.: . ..5---c}-) ..5---c}-) f Fixture or item: 6' Contractor's representative signature: /c Absorption valve Back flow preventer Print name: 1 f44'E /r 6 / ? 24 - e 114r Date: /2 -3 . Backwater valve • CONTACT PERSON Basins/lavatory 4 / ((,.( (., 4 Name: Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: . I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture /sewer cap Name (print): Floor drains/floor sinks/hub lb ,c Garbage disposal Mailing address: Hose bibb City: I State: I ZIP: Ice maker Phone: 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 ENGINEER Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: • Phone: I Fax: I E -mail: Total 2 3 4 1' Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 3 ��� Notice: This permit application Plan review (at %) $ ❑ Visa ❑ MasterCard expires if a permit is not obtained Credit card number: / / within 180 days after it has been State surcharge (8 %) $ Expires TOTAL $ I e " • `f Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount - 440 -4616 (6/00 /COM) PLUMBING PERMIT FEES: 1 . :PRICE': " A TiNevil letif:2=teftiNfst:WellttiOtehtii: :,,,, '''. ; ,,z,,A,,,T:..-_,,.!, FIXTURES la's:livid6i") ' „,"r--';' ,,-,,z„, ,, ;,,,,,z'aryy-,„;, ,, ,lea) , ...,_ 0, ' 4 , -AMOUNT _ _ , .,„ includesall.plum Josi.414,14rml , -0. ,..-0 .4 , .,,,,... Sink 16.60 . the dwelling aricIthe,tOt1 ft 0,0,,,.,, ,-,, , : c..".„,4 -,.- , utility d6iiiecitiiiii ; ' i." >, ‘, ' •' t e','',' Lavatory , 16.60 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 _ - - 2' : , • • ' Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 ' ,,, - ; '•;;;,;';;;-,• t ":, .,; ,, ; :lk`Perfomed r Water Heater 0 conversion 0 like kind ' ,,:. QUaiitity by WO 16.60 1 , Gas piping requires a separate mechanical Fixture Type - ;:, ,., :e. :1%19ye..., , Replaced Remov permit. MFG Home New Water Service 46.40 Sink Alg M FG 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 Other Fixtures (Specify) 16.60 Urinal Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Sink: 2" / S ewer - 1st 100' 55.00 3" Sewer - each additional 100' 46.40 4" W ater Service - 1st 100' 55.00 Water Heater Other Fixtures Pkestev- . Water Service - each additional 200' 46.40 (Specify) Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 ,. Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device* 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL , Isometric or riser diagram is required if Quantity Total is > 9 *SUBTOTAL ''',:,-', : S:14 '•';:,,i. :k '',,: 8% STATE SURCHARGE ;'''r ::';'!,',:,: **PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is >9 . TOTAL ,- -;:::,- ; ''',:n '''; $ * 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 plans with isometric or riser diagram and plan review. i:\dsts\forms\plm-fees.doc 10/10/00 • Accumulative Sewer Tally Tenant Nam,: This SWR# Address: This PLM #: Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New # Value Capped off value added '# added #s total Count off #s count value values Baptistry/Font 4 , Bath - Tub /Shower 4 - JacuzzilWhirlpool 4 . Car Wash - Each Stall 6 - Drive Through 16 Cuspidor/Water Aspirator • 1 Dishwasher - Commercial 4 - Domestic 2 Drinking Fountain 1 Eye Wash 1 • Floor Drain /sink - 2 inch 2 / r . - 3 inch 5 - 4 inch 6 - Car Wash Dm 6 Garbage Disposal 16 • - Domestic (to 3/4 HP) - Commercial (to 5 HP) 32 , - Industrial (over 5 HP) 48 • . Ice Machine /Refrigerator Drains 1 .. Oil Sep (Gas Station) 6 i Rec. Vehicle Dump Station 16 Shower - Gang (Per Head) 1 - Stall 2 ) S q Sink - Bar /Lavatory 2 / r / 4 / - Bradley 5 ,. - Commercial 3 - Service 3 Swimming Pool Filter 1 Washer - Clothes 6 Water Extractor 6 Water Closet - Toilet 6 , Urinal 6 TOTALS SO 3 /0 Total fixture values: S divided by 16 = 5+ �y EDU — 5 �5 1 HISTORY ' o f 7't .e.A el-Q.4—i 6 E - D'-c ' 1.,16 r-- PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# • PLM# EDU# SWR# PLM# EDU# SWR# . PLM# EDU# SWR# PLM# EDU# SWR# . i:ldstslswrtaly.doc •