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Permit
C ITY OF TIGARD PLUMBING PERMIT �i1 PERMIT #: PLM2006 -00411 DEVELOPMENT SERVICES DATE ISSUED: 9/14/2006 �= 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S 102BD -01900 SITE ADDRESS: 12910 SW PACIFIC HWY ZONING: C -G SUBDIVISION: HUDSON PLAZA LOT: OOD JURISDICTION: TIG Project Description: Site Utilities for environmental compound & parking lot. Other: (1) back -water valve, (2) raindrain connectors, 100 ft. of footing drain. CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 0 OCCUPANCY GRP: 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: 100 ft WATER CLOSETS: WATER LINE: 100 ft DISHWASHERS: RAIN DRAIN: 100 ft Owner: FEES HENDERSON, MARILYN DOROTHEA JENSEN HUDSON TRUSTEE Description Date Amount 11795 SW KATHERINE ST [PLUMB] Permit Fee 9/14/2006 $269.80 TIGARD, OR 97224 [PLMPLN] Plan Review 9/14/2006 $67.45 Phone : [TAX] 8% State Surcha 9/14/2006 $21.58 Total $358.83 Contractor: WESTERN PLUMBING 9460 SW TIGARD STREET TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 639 -5296 FAX 503- 684 -9015 • Reg #: LIC 2439 PLM 34 -29PB 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 folio ules adopted b - •reg• Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -13 ". Y. • . o• r copies of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. / Issued By: � ) Pe ittee Si, • to Call 503 - 639 -4175 by 7:00 a.m. for an insp.• tion that business day. This permit card shall be kept in a conspicuous place o • the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. , t 1\ Site.. Utilities - • k-l!a o?OD(o RECEIVE • - Plumbing Permit Application FOR OFFICE: 1'SF ONLY City of Tigard S E P 0 5 2006 R 9 - 7 Q tc ')..K- P No.- 0 O U vp y 1/ IIIII a 13125 SW Hall Blvd., Tigard, OR 972 VITY OF TIGARD Plan Review Phone: 503.639.4171 Fax: 503.SS � l � �ING DIVISION Date/BY. Other Permit No.: T I G A Iz I) Inspection Line: 503.639.4175 Date Ready/By. /) _ [ Jutis: RI See Page 2 for Internet: www.tigard- or.gov MM1��G�i�� ©11P Notified/Method % �,.,1 vV �� T/ � Supplemental Information TYPE OF WORK t FEE• SCHEDULE $.New construction ❑ Demolition For special information use checklist. ! Description I Qty. I Ea. I Total ---' ❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) (,,, CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 1/j ❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00 7 El Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 El Master builder ❑ Other: ,'�, Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: , 9 + 6 j). C / r C 14 W Catch basin or area drain 16.60 • City /State/ZIP: I /21-- /21-- Q 7 2-9- � Drywell, leach line, or trench drain 16.60 D el Suite/bldg./apt. no.: Project name: ' I( � �J • Footing drain (no. linear ft.:l 00 ) Page 2 47 • �� ' G Manufactured home utilities 110.00 (-1 Cross street/directions to job site: V Manholes 16.60 Rain drain connector Z. 16.60 334 "(Sanitary sewer (no. linear fl.: LL' Page 2 56 V., • 'Stone sewer (no. linear R: MO ) Page 2 }S Subdivision: Lot no.: )(Water service (no. linear ft.: Page 2 .."-` Fixture or item Tax map/parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK A Back flow preventer Page 2 ( E LA L € DEC, E V kH i 1�/9-l- Backwater valve / 16.60 1C,47-5 H D u }�� 4 ‘•=0211 ,) en LbT. Clothes washer 16.60 Dishwasher 16.60 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 \ \ D ,, ^ ' \ Ejectors/sump 16.60 Name: '- j f 12 �A t ) /4 t. NT .&) l3 Expansion tank 16.60 • Address: 1 1 -79 5 dt) I . 1 i-� f ,12Bit Fixture/sewer cap 16.60 City /State/ZIP , Aerl el --2) Floor drain/floor sink/hub 16.60 Phone: a■,3) 53 39 q Fax: ( 54O 2J (039 - 5G ID3 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: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRA OR Water closet 16.60 Business name: (4V K ij Lu i....//, ,c )O Water heater 16.60 Address: y Ll ( T ,. i 2,b . Other: I - . city/State/ZIP0 q-, �a,3 Subtotal 9,'76 Minimum permit fee: $72.50 Phone: ( ;p3) (p -5 a9 6 Fax: (.3) , ''To 1 5� Residential back flow minimum permit fee: $36.25 • CCB Lic.: P{ ( b' • : Lic. no.: + r' D r Pl r eview (25% of permit fee) ; e l t -.r / ■ , l 0 % State surcharge (8% of permit fee) Authorized signature: TOTAL PERMIT FEE Print nam � Da r This permit application expires its permit is not obtained within - 180 days after it has been accepted as complete. * Fee methodology set by Tri -County Building Industry Service Board. I:\ Building \Pomits\PIMU- PamitApp.doc 06/26 410.4616T(10/02/COM/WEB) ■ Plumbing Permit Application - City of Tigard - " ..t„, Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - I 100' / 55.00 ... .6:5' 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 55 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' / 55.00 S S Medical Gas Systems: Water Service - each additional 100' 46.40 V aluation: Permit Fee: Storm & Rain Drain - 1st 100' / 55.00 . S 5 $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 Inspection of existing plumbing or each additional $100.00 or fraction thereof to and including 00 ot $50,000.00. fi st $5 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 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: Replace ❑ Any new exterior plumbing site utilities. 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 Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system. • Floor Drain /sink - 2" Submit 2 sets of plans with any of the above. - 3" 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 - Service Swimming Pool Filter *Note: If the fixture work under this permit results in an Washer - Clothes Water Extractor increase of sewer EDUs, a sewer permit will be issued and Water Closet - Toilet fees assessed for the sewer increase must be paid before the Urinal plumbing permit can be issued. • Other Fixtures: i:\ Building\Pmnits\PLM- PeimitApp.doc 07/06/05 0 0( -/ // CITY OF TIGARD A _ ?OA iop 6 _ ,afit4=ler BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 bew I � I I : Ck Inspection Requests (24 Hrs.): (503) 639 -4175 R_ .. INSPECTION WORKSHEET FOR DATE: 1/ Lk /61 TIME: PAGE: SITE ADDRESS: \ 2I 1A3 Q CTe....--- �. CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # Message mu., bk. vl cd, -- t-vvi Corrections /Comments /Instructions: /})._} ( j <— , ( V&ASS____ ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ` /� Date: V Phone #: (503) 718 - 2-/-2-y CITY OF TIGARD ; , , - 4 o¢t BUILDING DIVISION �� PERMIT #: PLM2006- nn�. 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/27/2006 Phone: (503) 639- 4171 l oll Inspection Requests (24 Hrs.): (503) 639 -4175 u� F .. INSPECTION WORKSHEET FOR DATE: 11/27/2006 TIME: 7 :05AM PAGE: 35 SITE ADDRESS: 129J0 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: HUDSON PLAZA LOT #: 00D TYPE OF USE: PROJECT NAME: HUDSON PLAZA DESCRIPTION: Plumbing fixtures for new restroom /equipment structure. Other fixtures: (2) hose bibs. OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 503 Inspection Request Scheduled For: Date: 11/27/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 040224 -01 503-639-5296 N Corrections /Comments/ Instructions: 0 ...Z..._____ b U • PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: illA ti k . Date: I c ) ) Phone #: (503) 718- _ CITY OF TIGARD • BUILDING DIVISION PERMIT #: PLM200&0O411 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 9/14/2006 Phone: (503) 639 -4171 A l Inspection Requests (24 Hrs.): (503) 639 -4175 : ' 1 I .. INSPECTION WORKSHEET FOR DATE: 9/2212006 TIME: 7:02AM PAGE: 22 SITE ADDRESS: 12910 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: HUDSON PLAZA LOT #: 00D TYPE OF USE: PROJECT NAME: HUDSON PLAZA DESCRIPTION: Site Utilities for environmental compound & parking lot. Other: (1) back-water valve, (2) raindrain connectors, 100 ft. of footing drain. OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 503 - 639-5296 Inspection Request Scheduled For: Date: 9/22/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 330 Water service 037042-01 503-639.5296 N Corrections /Comments/ Instructions: lA 7 p v (0i — ...4e.vt,r_.-(.e ,, /' j ; i i �, / % "/ • 16 ; ,; ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS / FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: a Date: gle)-/I:C Phone #: (503) 718- G ` �2 CITY OFTIGARD U�• BUILDING DIVISION PERMIT #: PLM200G -00411 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/14/2006 Phone: (503) 639 -4171 /�mv I° n Inspection Requests (24 Hrs.): (503) 639 -4175 ' `'I�� INSPECTION WORKSHEET FOR DATE: 9/19/2006 TIME: 7 :05AM PAGE: 25 SITE ADDRESS: 12910 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: HUDSON PLAZA LOT #: ODD TYPE OF USE: PROJECT NAME: HUDSON PLAZA DESCRIPTION: Site Utilities for environmental compound & parking lot. Other: (1) back-water valve, (2) raindrain connectors, 100 ft. of footing drain. OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 503- 639 -5296 Inspection Request Scheduled For: Date: 9/19/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 305 Plumbing undersiab 036788 -02 503 - 639.5296 N Corrections /Comments /Instructions: ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: V Date: Phone #: (503) 718- --- LJ CITY OF TIGARD : ;E t BUILDING DIVISION ' PERMIT #: PLM2006 -00411 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/14/2006 Phone: (503) 639 -4171 A I ! Inspection Requests (24 Hrs.): (503) 639 -4175 ...' � 1 �.. INSPECTION WORKSHEET FOR DATE: 9/19/2006 TIME: 7:05AM PAGE: 26 SITE ADDRESS: 12910 SW PACIFIC HWY CLASS OF WORK: SUBDIVISION: HUDSON PLAZA LOT #: 00D TYPE OF USE: PROJECT NAME: HUDSON PLAZA DESCRIPTION: Site Utilities for environmental compound & parking lot. Other: (1) back-water valve, (2) raindrain connectors, 100 ft. of footing drain. OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 503 Inspection Request Scheduled For: Date: 9/19/2006 Pour Time: Code # Inspection Description Confirm # Contact # • Message 340 Storm drain 036788 -01 503-639-5296 N Corrections /Comments/ Instructions: V PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS - ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: / Phone #: (503) 718-