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Permit • 1 CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2009 -00188 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/24/2009 Parcel: 1 S 136CA01601 Jurisdiction: Tigard Site address: 11665 SW PACIFIC HWY Subdivision: Lot: 0 Project: Keybank Project Description: Replace existing fixtures: (1) drinking fountain, (1) floor drain, (1) lay, and (1) w/c for TI. 9/16/09 ADD: (1) primer; all other fees were paid and collected additional amount for primer. Owner: FEES HALL, DONALD W & GRACE L & Quantity Description Date Amount HALL, JOHN G ET AL, BY FIRST AMERICAN REAL ESTATE TA, 8435 N STEMMONS 1 ea Drinking Fountain 09/01/2009 $16.60 PHONE: 1 ea Floor Drain/Floor Sink/Hub 09/01/2009 $16.60 1 ea Lavatories 09/01/2009 $16.60 1 ea Water Closet 09/01/2009 $16.60 Contractor: 1 12% State Surcharge - 09/01/2009 $8.70 ENDEAVOR PLUMBING & CONTRACTORS INC Plumbing PO BOX 28037 6 ea Minimum Fee Adjustment - 09/01/2009 $6.10 Plumbing PORTLAND, OR 97228 1 ea Primer 09/16/2009 $16.60 PHONE: 503- 504 -6846 0 12% State Surcharge - 09/16/2009 $1.99 FAX: 503 - 477 -9159 Plumbing Type of Use: COM Class of Work: ALT Type of Const: Occupancy Grp: Stories: Total $99.79 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 or direct qu UNC by calling 503.246.6699 or 1.800.332.2344. Issue By: [ A/e/ e y Permittee SignaturAlailk j - 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. '` Plu bins Permit Application RECEIVE Building Fixtures FOR OFFICE USE ONLY City of Tigard JUL 15 2009 Received `D� Permit No.: par .Co g a 1 3125 SW Hall Blvd., Tigard, OR 97223 Date /By: �7 g P lan Review ��Q !� (�� 3 �(�(� tr Phone: 503.639.4171 Fax: 503.598.1960CITY OF TIGARD Other Permit No.(W\ /00 -03 CA Plan Review TIGARD Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready /By: kris; El See Page 2 for Internet: www.tigard - or.gov Notified/Method: D" . Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. I Ea. I Total E Addition/alteration/replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 ❑ I- and 2- family dwelling Eommercial/industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi - family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: I I Cp (p 5 5v...1 R1'I' I G Hwy • Catch basin or area drain 16.60 City/State /ZIP: 180.rd , ©R 91 2.' Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: I Project name: Ley (60A IC. - Ti o rd , Footing drain (no. linear ft.: _) Page 2 Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: _) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2 Tax map /parcel no.: I ,3 (l3 f „ (1'k % ( o' Absorption v or item 1 l w \ A valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 Limited - tenant Improvement Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ❑ PROPERTY OWNER I tg TENANT Drinking fountain I fly .410 Ejectors /sump 16.60 Name: Key �anK- Expansion tank 16.60 Address: 202.E, Qnta+io 31- . L44 -h Floor. Fixture/sewercap 16.60 City/State/ZIP: G1evejat'tci , CH I-41-1 115 Floordrain/floorsink/hub 1 16.60 Ib,b0 Phone: ( ) Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT El. CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: jacclo Interceptor /grease trap 16.60 Contact name: cAir i 5 saw -C• n t_ Medical gas (value: $ ) Page 2 Address: 9.,� E. brpcick et- , t,J }e II So Primer 16.60 City/State/ZIP: C,p \ij, -y-' 3 U S , OH "62-15 Roof drain (commercial) 16.60 Sink/basin/lavatory I 16.60 1(6.60 Phone: (40 1-) 431. 1 4 )(3 Fax: : ( )'- k 1 •4jOy Tub /shower /shower pan 16.60 �'1 E -mail: �rI5 ah1r(X,nK L CkC Oc05 • corn Urinal 16.60 CONTRACTOR Water closet I 16.60 16,60 Business name: - 1150 Water heater 16.60 Address: Other. City/State /ZIP: Subtotal Minimum permit fee: $72.50 `7 Phone: ( ) Fax: ( ) Residential backflow minimum permit fcc: $36.25 ! CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) / State surcharge (12% of permit fee) g•70 Authorized signature: ' 20 Jail , � • A' TOTAL PERMIT FEE Print name: � � ' +�G____ Date: n ( This permit application expires if a permit is not obtains within 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. 1: \Building\Permits\PLMF- PermitApp.doc 12/27/06 440.4616T(10/02/COM/WEB) / b 2 V l . Pl Mbin g Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee: Footing drain - 1" 100' 55.00 0 to 2,000 $1 15.00 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 Valuation: Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Stonn & 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 each additional $100.00 or fraction thereof, to P g P g or and including $50,000.00. 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. Commercial Fixture Work: Plan Review for Plumbing Installations Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following. please indicate work performed by fixture. Failure to Please check all that apply. accurately report fixtures could result in increased sewer fees * . ❑ Any new commercial building with water service 2" and Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed Fixture Type: . Replace engineer. Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure Baptistry/Font as defined in OAR918- 780 -0040. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities. - Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system. Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040. -Drive Thru Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above. Dishwasher - Commercial - Domestic Drinking Fountain Isometric or Riser Diagram Eye Wash ❑ Isometric or riser diagram is required for new buildings Floor Drain/sink - 2" that meet the qualifications above. -3" l -4" Car Wash Drain Garbage - Domestic Comments regarding fixture work: Disposal - Commercial - Industrial Ice Mach. /Refrig. Drains Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory YQS - Bradley *Note: If the fixture work under this permit results in an - Commercial increase of sewer EDUs, a sewer permit will be issued and - Service fees assessed for the sewer increase must be paid before the Swimming Pool Filter plumbing permit can be issued. Washer - Clothes Water Extractor Water Closet - Toilet *PS Urinal Other Fixtures: i:\Building\Pe mits \PLM- PamitApp.doc 1227/06 09/15/2009 07:57 15034779159 #2573 P.001 /002 • ' Plumbin Permit A licat CEIVED . . • Building Fixtur Dpep,di �SIalEP 15 2009 FOR OFFicr 1;Si oNi. City of Tigard - I v ' /6 .O y i r �m icxa. • ■ 13125 SW Hall Blvd Tigerd /t R�Jl OF TIGARD , , ti ` 1.Z 1 09 D0 /I F F ' Phone: 503.639.4171 Fax u;jnNG DIVISION .. Other � ,d �o�009 / '11C;AF: D lnspecxion Line: 503 ��� D intt mCt: www.ligard-or.o v ` Ed Page 2 for e • Sopplemendlloformation 0 New construction ■ Demolition For special information use checklist t�4 ■ Other: Description I Qty- - J F"a. 1 "total New l dwellings (inch for each Utility .:�_' =_,a _.. ,, : �. , ,: �• , _ _._ ,._._ .,., 2-family odes 100 R r connection , ..1_^J_;: i :- IIf; E4_ „'.. � '' t`i: ^ J� d' �' ' �'e'.'i 1 �� S FR (1) bath _.., Rt�a• � a , 249.20 1 -and 2- family dwelling iG . • SFR (2) bath — 350.00 — Accessory building ■ _ 399 ❑ Master builder ■ . „ - 11 .. .5 L r.••_e . �:wwvc:cx. , l y,l qt u" T rtR p i r sprinkler �. _ f�-`" ; . , .,,, • . - F!T'' � r c, : ,may � 'ti•rk'�;���r,,, 3,.: f =,.1 `b .i f- r R 1. x �'. ti - -Mi • , Er e � 3% Mi is %5 (' •h� '� �1( -..: .___- �€'nA• -' r` -i - •n:!'Fk:':�}1L'i 'd�' L?Fa a� ,h��•:`'m; Site utilities Job site address: f) _ 5c..._) Pot . /P /G I ./GJ f `: drain _ 16.60 City/State/Z1P: l &4i26 . On ` . Z2 Drywell, leach fine, or trench drain 16.60 Suite/bldg./apt •no.: Project name: s , _ ja,,.v.- Footing drain (no. linear ft.: ) PEST 2 — Cross street/directions to job site: Manufactured home utilities 110.00 • Manholes . . _ Page 2 Storm sewer (no. linear It: ___) Page 2 — Subdivision Lot no.: Page 2 Tax map/paroel no.: Future or item _:. i'f`r:- _�� .. _ k.. : =r"�' N _if':. z. � ?d5t"a`,i : ' !!T �: _ -_ ��.P.R'�F'�'- ' "' �.:. „i_: ��i5`::3C . �: lrl�' („,:' Backflow prevenwr Page 2 64 (4fri- 0 Lam. ” qu. r% X 'R.02.SC. • Backwater Valve 16.60 iZ , fP " W4 € c 1 .1 Clothes 16.60 _ r► ° a L rg G Irlr i 16.60 MOM • � ;a Drinkin° f ou m ain 16.60 . , • x }3i.. ,- �. S r "3 �-ML A i r �, •,, ` i �, • ' " ° x ° • . v ''' ' Ejectors/srunP _ 16.60 Name: K. e 1c �1A • �) Expansion tank 16.60 Ill= Address: Fixtlu�. + r cap 16,60 City/State/ZIP: , 11 ' r oor dr. t oor sink/hub NE,,,/ 1131E' 16.60 Phone: ( ) / !�_ � = b � �iFw ...._ -- 'FT's$ ,,,,� f ��-r�i+ { , 1 ;s;: __ , . . ,, i:it.7,1 , �� . _�__t ?# ,4 . ! zi ,. ��„ 1tI , ,": r •.9 ` " � ,s l e.fS' rrii,raa i ma II 16.60 Business name: . Interceptor/grease trap 16.60 Contact name: ' Medical - Page 2 Address: �- • 16.60 ''• " 1 City/State/ZIP: Roof drain (com ID :) 16.60 Si do/ Sink/ 1 ' ; 16.60 / Phone:( ) Fax::( ) �. q E-mail: • Urinal 16.60 ii. _ . h •. .,; •t .[h. �: > tix � '1,� � �':V.ab:.." -. s� �� �: d'ru' __: i�.._ e.. sAtur� Water closet Mr 16.60 Business name: _..` 400AVO._ //e,/,41,64.......„11,,_/, ,1 6. 16.60 Address: • 0x 2.0031_ • - 4,60x 3 City/State/MP: 'a r O , q' 2241 , ' minimum permit Phone: (. ) �y� Fax: (� • � j `3 ..� . permit CCB Lie.: / 6 9 2_ ✓ Plumbing Lie. no.: ' L z6 19- Authorized signature: 6 TOTAL PERMIT FEE •°' r g ' . - ( 2 Print name: L 'v ' Date: O permit application expires if a LS "� ffd[�s� I � /� Q `� .I This P� PP W permit is not obtain �. within 180 days after it has been accepted as complete. *Fee methodology set by Tri-Coumy Building Industry Service Board. I AnuildingTerrafts NPLMF-PosailApp.doc 17I27/o6 440- 1616T(IO/o/COM/WEB) A., too /69 q /n, Phi lig 2009 09:01 15034779159 , ,' #2520 P.001 /003 Plumbing Permit Application 12 e Id ' Building Fixtures , FOR OFFICE E 1 ;5- ONLY City of Tigard J LAA 1, Per No.: -o12�i • �1 13125 SW Hail Blvd. Tigard, OR 97223 Review as Phone: 503.639.4171 Fax: 503.598.1960 Da Other Peztmt No.i 0O4 ,CGC3 , L( T [ GA RD homer Line: 503.639.4175 p Ready/Br: Q[ Seepag 2 for Intcme : www.tigard- or.gov Notified/meihod Sopplemeaw Information •4 '.ys.� !h �.. . . . >. ,' c- FS� `»i.3> +. c t •+ .. 'i' f. q+ - y.. -r " - -� v '., - ' . ' . -.. ' ° _. ' : � S ' , . 4 - y 1 .,, � ., % : -. . i F 4. a .t"iA.3c . ,. , `5- K ,1, . 4i •%�� :,,,rr.u. <f . i � - ,, j." " Pot ormadon use r 0 New construction ❑ Demolition ommercial/industri l' Addipon/alter�ion/re IaccmCnt Other: Descri.tion etZ� Ea. Total 0 _ . - 2-fam y wel ings ( es 100 R fo eac utii ew 1 ii d mclnd icy Corinecrion) j ,. : tX 4 ...: `/ ? o - '� a'• .a''' \. :.a�:•, r•n f�F mi $ • N ,jig _.. •:, ; r: • ❑ 1- and 2- family dwelling :, _% r s` � ` ' SFK (i) bath 49.2 M. l j,�r z 0 1 SFR (2) bath 350.00 Q Accessory build ng i ❑ Multi- £amity SFR (3) bath 399,00 ❑ Master builder ❑ O Each additional baffiRd6ctlrn 45.00 •o . y ,C"+� ° Lc ¢ors S.� /d i s y� Fire sprinkler L_ sq. ft.) Page 2 =;y,F ,.'; s• - • t3'. - Yy V `- s r .'_„ Site Mlles Job site address: W PA V 1 • w t; Catch basin of area drain 16.60 City /Statc/ZTP: ` A O 1 " 2"L Drywell leach !die, or tree h drain 16.60 Suitc/bldgiapt. no.: Project name: Footing drain (no. linear ft: P ..e 2 Manufacwred home utilities 110.00 Cross street/directiions to job site: Mimes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear R: __) Page 2 Storm sewer (no. linter R: ) Page 2 - Subdivision_ Lot no.: Water service (no. linear ft.: `) P 2 Tax map/parcel no.: I S1 3 (p • G i a C AbSor a or item ,� ,,. ; �- _ Abiexption valve 16.60 . • r ) _ f1� 1' yi, s-•, ''N'' �.. ? '.. '4. ' acitflow preventer P 2 EI 4_ .: �' .:lJ �Y � � � ^i�i.'Q:]�L. ��u' :ti. J: a' :37�1 B }app BaCk'water Valve 16.60 16.60 16.60 .fiat ^1 x = a�. waww k �3�� 7x - , Dunking foemt! M' 16.60 .ti '� eii si :.9 1) �t .. ``,, "° Y` +.v5t .i� M �t ,;, r m��,- ��^s �5:; .-�:�a�. � � . 5 ..... > ,,,_ _ ; ; ..x.tr � :3 Ejeciors/sump � 16.60 Name: I` -r 6 4r) rr AO F^i Q2 , - Expansion tank 16,60 Address: Fixture/sewer cap ■ 16.60 City/State/ZIP: . Floor drai /foor sink/hub Eir, 16.60 Phone: ( • ) Fax: ( ) dispersal 16,60 .v.,• . =": 4 "- t' ; ; e:'%. • } : 1 - . y � : N.,.. " A xti,, r - v Hose bib 16.64 ..::�' .'X z_'.. _ .+ . )1, . . i ,. '4 i C .5' M . .. - r. 1 .w_„, , h, °v,a {vim ice maker Business name: - 16.60 interceptor /grease trap 16,60 Contact name: Medical gas (value: S ) = Page 2 Address: Primer 16.60 - City /State/ZIP: Roof drain (commercial) 16.60 M Phone: ( ) Fax:: ( ) Sink/basin/lavatary 16.60 Tub /shower /shower pan -- 16.60 E -mail: , Urinal 16.60 : i � 4 4 - :; .. y,r j} -r• MO sfy' q "'• ', ' ,,v , "n11 i•'' 1.0 ;:M't`:i: „ ., , ,. ••.v;•i, .- ....., , 5_ ? i s ' „ v , F� i �' i•1 Watei CIOSet 16.64 • Business name: 6a-AJoIL pi- osnai- >(p r 'Xitl G. Water healer 16.60 Address: eO F2ox Z S 3'4- y Qo r2 A i!) Q g -- la Subtotal Cit /SIa1 rJZi P : 4 o Phone: , ) • • G i !o r O Fax: ( _so - 15 1 Residential bsckflow mi um per f c x3625 - . g o CCB Lie.: i s , .• Plumbing Lic. no.� 2 , Plan revie w (25 of pe rmit fee) Authorized signature: f1 S �T07AL o PERM1T ) ' W / 61,2 j Print name: 6S ( /te H 0 ci sc-r-0-a [Date: O 3 1 09 This permit application eapirts if a permit is not o • . ' • ed withi • 180 days after it has been accepted as comp! , *Fee methodology set by Trio inty Building Industry Service Board I: rBudSaeglPanueslPL.�•Pmnrtnppdoe 11127A0d dbs6l6rt70b3/COM/WEBI \ � \ A A /3/� � Gf -C,