Permit .' ' CITY OF TIGARD PLUMBING PERMIT
1 ,1� DEVELOPMENT SERVICES
PERMIT #: PLM2002 -00336
�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/02
SITE ADDRESS: 13727 SW PACIFIC HY 100 PARCEL: 2S103DD -00400
W
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS: 2 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 2 GREASE TRAPS:
LAVATORIES: 3 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: T1 Plumbing fixtures.
FEES
Owner:
Description Date Amount
WILSON'S TIGARD RETAIL CENTER
BY BOMCC ESCROW ADMINISTRATION [PLUMB] Permit Fee 9/12/02 $182.60
TX1 -2495 [PLUMB] Permit Fee 9/12/02 $0.00
DALLAS, TX 75201 [PLMPLN] Plan Review 9/12/02 $45.65
[PLMPLN] Plan Review 9/12/02 $0.00
Phone 1: [TAX] 8% State Tax 9/12/02 $14.61
Contractor: [TAX] 8% State Tax 9/12/02 $0.00
MARXMEN PLUMBING INC Total $242.86
9665 SW 163RD AVE
BEAVERTON, OR 97007
REQUIRED INSPECTIONS
Phone 1: 579 - 2200 Top -out Insp
Final Inspection
Reg #: MET 00001112
LIC 102432
PLM 34 -161PB
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: Qeit/ /
C II (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
w 2 Dcoa - ooa-63
Plumbing Permit Application i / FOR OFFICE USE ONLY
Received Plumbing
Date/By: - a,1'O?- B43 Permit No i.- 1 207 2--C'33t.
City of Tigard _Test Torn =, r; Planning Approval Sewer
Planning
y: Permit No.:
13125 SW Hall Blvd. ' .- Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 ''Vil i D te/By 1ew Land Use
Case No.:
Internet: www.ci.tigard.or.us - ^ ^2 Contact Juris.: ® See Page 2 for
24 -hour Inspection Requesij;,1403 -629- 41+7 - T , Name /Method: Supplemental Information. i
31010
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: T1 New 1 - & 2 - family dwellings
(includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION
SFR (1) bath 2
❑ 1 & 2- Family dwelling ZCommerciaUlndusttial 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 LOC1ION i Fire sprinkler - sq. ft.: Page 2 \
Job site address: 13 T1 S. LA). VAC ? I i., HO vt ' Site Utilities
Suite #: ! 5a7 Bldg. /Apt. #: _ Catch basin/area drain 16.60
r / - }' S Drywell /leach line /trench drain 16.60
Project Name: Ok , ' f,, Cdr Footing drain (no. linear ft.) Page 2 }�+
Cross street/Directions to job site: Manufactured home utilities 110.00 i
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
•
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: Expansion tank "' 16.60
Address: Fixture /sewer cap 16.60
City /State /Zip: Floor drain/floor sink/hub ;2. 16.60 33, AO
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
❑ APPLICANT ❑ • NTACT PERSON Ice maker 16.60
Name: M t rt. ■.e■ 4 VA to114 li.+ Interceptor /grease trap 16.60
Address: 5 ` v� Medical gas - value: $ Page 2
• Primer • 16.60
City /State /Zip: QE • Roof drain (commercial) 16.60
Phone: 5C>3 .-6 • -11.0 503 -5'1q •12 Sink/basin / lavatory 16.60 ‘,/?, �d
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR ` - / Urinal ,2 16.60 33 • �O
Business Name: M A2xh IJ (' . u i ‘s• Medical
closet 3 16.60 5 if0
Water heater 1 16.60 go •60
Address: (prat) S.‘..0 , \ 103 AJ Other:
City /State /Zip: B Or Other:
Phone:503 -5' - 1.1 V Fax: 585''12 -220 O I Plumbing Permit Fees*
Subtotal $ /$?. • X00
CCB Lic. #: 10' ' i' b. Lic. #: 34-1610e Minimum Permit Fee $72.50 $
Authorized / tit ' / Z Residential Backflow Minimum Fee $36.25
Signature: I _ - . . 2e21' Plan Review (25% of Permit Fee) $ V5,625"
State Surcharge (8% of Permit Fee) $ /(// - 6/
TOTAL PERMIT FEE $ a ../,a , k(D
• ase print name) Notice: This permit application expires if a permit is not obtained within
All new Commercial building require 2 sets of plans with isometric or 180 days after It has been accepted as complete.
Fee methodology set by Tri - County Building Industry Service Board.
riser diagram for plan review.
0
ll' 3 °-
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
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:
CITY OF TIGARD 24-Howair
BUILDING Inspection (dine: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
t tA )D ' 4i BUP
Received S Date / Requested 7.--- AM PM BUP
Location _ • Suite /6 MEC
X 33
Contact Person Ph ( ) P LM o ? -4
Contractor Ph ( ) SWR
BUILDING Tenant/Owner F.zieig ELC
Footing
Foundation ELC
F Access:
t Drain /
Ftg
Crawl Drain �r 1� 6 v E G.� ELR
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
' •ug
a er Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
MECHANICAL
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
ADA \ 1/ Approach/Sidewalk Date C , v { � a Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING • Inspection LIn1e: (563) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
c� BUP
Received Date Requested 1/. AM PM BUP
Location 7) 7 e/LA° ' Suite /() O MEC
Contact Person Ph ( ) PLM ?0-D _a C 33(
Contractor Ph ( ) 6- 7 5 - 2- SWR
BUILDING Tenant/Owner k.4 a�! �.��.� �i ELC
Footing
Foundation ELC
Ftg Drain ( U6 � c r 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
Susp'd Ceiling
Roof
Other: •
kl
FAIL
MBING
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fes,:
'ASS PART FAIL
ICAL
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
ADASupply Line / ��
7 Approach/Sidewalk Date g / <6 Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL