Permit v CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00598
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/27/2006
PARCEL: 2S 102AB - 04500
SITE ADDRESS: 12436 SW MAIN ST ZONING: CBD
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Other fixtures: Ice Maker, Primer.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: 70 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CACH, GERALD C + JOAN L
12525 SW MAIN Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 121261200E $242.20
[TAX] 8% State Surcha 12/26/200€ $19.38
Phone : Total $261.58
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 By: J ( f�i/ Permittee Signature: 2 ?."k 4
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.
Building Fixtures pp iv . 1 . 5 i c) 1 _G y Plumbine Permit A Q i Fol( of s� I Ic F• USE ONLY
City of Tigard DEC 26 2006A Daze/By /� �V /� Permit Ne l 1 �( op 5
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1 f w e4r /;i' '• Date/By. Other Permit No.. ,L-,i, -- . 7-.4 24- Hour Inspection Line: 503.639.41(5j1 I (i 1!t ._ ' f 1 Date Ready/By: Juris: ® See Page 2 for
Internet: www.ci.tigard.or.us TliTUT -T 1 Notified/Method: Supplemental Information
E" O T F M FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. 1 Total
Addition /alteration/replacement ❑ Other: New I - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION ' SFR (I) bath 249.20
❑ I- and 2- family dwelling Commercial /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: ( (, .SLj Wick(' d i S t". Catch basin or area drain 16.60
City /State/ZIP: -7Th as...A 0 .R__ al - 2 �3 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: 'n^ Footing drain (no. linear ft.: ) Page 2
Project name:
CY 1 a l h Sf • SSE Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
J4 "tJ eat j L./,r' 11 AC40✓.. ( ( a-4-o4 . .1 - Rain drain connector 16.60
on 04 CZ 1 e J Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no Water service (no. linear ft.: 70 ) Page 2 4. .4
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF 'WORK •
/ / �� p Back flow preventer Page 2 44( 44( ,-4 ')
Acid haoti s/ K fC / 4 S H4- 7 1e1 - - Backwater valve 16.60
_ 5r) ` - - i '` t t / S( o SAN >E /rr a ta.�., Clothes washer 16.60
O g Dishwasher 16.60
r ❑' PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer 16.60
City /State /ZIP: Floor drain/�oor sin /hub ' / 16.60 f 6 , (o c.,
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
• ❑ APPLICANT ' ❑ CONTACT PERSON
Ice maker / 16.60 lb ,6,.>
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer / 16.60 /C , ( o
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) MEE
avato, 16.60
ub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet i 16.60 I (2 ,(•
Business name: Rez) Qir '4l c, ws., 6/ a 3 /`j L Water heater r 16.60 ( , (o p
Address: p, v , ' 231 if S- Other:
City / State/ZIP: £z� �� Subtotal 2,4 Z Z
Minimum permit fee: $72.50
Phone: (jai) ( Ly f.
s er �
e.› Fax: (5 J3) ye 2 (7� Residential backflow minimum permit fee: $36.25
CCB Lie.: �' e , 7 Plumbing Lic. no.: Zh- Vf!S14d Plan review (25% of permit fee)
State surcharge (8% of permit fee) I •3�
Authorized signature: ',,/ 9 _ / TOTAL PERMIT FEE 2 , s f
Print name: £ (_2 - ekl./✓) ems,. Date: ( . /Z Vol, This permit application expires if a permit is not obtained %vithin
/ 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
i.\ Building ■Perniu\PLMF- PerrniWpp.doc 06/05 410 -4616T(10 /02/COM/WEB)
Plumbin! Permit Application - City of Tigard ,
Page 2 - Supplemental Information -
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities • '''r'''' "' • • ?"r; Qty. Fee (ea) Total
Square Footage: Permit Fee:
Footing drain - l' 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 4(,,.../. 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
Commercial Back Flow Prevention Device 46.40 including $10,000.00.
$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: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes ", A `complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
- Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: ;; i . . ,. , • Replace ❑ Any new exterior plumbing site utilities.
. , -- i- -- -- -'Previous" : Capped , ` Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor /Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink - 2" 1. / Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain Isometric or Riser Diagram .
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains `
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang _
-Stall _
Sink - Bar/Lavatory
- Bradley
-Commercial _ J
- Service -
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor P
Water Closet - Toilet I rlit increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
•
i:\ Building \Permiu\PLM- PermitApp.doc 07/06/05
CITY OF TIGARD .
1 BUILDING DIVISION / PERMIT #: PLM 00&tIpE,c;t3
13125 SW Hall Blvd., Tigard, OR 97223 1 DATE ISSUED: 12/21/2006
Phone: (503) 639 - 4171 Augp*,it
Inspection Requests (24 Hrs.): (503) 639 -4175 .!!J' A_ • ,
INSPECTION WORKSHEET FOR DATE: 1130/2007 TIME: 7:03AM PAGE: 19
SITE ADDRESS: 12436 SW MAIN Si CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET S6'ORE
DESCRIPTION: Other fixtures:; Ice M3km, Primer.
OWNER: CACH, GERALD C + JOAN L, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503 624-4880
Inspection Request Scheduled For: Date: 1/30/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 042608 -01 503 - 624 -4880 N
Corrections/Comments/Instructions:
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L AAri - .0_,..)-1--",., L.61 —
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: D ate: d /�� Phone #: (503) 718- 2-4 L(1.
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: PLM200600586
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/27/2006 -
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 �. :�L
INSPECTION WORKSHEET FOR DATE: 1/24/2007 TIME: 7 :02AM PAGE: 29
SITE ADDRESS: 12436 SW MAIN Sr CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET STORE
DESCRIPTION: Other fixtures: Ice Maker, Primer.
OWNER: CACH, GERALD C + JOAN L, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503 - 624 -4060
Inspection Request Scheduled For: Date: 1/24/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 042442 -01 503.624 -4080 N
Corrections /Comments /Instructions:
•
. L/ 1
•
❑ PASS y PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: i f i ta r 6 Date: 4' Phone #: (503) 718- .9-137 ,37
CITY OF TIGARD .-
BUILDING DIVISION ., PERMIT #: PLM200G00598
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/27/2006
Phone: (503) 639 -4171 77114, Y`w � "II r\
Inspection Requests (24 Hrs.): (503) 639 -4175 I
INSPECTION WORKSHEET FOR DATE: 1!18/2007 TIME: 7 :06AM PAGE: 14
SITE ADDRESS: 12436 SW MAIN ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET STORE
DESCRIPTION: Other fixtures: Ice Maker, Primer.
OWNER: CACH, GERALD C + JOAN L, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503 -624- 4880
Inspection Request Scheduled For: Date: 1/18/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 042256-0/ 503-624 -4880 N
Corrections /Comments /Instructions:
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
X l FAIL (CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: p L i i Date: 1 Vii 0 1 7 Phone #: (503) 718- 2 .
CITY OF TIGARD L ,
BUILDING DIVISION -� PERMIT #: PLM2006- 00F,98
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/27/2006
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 I J..
INSPECTION WORKSHEET FOR DATE: 1/121200 TIME: 7 :04AM PAGE: 37
SITE ADDRESS: 12436 SW MAIN ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET STORE
DESCRIPTION: Other fixtures: Ice Maker, Primer.
OWNER: CAChI, GERALD C + JOAN L, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503 -624 -4000
Inspection Request Scheduled For: Date: 1/1212007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 04205401 503 -624 -41380 N
Corrections /Comments/ Instructions:
—G) PA.e1, nr 1b i x`. LS "fc\ i 14 A eA6 , QC
a 6tk6 (cartsfkaTmg) sit\\K- .
loRgt.1.1
ate IRS :?1.. N ■ . L TZ -
NNc`8 P kiq €F fpm , 6LA 5 •.
L - -Eft., c J l,pito (INikdk__)
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: E( ) L.6"
Date: 1 .12 - OT7 Phone #: (503) 718- A 1,t0'
CITY OF TIGARD .
BUILDING DIVISION i PERMIT #: c
PLM200i;�Q0. X08
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12127/2006
Phone: (503) 639 -4171
A 8 ;'i
Inspection Requests (24 Hrs.): (503) 639 -4175 F 'I I..
INSPECTION WORKSHEET FOR DATE: 12/281200 TIME: 7 :01AM PAGE: 42
SITE ADDRESS: 12436 SW MAIN ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MAIN STREET S ORE
DESCRIPTION: Other fixture.:: Ice Maker, Primer.
OWNER: CACH, GERALD C + JOAN L, PHONE #:
CONTRACTOR: BRUNER PLUMBING PHONE #: 503 674 -48B0
Inspection Request Scheduled For: Date: 12/2W2006 Pour Time:
Coe # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 041559-01 503624 -4860 N
Corrections/ Comments/ Instructi • ns: `/ if
1 etie ' . i Air 1 , ,___O___,k‘tr__ ,
Erj . F1Z 0 (R - bOLQ
I 3 2D IQP-1 k&A. lz% - .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Vij ■ Date: C2 1"1° Z "1° (47 Phone #: (503) 718 - 2-