Permit tr - TY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00195
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/16/2007
PARCEL: 1S135DA-01000
SITE ADDRESS: 08530 SW PFAFFLE ST ZONING: C -P •
SUBDIVISION: METZGER ACRE TRACTS LOT: 020 JURISDICTION: TIG
PROJECT: DALTON'S CATERING
Project Description: Interior plumbing for addition. Other fixtures: (1) ice maker & (1) grease trap.
•
CLASS OF WORK: ADD GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 3 TRAPS:
STORIES: WATER HEATERS: (I CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES •
• DAVID DALTON •
8530 SW PFAFFLE ST. • Description Date Amount
TIGARD, OR 97223 - [PLUMB] Permit Fee 5/16/2007 $149.40
[TAX] 8% State Surcharl 5/16/2007 $11.95
Phone : 503- 639 -7211 Total $161.35
Contractor:
R A WARNER PLUMBING
PO BOX 820785
VANCOUVER, WA 98682 REQUIRED ITEMS AND REPORTS
Contact # : PRI '360- 896 -0370
Reg #: LIC 151329
PLM 37 -521PB
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•issuanoe, 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 • •3.246.6699 or 1.800.332.2344.
Issu - • By:. r . � _ ` Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit cardshall 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.
Plumbing Permit Application
' FOR OFFICE USE ONLY
Received �//��
City of Tigard Date/By: 2 /7 '' 0 Permit No.: L! r /w7 .. 06/9
V 13125 SW Hall Blvd., Tigard, OR 97223
i C Plan Review n ^ . ? ".
- � //
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.: �(�rf
Inspection Line: 503.639.4175 Re
T I G A R D Date Ready/By:
„ le i' El See Page 2 for
Internet: www.tigard- or.gov Notified/Method:
Supplemental Information
TYPE OF WORK FEE* SCHEDULE
El 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 CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: d 3 0 C _ 0 -- l cr{- Catch basin or area drain 16.60
City /State /ZIP: fi /LIO / 0/1-170 '7-l Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: w C r�n 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
T-�
n Fixture or item
Tax map /parcel no.: ! wg -Of DOD Absorption valve 16.60
/ � , � DESCRIPTION OF WORK Backflow preventer Page 2
P OP/ 7747 ' 6 4.4 /�/ p//t-e Backwater valve 16.60
Clothes washcr 16.60
Dishwasher / 16.60 /6.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
6 ��
Ejectors/sump
t 16.60
Name:
Expansion tank 16.60
Address: g!'3 0 s , P, (' Fixture/sewer cap 16.60
City/State /ZIP: f/ OM / 6 /1 ' 4 10 1-/ / I /-z/7-3 Floor drain/floor sink/hub -. j 16.60 16 ()
Phone: ( yam) (0 3 q -7 %4 ( Fax: ( pit ) 620 --F/ 2 -7 Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker / 16.60 A .4 0
Business name: ��
Interceptor /grease trap f 16.60 ()
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State /ZIP: R f drain (commercial) 16.60
Phone: ( ) Fax: : ( )
r Si asin/lavatory -- 7 16.60 cf. f . O
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: b t i il i e,Z/C//7t_. Water heater 16.60
Address: 3 o, (1.04 g - Q7 Z(- Other: e ?
City/State /ZIP: 1/ (0-xi (-pc( (/(' -- 1 9 8' (8 Z Subtotal
r Minimum permit fee: $72.50 l life?. /to
Phone: ( �.) 6 3 9 -7L // Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: / s /3 2,4 Plumbing Lic. no.: 37 . L /P6 Plan review (25 %of permit fee)
\ 4\0 4 State surcharge (8% of permit fee) 11 .Q 71.
Authorized signature: 1111°47
TOTAL PERMIT FEE 11406
Print name: /e ( k j '2 ,t -C9� -- I Date: S/" - This permit application expires if a permit is not obtained wit
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:\ Building \Permits\PLM- PermitApp.doc 12/27 /06 440- 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: 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
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
Q ty. Fe (ea) To tal additional $100.00 or fraction thereof, to and
Fixture or Item 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 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work:
Are you capping, adding or replacing fixtures? If "yes", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Etdstina engineer.
Baptistry/Font
❑ New exterior plumbing site utilities for any complex structure
Bath -Tub/Shower -Jacuzzi/Whirlpool
as defined in OAR918- 780 -0040.
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
-Drive tall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
- Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" 1 ❑ Isometric or riser diagram is required for new buildings
if - that meet the qualifications above.
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains / I"
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink Bar/Lavatory *Note: If the fixture work under this permit results in an
- Bradley
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
_ Other Fixtures: A' r
�' � /u,�alo
is Building \Permits\PLM- PermitAPP.doc 12/27/06
05/16/2007 10:06 360 - 263 -5354 RA WARNER PLBG CO PAGE 01/01
MAY - 16 -07 WED 10:91 DALTON'S GRILL CATERING 6288127 R.01
CITY OF TIGARD
C OMMUNITY DEVELOPMENT
y'EC'nkD' 1312$ SW Hall Blvd., Tigard, OR 97223 603.639.4171
Plumbing Signature Form
IMPORTANT PERMIT NOTICE
R A WARNER PLUMBING
PO BOX 820786
VANCOUVER, WA 98682
Permit #: PLM2007 -00195
Date Issued: 511612007
Parcel: 1 S135DA -01000
Site Address; 08530 SW PFAFFLE ST
Subdivision; METZGER ACRE TRACTS
Lot; Q20
Jurisdiction: C_p
Zoning: TIG
Project Name: DALTON'S CATERING
Description: Interior plumbing for addition. Other fixtures: (1) ice maker & (1) grease trap.
Your company has been indicated as the plumbing contractor for the permit refe -enced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this Plumbing
Signature Form odor to the start of the work. Please mall the form to: City of Tigard, Building Division,
33125 SW Hall BRVd„ Tigard, OR 97223, or you may fax the form to; 603.624.3681.
it you have any questions please call 503.716.2433.
No plumbing Inspections will be authorized until this completed form Is received
OWNER: PLUMBING CONTRACTOR:
DAVID DALTON R A WARNER PLUMBING
8530 SW PFAFFLE ST PO BOX 820785
TIGARD, OR 97223 VANCOUVER, WA 98682
Phone #: 503-639-7211 Phone # 360.896 -0370
Reg #. LIC 151129
PLM 37 -52I PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
Sign ure f Authorized Plumber Name (printed)
d -a,,
. .- -.r - - - - - -' - CITY OF TIGARD . ^'1 ---,,
BUILDING DIVISION Aima i -oo I9_
PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/20(17
Phone: (503) 639 -4171 111 A.4.
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/79/2007 TIME: 7:00AM PAGE: 57
SITE ADDRESS: 08530 SW PFAFFLE ST CLASS OF WORK:
SUBDIVISION: METZGER ACRE TRACTS LOT #: 020 TYPE OF USE:
PROJECT NAME: DALTON'S CATERING
DESCRIPTION: Site utilities for 970 sq ft addition. Other fixtures: (4) rain drain connectors.
OWNER: DALTON, DAVID PHONE #: 503-639-7211
CONTRACTOR: WISDOM, EARL PHONE #: 503. 528.955'1
Inspection Request Scheduled For: Date: 8/29/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3.99 Plumbing final 054784 -01 503.639 -7211 Y
Corrections /Comments /Instructions:
L. b 1 p 1v......,D.,.., ei,nr -s- PL hA 2, 0 - 7 - 00 q S
•
Ca,rc, e i...ti -vt if")
igl PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CP tel NA..-) \ \ 1 p..--2_ Date: ? J 2M' o7 Phone #: (503) 718-
' CITY OF TIGARD . -
BUILDING DIVISION PERMIT #: PLM2007 -00195
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/16/2007
Phone: (503) 639 -4171 I,,u11
Inspection Requests (24 Hrs.): (503) 639 -4175 ...'!� `'I i ..
INSPECTION WORKSHEET FOR DATE: 6/17/2007 TIME: 7:00AM PAGE: 73
SITE ADDRESS: 08530 SW PFAFFLE ST , CLASS OF WORK:
SUBDIVISION: METZGER ACRE TRACTS LOT #: 020 TYPE OF USE:
PROJECT NAME: DALTON'S CATERING
DESCRIPTION: Interior plumbing for addition. Other fixtures: (1) ice maker & (1) grease trap.
OWNER: DALTON, DAVID PHONE #: 503-639 -7211
CONTRACTOR: R A WARNER PLUMBING PHONE #: 360 - 696 -0370
Inspection Request Scheduled For: Date: 6/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 048461 -01 503 - 267 -4419 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 fr Date: /2/ Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION A PERMIT #: PLM2007 -00195
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5 5/16/2.007
Phone: (503) 639 -4171 r 1
Inspection Requests (24 Hrs.): (503) 639 -4175 °' L.
INSPECTION WORKSHEET FOR DATE: 7/2/2007 TIME: 7:02AM PAGE: 17
SITE ADDRESS: 08530 SW PFAFFLE ST CLASS OF WORK:
SUBDIVISION: METZGER ACRE TRACTS LOT #: 020 TYPE OF USE:
PROJECT NAME: DALTON'S CATERING
DESCRIPTION: Interior plumbing for addition. Other fixtures: (1) ice maker & (1) grease trap.
OWNER: DALTON, DAVID PHONE #: 503 - 639.7211
CONTRACTOR: R A WARNER PLUMBING PHONE #: 360.696 - 0370
Inspection Request Scheduled For: Date: 7/212007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 051291 -01 503-639-7211 N
Corrections/Comments/Instructions:
'aAlrAlrAir I_
�j/ / ��I%
i
•
■ ' - SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /) Phone #: (503) 718-