Permit CITY OF TIGARD PLUMBING PERMIT
r COMMUNITY DEVELOPMENT Permit #: PLM2009 -00062
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/23/2009
Parcel: 1S136DB02601
Jurisdiction: Tigard
Site address: 11606 SW PACIFIC HWY 250
Subdivision: Lot: 0
Project: Living Art Tattoo
Project Description: Install (3) lays„ move (1) sink, and (1) w /c.
Owner: FEES
HWY 99 LLC Quantity Description Date Amount
2655 MARYLHURST DR
WEST LINN, OR 97068 1 ea Sink 03/23/2009 $16.60
3 ea Lavatories 03/23/2009 $49.80
PHONE: 1 ea Water Closet 03/23/2009 $16.60
1 12% State Surcharge - 03/23/2009 $9.96
Contractor: Plumbing
POWER PLUMBING CO
PO BOX 19418
PORTLAND, OR 97280
PHONE: 503 - 244 -1900
FAX: 503 - 244 -8825
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $92.96
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules ..
Issued By: m a I ajatgA)45 Permittee Signature: SR i t 41 iey
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.
..MAR/18/2009/WED 02:12 PM POWER PLUMBING FAX No. 503 244 8825 P. 002
Plumbing Permit Application RECEIVED -
Building Fixtures For: OFFICE t;sr ONLY
Ci MAR 18 2009 Received
4J of Tigard Da , .. . `I ' pemutNo.: {l , i :ia • • • v , Z
. a 13125 SW hail Blvd_, Tigard, OR 9722.3 ^ OF TIGARD
Phone: 503.639.4171 Fax: 503.598,1986 FEWAIIIIIIIIIII OtherPermitNo.: ; 0 I.' • , Q(13(3
1.1 t _ ,, I: u J spection Litre: 503.639.4175 BUILDING DIVISI 1 i li7 see Pago 2 for
Internet www.tigatdor.gov su . .lemental Information
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❑ New construction ❑ Demolition For special information use cheekllsx
Description I Qty_ I Fs. 1 Total
V Addition/alteration/replacement ❑ Other: New 1- 2 -family dwellings (includes 100 ft. for each utility connection)
r, 4 i a - ,.(n t f7" 'T'" - G)Wt l �k^■wl �i (rf ��� ;L C4 (Oti }} r� �7F}^ ti 7-7773;" .
_�niv . a., _ . n .., , "-'^ - " ^ . k ,:!L'^r L_r% �" �:-i;: i (r , _ SFR (1) bath I 249.20
❑ 1- and 2- family dwelling 14 Commercialhmduatrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family
SFR (3) bath 399.00
❑ Master builder Other
Each additional bath/kitchen 45.00
0 ti c av�! r� r zr , c, Firs sprinkler sq. R) Page 2 _
It 7 n - , ,' , iii , ,nru r1 .cti , r , rL , 3k ^l t. ;f Z )c ,I srs� c.. t,4,'t�'lkf .,,l Multi a'f � Site utilities
Job site address: \ \ GO G SV Pc \ LtOY Catch basil, or area drain 16.60
City /State/ZIP: l c ik ,- Q 1 a S Drywell, leach line, or trench dram 16.60
Sui ]d apt. no.: I P Project 1380C: L'1 Y't nn k To 7oa Footing drain (no. linear ft.: ^) Page 2
t / 1 Manufactured home utilities 110.00
Cross stteetldirections to job site: L.oc_� :tc ,...,k 0 ,,-, C i4 l � rr Manholes 16.60
`T UJ4 t A,A--. oQ - 114" . " 4 I F . Rain drain connector 16.60
Sanitary sewer (no. linear ft.: __) Page 2
Storm sewer (no. linear R: _ ) Page 2
Subdivision I Lot no ; Water service (no_ linear ft: ) Page 2
Tax map/parcel n0 Fixture or item
Absorption valve 16.60
∎ ,m r k ' { Jq 41. l,�'lC} i "r { 2 . fi "0 1 +�n.. Y a , r -"
,;, . a. l.t .r,.! , ; .. ,:.= .. _Rt,.- �a.IC � +d.,^3,. '. 17. =_'u.'L.s_arr..:;�.r..Z v.:. t Back low preventer Page 2
!' tkei1. 3 n le_.t,.J 1 el l5 \ el ...x) 1t . Backwater valve 16.60
`- Clothes washer 16.60
5�Q r Dishwasher 16.60
4 t' .. ,. -c� 4 w }rat ' i n1 r -{ x 5 v r a r."' 3' si? Mountain 16.60
: �Y �, '. r - 1 t_7J1 : G r ` � qJ �-vf. ,1 +`_.� h !1 ' Irt'�I J. n �7, �E 11'.1 � , + f ,
7.:r.. ,, n.:u.a.zr�._y s. t.. +_ (• i ' f " �. u� A ..�,,..zd .
Ejectors/sump 16.60
Name:
t 1,'t n .. �c' 76 \
D Expansion tank 16.60
Address: /00 1 . PO(,.Jej/ Fixture/sewercap 16.60
• City /State/ZIP: Cy CGSYSIlysi / (7 R 910 &) Floor drain/floor ainldhub 16.60 t
Phone: ( .,3) 4 9' - 6 y � e Fax: ( ) Gee disposal 16.60
,, <':rt 9 "�i l ie:t('9et *r ''a3 7 ,r Td4 ? �
"y 1 ?-7x .c �?,,,;7 ,1 :4 Rose bib 16.60
;" . .L
Ir 2% i,,,,.7 a' .,, a � �1- Fr-tRl '.�3':i Z-':':.',1: ntr._.aL; Ice make] 16.60
Business name: Pot.. r P 1�.,e, id yet. 7 CO , Interceptor /grease nap
1' 16.60
Contact name; till t h (T 1,A,)r1C C c../1 Medical gas (value: $ ) Page 2
Address: b(eI 5(.0 IYLLAAk- no Ala tn , e:,ly 81. Primer 16.60
City /State/ZIP: Pork \a�r r•,),, Q / Q - 1 a 3 Roof drain (commercial) 16.60
1 Sialc/basin/lavaro 14 16.60 64 O
Phone: (60 ) ( ;(.4C.1 - 1q00 Fax: =(5o'� �y $ $ e ` 7 's
d Tub /shower/shower pas 16.60
E-mail 'M't\ '? • • OWCr *VUuYVlbtfl • ebm Urinal 16_.60
w�
u L�, _
'�' 1 -tr z 7 r `- ;:
,, :. , = r .. ti 4 C f ., , F�C�( �t 4 ,t ' ' r P rJ 4 , t• e y : R , t �r y 16.
a.- rL ,:'? .. ., y n„ �. 4r(. M..,?:.x fr j � � ' r? Mc31. r, F .krt .., ,` . r .fw..f { C 7 ry Weser closet 16.60
Businesaroame: f'Pl(,� P1,uxvlb'1C1 Ca, W ater heater 16.60
Address: 6 R + �) 01 u.-1 4-n o M a 61./fJ Other.
ty Po rIct c,„„ 9 . , O R , c7,2 v 3 Minimum emit u �zso 0 ci /stater F3`5.
Phone: 5o3 g 4 t i - /gm Fax: (.sa3) ; y Ll g g a 5 Residential back:9ow minimum permit fee: 536.25 1- ''
CCB Lis.: 5; • 7 t3 Plumbing Lic. no.: Sy. 152 156 Plan review (25% of permit fee)
Authorized sigaatnre: State surcharge (12% of permit fee) , 9(�
G 7/ _ . r. TOTAL PERMIT FEE 4.1., q b
Print name: 141 Ike_ W a.. ` ref, Date: 3- /5 - 09 This permit application expires if a permit is not obtained within
180 days after it has beta accepted as complete.
'Fee methodology set by lki-County Building Industry Service Board_
U\BaildiosIPeminiPLNID- reamiNpp.doe 12127/06 440- 4616100/02/cOM/WEB)
12 Lt00
..MAR /1,8 /2009 /WED 02:12 PM POWER PLUMBING FAX No, 503 244 8825 P. 003
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information •
Fee Schedule: Residential Fire Sue a ression S stems:
IF • , y 'T'y" � r �Y x'7 J .K 'rufY r , k zr4.wy ,� . R ;J „r4
t ,I ro G III! {!`1 .�`� ,� ' s r S C 1�cv ,. � , : ''S" v c tl 1 , t : ::4 J q f � "n.'''
'
, .n.t � .i:f `' 'Lt � ;J� � ... i� 4. C � t r : c 1 ( I � � I l . d . R �(_ ...., k7 M «..,
1.J.. i ��- .. r -' •• L>_ _.�. 1� .r,.,.�., r��_•r -:', c�:• a,.-:. r�• �. �n+. -r ,: it :`� ,��"'1.. �l'�
Footing drain -1° 100' - 55.00 0 to 2.000 5115.00
Footing drain - each additional 100' 46.40 - 2 001 to 3 600 5160,00
1st 100' 55.00 3 601 to 7 00 5220.00
Sewer
a 7 01 and = 5309.00
Sewer - each additional 100' 46.40
Water Service -1st 100' 55.00 MI Medical Gas S stems:
Water Service - each additional 100' 46.40 y -..,-,-------7, . -7 �-- , r t � y .7,.. ....-1. ;N ` 1�";1Y r-F- ' r x
• ...T l _2 Y.. - :... .:::tT.:_ . - .sn'. �..u i ,.1 Y I..:� 61..,:
Storm &Ram Dram -1st 100' 55.00
$100 to $5,000.00 Minimum fee $72.50
Storm Be, 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
ie �c, N c +)tr I� •'i • t l -, e 1 � '^t. r ,Ti _ i I ?In7 ;gt �a _ -rr ; 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 Bacldlow Prevention Device each additional $100.00 or faction thereof; to
minimum' • ••'r fee $3625 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 51.45 for
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or
and including $50,000.00.
eci : estee3 ' • , ections - • r how 7250 $50,001.00 and up $ 742.00 for the first $50,000.00 and $120 for
Subtotal: _� each additional $100.00 or fraction thereof.
Cbmmercial Fixture Work : ��r l f s -1 `1 -,L,-.4.:1,,, / ., i 7 sI, _+,r• ry,.r �` "r a.:r
lil.' L._..�:,= 4-.,; . i c-I.cr . 1 .l- -rx+ cT rJa �'f t . l F: ..- _,:.T
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
•
please indicate work performed by fxture. Failure to • Please check all that apply.
accurately re . ort fixtures could result in increased sewer fees *. in any nit commercial building with water service 2" and
, '. , t �, r N n r eater, except systems designed and stamped by licensed
i � 1�,�{.. 1 i, ,'i ,'�,� t f ;1� r � C ;, x �. ..Ak�l .�� � 71 ! J j i� ttr gr r
rl�rk -�-t5 a 7i r a h ' { !!h. t r ie ` i' t . 73 'a ' , engineer.
I� '- "" r.. M i.'? i A` a t U . r .1 Y.F s _v,iT 1 .1.
_ ... . _:: :_ ,.tia� a ❑ New exterior plumbing site utilities for any complex strum=
B: •r:.,,. /Font s -- as defined in OAR91 8-780-0040.
Bath -Tub/Shower - - -- ❑ Medical gas and vacuum systems for health care facilities -
-Ja .00l - -__ ❑ Any multipurpose fire sprinkler system.
Car Wasb -Bach Stall - - -- ❑ Any complex structure as defined in OAR918- 780-0040. •
-Drive Thru - •111111111111111111•
a. .idor/Water • 'hator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial i
-Domestic l� : _.. -�, t"j t.'„ .'• .: '� t z L, r.'r:P�c y r. n i
Arinldu' Fountain - - -- c..� 4_.� <'rL f r , t t �, r .
r !�j c' " r : , - � • K 1 4 �ti c l �',r'� y _�
e Wash -EMI . isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the ' : ' • cations above.
3" MN
-� --
Car Wasb Drain -�-
Garbage - Domestic Comments regarding mature work:
Disposal - Commercial -EMI
- Industrial - - --
Ice Mac . ' _ •� _ Drains - - -MIMI �,-
Oil S ' : -r Gas Station - - --
Rec. VehicleDrm• Station .1.11.111111.111�-
Shower -Gang -�- --
•
-GG -
-Stall IIIIIIIIIIIIMI
Sink - Bradley /vatory � MN= *Note: If the fixture work under this permit results in an
- commercial increase of sewer EDUs, a sewer permit will be issued and
- Service MEM OREM fees assessed for the sewer increase must be paid before the
S, . tr ;r ,r : Pool Filter phwtbimg permit can be issued.
Washer- Clothes - -
Water Extractor
Water Closet - Toilet Mill.111111111 MEM
Urinal - - --
Other Fixtures: 11.1111111 ��-
•
i \BuylcrinsTmhu1PLM- Pnmitetppdoe 12/37/06