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Permit CITY TIGARD PLUMBING PERMIT *go DEVELOPMENT SERVICES PERMIT #: PLM2003 -00366 '�I �! 13125 SW Hall Blvd., Tigard, O R 97223 (503) 639 -4171 DATE ISSUED: 7/28/03 SITE ADDRESS: 13050 SW PACIFIC HY PARCEL: 2S102CB -02700 W SUBDIVISION: FREWINGS ORCHARD TRACTS ZONING: C -G BLOCK: LOT: 020 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Relocate 1 sink, cap 2 sinks, add 1 toilet. FEES Owner: Description Date Amount CAPONE, ANTHONY M 13056 SW PACIFIC HWY [PLUMB] Permit Fee 7/28/03 $72.50 TIGARD, OR 97223 [TAX] 8% State Tax 7/28/03 $5.80 Total $78.30 Phone : Contractor: BRUNER PLUMBING PO BOX 23985 TIGARD, OR 97281 REQUIRED INSPECTIONS Phone : Rough -in Insp Final Inspection 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. • Issued By: � , '.�' Permittee Signature: Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures licaon FOR OFFICE USE ONLY P1Umi ing Permit ApN ti Received fp Plumbing Date/By: 7 -o;A G �� 3 Permit No. �}O0 � Planning Approval Sewer City of Tigard Plan Re Permit No.: : 13125 SW Hall Blvd. RECEIVED Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: JUp - 3 9 8 -1' S v t 3 4! f� Post - Review [.and Use Internet: www.ci.tigard.or.us e i I I Date/By: Case No.: Contact Juris.: ® See Page 2 for - 24 -hour Inspection RequeGIPO A1 - D Name/Method: 7 /C, Supplemental Information. BUILDING DIVISION TYPE OF WORK , . - - FEE* SCHEDULE (for special information use checklist) ❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total IN Addition/alteration /replacement ❑ Other: New 1- & 2- family dwellings CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) SFR (1) bath 249.20 ❑ 1 & 2- Family dwelling * Commercial/Industrial SFR (2) bath 350.00 ['Accessory Building ❑ Multi- Family SFR (3) bath 399.00 , ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2 Job site address: ) 3 o 5 0 SL1 61 . -Ft C. s, Site Utilities Suite #: I Bldg. /Apt. #: / Catch basin/area drain 16.60 Drywell/leach line/trench drain 16.60 Project Name: _ 744civ 'FelG (..) e 0_, Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: l( Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2 Water service (no. linear ft.) Page 2 - Tax map /parcel #: Fixture or Item DESCRIPTION OF WORK Absorption valve 16.60 4d I iqv A fS - t 2z,.-_ Bacicflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 , Dishwasher 16.60 Drinking fountain 16.60 0 PROPERTY OWNER I 0 TENANT Ejectors/sump 16.60 Name: Expansion tank 16.60 Address: , ttur sew ca / 16.60 City/State/Zip: Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 ,0 APPLICANT ❑ CONTACT PERSON Ice maker _ 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: R drain (commercial) 16.60 Phone: I Fax: Sink/basin/lavatory / 16.60 E -mail: • Tub /shower /shower, pan 16.60 • CONTRACTOR , 16.60 / ` Water closet / 16.60 Business Name: ,�r7J1i/t✓� Fl 11 14 I Ili 1 nt_, W ater heater 16.60 Address: eOJ i{ axles Other: City /State /Zip: 11.. ,., .( 0 Other: Phone: 6 2.-/ �ey o Fax: 6 Z V 2,1 7 Plumbing Permit Fees* / e3 Z( - '/Y pd Subtotal 72.50 $ CCB L1C. #: Pl L1C. #: Minimum Permit Fee $72.50 $ 7Z , SU Authorized > - 3 i -0 Residential Backflow Minimum Fee $36.25 Signature: Date: 7Z 3 3 Plan Review (25% of Permit Fee) $ q / / /7i, gniii e y am- State Surcharge (8% of Permit Fee) $ S , ( (Please print name) TOTAL PERMIT FEE $ -j . 3c7 Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with 1soitletric 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. i:\Dsts\Permit Forms \PlmPermitApp.doc 01/03 /66 / ' -`• Plumbing 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 $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 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 additional $100.00 or fraction thereof, to and Fixture or Rem Qty. Fee (ea) Total 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 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 $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: 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 *. Quantity by (Fixture) Work Performed Comments regarding fixture work: Fixture Type: Replace New Moved Existing Capped ' 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 „ -4 " Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic Disposal Commercial increase of sewer EDUs, a sewer permit 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. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet / Urinal Other Fixtures: i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested ' AM PM BUP Location 3 -� ✓ �� i Suite MEC Contact Person Ph ( ) SSD — � feat pLM 3 -l'v 3 (o Contractor Ph ( ) SWR BUILDING Tenant/Owner a ELC Footing Foundation ELC Access: J � _/ C Ftg Drain T7 ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors • Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler C � 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 Storm Drain Shower Pan Ot'- • • • PART FAIL CHANICAL 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 L Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date /1/ 4/ Inspector »7 7/ / 7 Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL