Permit C ITY OF TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM2005 -00082
��, I� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/9/2005
SITE ADDRESS: 12959 SW PACIFIC HWY PARCEL: 2S102BD -02600
SUBDIVISION: NORTH TIGARDVILLE ADDITION ZONING: C -G
BLOCK: LOT: 037 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: (3) sinks, (1) water heater.
Owner:
FEES
KIM, ROBERT + HAE LIM Description Date Amount
1360 SW WOODWARD WAY
PORTLAND, OR 97225 [TAX] 8% State Surchari 3/9/2005 $5.80
[PLUMB] Permit Fee 3/9/2005 $72.50
Phone : Total $78.30
Contractor:
MR ROOTER OF PORTLAND
PORTLAND SERVICES INC REQUIRED ITEMS AND REPORTS
15033 SE MCLOUGHLIN BLVD #344
MILWAUKIE, OR 97267
Phone : 503 653 - 5301
Reg #: LIC 138941
PLM 3 -434PB
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: - 46„;,, A ► /
Call (503) 639 -4175 by 7:00 P.M. for an inspection the next business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the pro -ct.
Approved plans are required on the job site at the time of each inspection.
i
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Da �1 - L7S
Plan n Re view '� I M�aos od d $,2.
Review 503.639.4171 Fax: 503.598.1960 / , �a � 'i�,� h'i Date/By: Other Permit No. I U� f
Oal( I
24 Hour Inspection Line: 503.639.4175 _s1,1,
_. . Date Ready/By: ur : El See Page 2 for
Internet: www.ci.tigard.or.us �" X
Notified/Method: J �V Supplemental Information
TYPE OF WORK , ' ' . - , .. ; 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 .CONSTRU ION " SFR (1) bath 249.20
❑ 1- and 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/Idtchen 45.00
Fire sprinkler ( sq. ft.) Page 2
- JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: il ,2 c) sq Sur ( p t C l \- i C.,.- .-t-1 t C1 Catch basin or area drain 16.60
City/ State/ZIP: ! ( G�-.ii V o I+� c� 7 2 2 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: I I 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: Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
. DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 1 6.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name:
Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
1 '` Ice maker 16.60
Business name: T p N.4 `` l Lc 51\ �t) dj Interceptor /grease trap 16.60
Contact name: TA NJ 'b..) 0 Jul Cr Medical gas (value: $ ) Page 2
Address: I 2_3 I I S (.J •-\-i J L--L.0 UL.) j__ NJ Primer 16.60
City/ State/ZIP: ( C A p_ ,J a. W 3- 2 1 Roof drain (commercial) 16.60 Po
Phone: (3 ) � ..[� ^ 6, 9 0 ' I Fax: : ( ) in asin / lavatory 3 16.60 �
1 Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
• CONTRACTOR , "' Water closet 16.60
Business name: h y ' Water heater / 16.60
Address: f i s---4) 4 5,61 /v 1( I W J1 IiA ', / ✓cI 0 34/t1 Other:
City/State/ZIP: iyi i I L IL I. 2_ CI OA Subtotal
"� ) Minizumi PEmi fee: $72.50 50
Phone: 4 -9 r . -- J 1 Fax: ) Residential backflow minimum permit fee: $36.25 7 , Z'
CCB Lic.: / '› y _' '� Cj.4 I Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5 �O
Authorized signature: J �/w1 �-
TOTAL PERMIT FEE ,? 3D
Print name: R t � / C ' j " Date:`3J7 O This permit application expires if a permit is not obtained within
L ! j 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
is\ Building \PermitoLM- PemutApp.doc 12/03 440 -4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage; ,', 'c F•: 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
Sewer - 1st 100' 55.00 3,601 to 7,200 $220.00
•
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
Storm & Rain Drain - 1st 100' 55.00 Valuation: ' Permit Fee: .
$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) r„ 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 $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
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
Fixture Type: • Replace
N Moved Existing Capped Comments regarding fixture work:
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"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice MachiRefrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
,Urinal
Other Fixtures:
i:\ Building \Permica\PLM- PermiNpp.doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00082
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3!912005
Phone: (503) 639 -4171 14 w 6 144,1111
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/11/2005 TIME: 7:27AM PAGE: 57
SITE ADDRESS: 12959 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NORTH TIGARDVILLE ADDITION LOT #: 037 TYPE OF USE:
PROJECT NAME: TOP NAILS SALON
DESCRIPTION: (3) sinks, (1) water heater.
OWNER: PHONE #:
CONTRACTOR: MR ROOTER OF PORTLAND PHONE #: 503-653-5301
Inspection Request Scheduled For: Date: 3/11 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 001378-01 503 - 579 -6908 N
Corrections /Comments /Instructions: EXPIRED
• #2.7,‘
•
❑ PASS $PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ail Date: Phone #: (503) 718-