Permit r i
CITY OF . PLUMBING PERMIT
41 /1
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00317
` -- �� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/11/03
SITE ADDRESS: 12325 SW KATHERINE ST PARCEL: 1S134CC 01700
SUBDIVISION: MARY WOODARD SCHOOL ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: El FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
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: 400 ft
Remarks: Site utilities.
FEES
Owner:
Description Date Amount
SCHOOL DISTRICT #23 JT
13137 SW PACIFIC HWY [PLMPLN] Plan Review 7/11/03 $60.15
TIGARD, OR 97223 [PLUMB] Permit Fee 7/11/03 $240.60
[TAX] 8% State Tax 7/11/03 $19.25
Phone : Total $320.00
Contractor:
PORTLAND MECHANICAL CONTRACTOR
6521 SE CROSSWHITE WAY
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Storm Drain Insp
Phone : 788
Rain Drain Insp
Reg #: LIC 151807 Final Inspection
PLM 3 -425PB
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
/ 410" - -
, %� , i i Permittee Si nat -. i� /' I // I 411
IssudB , u 9 �11��h�h.�
Call (503) .39-4175 by 7:00 P.M. for an inspection needed the next business day
S : Utilities ,,�, . - 63
Pi • rtbing Per _� A +j n FOR OFFI USE ONLY
t '11 ty.�� Received Plumbing � n
Date/B : I L
Ai
I Permit No. -t l` . QO - CO 3/
City of Tigard JUL 1 2003 Planning Approv• Sewer
Date /B Permit No.:
13125 SW Hall Blvd. Plan Review Other -
Tigard, Oregon 97223 CITY OF TI I GARD Date /B : Permit No.: o
Phone: 503- 639 -4171 Fax: ICJUV Post- Review Land Use Q
� � � /�imiu�Nl �� . ( F� DateB Case No.:
km www.ci.tigard.or.us e .� I Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 c ° "" W Name /Method: Su lemental Information.
NO
'" a . :' _6- :,'.. "„ t F E - . E 'fors' eci41 information1userchecklO
. ate. � TYPE OF WORK � .m,.... � n'` �.. � b � .._. .*.. _._..._.. _�...� P.
III New construction El Demolition Description I Qty. I Fee(ea) I Total
g, Addition/alteration /replacement , ❑ Other 'k ( c► fain wy ll ngsCr _ , }
'New14 &2 it d i R
Y
. , , m udes„ I;OO ft �for�ea'c ; corm ion ,�
. :'; . a CA�T,-EGORY OF CQNSTRU.0 101∎T z,, .. .: . SFR (1) bath 249.20
[❑ 1 & 2- Family dwelling Commercial/Industrial SFR (2) bath 350.00 e
❑Accessory Building Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
: '! ; F JOB SITE' =INF.ORMATION andLOCATION ° ``; ', • Fire sprinkler sq ft Page
Job site address: 1 l 2.5 /)T4E SJ6 sr -, ; _ 4 rr, Site Uiitiiteszr. :.�,�° ��. -_ � �3.... , ,
Suite #: ® Bl g. /Apt. #: Catch basin /area drain 16.60
�OO�ALP � opts 0 Drywell /leach line/trench dram 16.60
Project Na Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
K4r "qua/ &mow / f 14 ` T Manholes 16.60
(/ Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
_Subdivision: . Lot # -
Storm sewer (no. linear ft.) 44afi Page 2
Tax map /parcel #: j t St G� °l®® Water service (no linear ft) Page 2
•x • g : 01 :24 x a lve 16.60
ii ,i . Fixture i it m ., . '.,. a . =Neat-.. _:.' . t
�'` ,. , ,;;DES.CRIPTION`®F „WO i, . ; °s< _ Absorption valve
DM 41 4M * PG 14 gEA Backflow preventer • Page 2 '
Backwater valve / . 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinkin fountain 16.60
. `;PROPERTY' O:WIST Egg:W ® TENANT . . ,
Ejectors /sump 16.60
Name: T7 Sp 2.3 3 Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /Zip: " rw,. P Floor drain/floor sink/hub 16.60
Garbage disposal 1'6.60
Phone: 41C. 41100 Fax Hose bib 16.60 •
APPLICANT,`IT AV° . ,[CON,TA0it PERSON:,.; Ice maker 16.60
Name: ,,,,,5, wN up 6s TPA +t.. (MO AIRC) Interceptor /grease trap 16.60
Address: '5( t so) 4)A 4Wma4 T)! Medical gas - value: $ Page 2
City /State /Zip: "girt-AP p OA 9 /Ls Primer 16.60
e Roof drain (commercial) 16.60
Phone: t 24. . 4.! l Fax: 1,1S . q e q L Sink/basin/lavatory 16.60
E t,40 0s4 dt. Cipwdt , Tub /shower /shower pan 16.60 Mt �'� Urinal 16.60
ik itil .,. ICON7'RACTO Ct l.s . : . :.
Business Name: 4 kii 0 I/ gr,N . C'o lP...s Water closet 16.60
Water heater 16.60
Address: ( -A f 1.4 - Other:
City /State /Zi 6a 97 94949 Other:
%:, 21 P.lamliiiig: r
Phone: ( 7� ' -55-70 t� Fax: :.; . . , �... Permit Fees* - �F <,
Subtotal $
CCB Lic. #: /5/ 8o 7 P1 .•■ b. Lic.#: 1 Minim Permit Fee $72.50 $ /, / _o
Authori ed j ? Residential Backflow Minimum Fee $36.25
Signature: � ' Date: 1 I 01 Plan Review (25% of Permit Fee) $ ( , /;-)
f . 0011U _0- 6-4f44_t.t•_ - - State Surcharge (8% of Permit Fee) $ /9, a
....Wise print name) TOTAL PERMIT FE E $ A a010b
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
, .
. „
Fee Schedule: Residential Fire Suppression Systems:
rma=z•==x ktrA '- ,
T-4 'Moo 7: '!f' eiVaP ,,totr
i;"1 .-, SqiiareFootage: :,,-:' , :Termit•Fee; : r„
';, 4-
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 ',...yikitlatiotif, ',,' ' ...;',,,t-: ,R,priiinti ee, ,-,-; , ,'.,- , • - • : ; ::: ,-... -, ', •-,,, •
Storm & Rain Drain - 1st 100' . /09 55.00 . 5 - , o t, $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 300 46.40 /39 ao $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
4 20 - 4074 .610W0 Qty. additional $100.00 or fraction thereof, to and
.c.'"5 i IF-HOW 41:.0I74Q including $10,000.00. .
Commercial Back Flow Prevention Device / 46.40 44,1 $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 i -
$50,001.00 ' : . $742.00';for the first $50,000.00 and $1.20 for
Subtotal: l each additional $100.00 or fraction thereof.
• • 1
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• • .,
, - • •
•
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*. • .
it.IMMUW '4 R,:!OrifihrtyjKOix"rur iilWiilk",T,-Ofirfiiie:da Comments regarding fixture work:
.. „
I 5ie;g0i45: EfiG,;;.:V 2-140,0: NSP6W,
i,4iste'ili:7 ,:,1, W.Miiiied4 , gri:eiffileWoi
Baptistry/Font
Bath -Tub/Shower
-Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
. .
Cuspidor/Water Aspirator '
Dishwasher -Commercial
-Domestic
Drinking Fountain .. •
Eye Wash ,
- - ,. • - „
Floor Drain/sink - 2" . .
, . •
. 3 . •
Car Wash Drain *
Garbage -Domestic Note: ' If the fixture , work under this permit results in an
Disposal -Commercial
increase of-sewer EDt.Js, sewertpeimit will be issued and
-Industrial .• fees assessed for the sewer increase must be paid before the
Ice Mach./Refrig. Drains - plumbing permit can be issued., , 4;
Oil Separator (Gas Station) . ... •
Rec. Vehicle Dump Station -
..
Shower -Gang . , -
-Stall
Sink -Bar/Lavatory " . .. , . , .4
-Bradley
-Commercial ' . •
-Service .
-
Swimming Pool Filter • ` .
Washer - Clothes ,. . .
.
Water Extractor . - . ' ,
•
Water Closet - Toilet . . . .
- I
.
. .
Urinal V
• . ..
Other Fixtures:
i: \Dsts \Permit Forms\P1mPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUI,LDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Request 9d 7 AM PM BUP
Location 1 �`-� �� j<Q ifu Suite MEC
Contact Person Ph (. ) 30 1 ? PLM . - dl) 31 7
Contractor Ph ( ) SWR
•
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access: •
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath /Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal I
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING ,
Post & Beam
- Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole •
or Drain
Shower Pan
Other:
4,E2170) PART' FAIL
HANICAL
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 ❑ Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA Date ! C ad) o 3" Inspector � ►"►�Mr i) 1: Ext
pproach /Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL