Permit C ITY OF TIGARD PLUMBING PERMIT
p, DEVELOPMENT SERVICES PERMIT #: PLM2005 -00233
s `�'` f 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/2/2005
PARCEL: 2S 110DC -02200
SITE ADDRESS: 15532 SW PACIFIC HWY C -2 ZONING: C -G
SUBDIVISION: WILLOW BROOK FARM LOT: 011 JURISDICTION: TIG
Project Description: Replace backflow prevention device.
CLASS OF WORK: OTR 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
Owner: FEES
TIGARD CENTER Description Date Amount
9777 WILSHIRE BLVD.
#609 [PLUMB] Permit Fee 6/2/2005 $72.50
BEVERLY HILLS, CA 90212 [TAX] 8% State Surcharl 6/2/2005 $5.80
Phone : 503 968 - 6580 Total $78.30
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY REQUIRED ITEMS AND REPORTS
BEAVERTON, OR 97005
Phone : 503- 643 -7619
Reg #: LIC 128892
PLM 34 -4PB
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
952-00e : i : • rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
call' g 503-246-66'' ' • 1 -' 00-332-2344.
Is- ued By: I ! / 4, • Permittee Signature: 4.,
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.
Building Fixtures
0 , -
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received Plan P Review . (. ifN� , r , „' 'L' (f M 4P-3
13125 SW Hall Blvd., Tigard, OR 97223 ■ {�. �� `�
Plan Re
Phone: 503.639.4171 Fax: 503.598.1960 usn p ; 1� c1 f (l f;� Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 ` Date ReadyBy: lam: m See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / f Supplemental Information
-.. T YPE OF WORK , • - FEE* SCHEDULE .. .
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
I[ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
• . CATEGORY OF CONSTRUCTION . . . . SFR (1) bath 249.20 •
❑ 1- and 2- family dwelling KCommercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Ot her:
Fire sprinkler ( sq. ft.) Page 2
. JOB SITE INFORMATION AND LOCATION . , Site utilities
Job site address: ksssZ 1 9aGI c.c e'1Wy C. Catch basin or area drain 16.60
'Tv chord Oregon Cr( 2 City/ State/ZIP: ` Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Proj ect name: Clem-Net- Footing drain (no. linear ft.: ) Page 2
C 2 f C1rnbr(dgc 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
Fixture or item
Tax map /parcel no.: _, Absorption valve 16.60 y
�/
1, DESCRIPTION OF WORK Backflow preventer Page 2
Q4*1ce. ?Ar E Ir%(, de i e rc Backwater valve 16.60
T Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
' ROPERTY OWNER - . , . ❑ TENANT
rr `` n Ejectors /sump 16.60
el C '
Name: l 1.3-7---t Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain /floor sink/hub 16.60
Phone: (6:6) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT • ' ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR ' - • Water closet 16.60
Business name: �erwexE on P1 urn - -LK1C. Water heater 16.60
Address: fi'9$a 7) 4 \ 1. C V \ eii 1ktzt-k Other: Subtotal
Minimum permit fee: $72.50
City/ State/ZIP: C3efaNPp kc� an crl-LAS? ,./01
Phone: ( /s) ((,{ i Fax: ( ) ( J _ 1 Liao Residential backflow minimum permit fee: $36.25 ]
CCB Lic.: Q` Plumbing Lic. no.: '6(4 - LA Plan review (25% of permit fee) 5,gv
Authorized signature: ^ [ - State surcharge (8% of permit fee) C5 l pal TOTAL PERMIT FEED
Print name: �' n L . ° ear\ Date: U, -a. o b This permit application expires if a permit is not obtained witllip
�^' � 180 days after it has been accepted as complete. 7$. 7 C 1
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Pemdu\PLMF- Pem.itApp.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: • Perinit 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
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 e 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: $50,001.00 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
New 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"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice MachiRefrig. Drains
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
Bradley Quantity Total
Comme ia► 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 \Pmnits\PLM- PrnnitApp.doe 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00233
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 612/2005
Phone: (503) 639 -4171 .��°'uq i t i l i 'It,
Inspection Requests (24 Hrs.): (503) 639 -4175 ..........-40- �4 F__..
INSPECTION WORKSHEET FOR DATE: 616/2005 TIME: 7:13AM PAGE: 56
SITE ADDRESS: 15532 SW PACIFIC HWY G2 CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 011 TYPE OF USE:
PROJECT NAME: CAMBRIDGE CLEANERS
DESCRIPTION: Replace backflow prevention device.
OWNER: TIGARD CENTER, PHONE #: 503 -968 -6580
CONTRACTOR: BEAVERTON PLUMBING INC PHONE #: 503-643-7619
Inspection Request Scheduled For: Date: 6/6/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 008518 -01 503 - 643-7619 N
Corrections /Comments /Instructions:
( i r _.../
ig PASS ❑ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Date: ; ! // Phone #: (503) 718-