Permit CIT O TIGARD PLUMBING PERMIT
P ERMIT #: PLM2003 -00092
a DEVELOPMENT SERVICES DATE ISSUED: 3/17/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 13727 SW PACIFIC HY 100 PARCEL: 2S103DD -00400
W
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B 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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of RP device at coke dispenser.
FEES
Owner:
Description Date Amount
WILSON'S TIGARD RETAIL CENTER
BY BOMCC ESCROW ADMINISTRATION [PLUMB] Permit Fee 3/17/03 $72.50
TX1 -2495 [TAX] 8% State Tax 3/17/03 $5.80
DALLAS, TX 75201 Total $78.30
Phone :
Contractor:
AKITA PLUMBING
3550 SW 178TH
BEAVERTON, OR 97006 REQUIRED INSPECTIONS
Phone RP /Backflow Preventer
hone : 503 - 642 - 7776
Final Inspection
Reg #: LIC 151026
PLM 34 -404PB
•
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
Iss By: k • &a4? Permittee Signature: t• /VA"
Call (503) .39-4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Plumiine Permit Application FOR OFFICE USE ONLY
Received Plumbing ,
Date/B : > /7 O0 Permit No.: CW403 0009
Planning Approval Sewer
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Pa au� � ; ri " !l I' (' Date/By: Case No.:
Internet: www.ci.tigard.or.us _ J,l e 'l i Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 Name/Method: Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
1 & 2-Family dwelling Commercial/Industrial SFR (1) bath 249.20
[I=1 Y l g ❑ C l/Id 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 an hLOCA N _ Fire s•rinkler - • . ft.: Pa•e 2
Job site address: /37A7 w f ft' e! / iUy d//00 Site Utilities
Suite #: B ldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line/trench drain 16.60
1 Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: 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
Tax map /parcel #:
Water service (no. linear ft.) Page 2
Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
Backflow preventer / Page 2
Backwater valve 16.60
Clothes washer 16.60 •
_ Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name: W, 1 J, /3'6 Timers kiTA/ L C'.CAl cL Expansion tank 16.60
Address: hy 4yaL E56/201,0 /4,H.. Fixture/sewer cap 16.60
City /State /Zip:7)ft . ,95 -y • 76010/ Garbage drain/floor disposal sink/hub 16.60
Gbe disposal 16.60
Phone: Fax: Hose bib 16.60
❑ 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: Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower. pan 16.60
CONTRA OR Urinal 16.60
Business Name: J,T l ck,i,pb1 /J('o• Water closet 16.60
Water heater 16.60
Address: Other:
City /State /Zip: Other:
Phone:&.0 - 7o5 Fax: Plumbing Permit Fees*
Subtotal $
CCB Lic. # Plumb. Lic. #: Minimum Permit Fee $72.50 $ 2a g (.)
Authorize. iire Da te: Residential Backflow Minimum Fee $36.25
Signature: Si
gn \ � 3 l � Plan Review (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ _'. 80
(Please print name) TOTAL PERMIT FEE $ ' k' . 30
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric 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
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 Item 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 increase of sewer EDUs, a sewer permit will be issued and
Disposal - Commercial
- 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\ PermitForms\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested AM PM BUP
Locatio Suite MEC
Contact Person 'i / ". 0 :: Ph ( ) PLM 73 -c i L
Contractor Ph ( ) SWR
BUILDING Tenant/Owner 1 7 a. p C ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm _,47, 0 s
Susp'd Ceiling
Roof
Other:
Final
S PART FAIL
P Iii; r m'r 1
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer /
Rain Drains
Catch Basin / Manhole
Storm Drain Shower . � F
Other:
F,i
PART FAIL
ANICAL
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 ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
l
ADA
Approach/Sidewalk Date _ Inspector s Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site..
PASS PART FAIL