Permit C ITY OF TIGARD • PLUMBING PERMIT
• i p DEVELOPMENT SERVICES PERMIT #: PLM2003-00608
� � ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/4/03
SITE ADDRESS: 12288 SW SCHOLLS FERRY RD PARCEL: 1S134BC-00300
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: 2
OCCUPANCY GRP: 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 (2) commercial irrigation backflow prevention devices.
FEES
Owner:
Description Date Amount
BPP RETAIL LLC
BY BURNHAM PACIFIC PROPERTIES [PLUMB] Permit Fee 12/4/03 $92.80
ATTN: JOHN WATERS [TAX] 8% State Surcharl 12/4/03 $7.42
SAN DIEGO, CA 92101 Total $100.22
Phone :
Contractor:
TRITON PLUMBING & MECHANICAL
P.O. BOX 1904
WOODLAND, OR 98674 REQUIRED INSPECTIONS
Phone RP /Backflow Preventer
hone : 36O - 740 - 7701
Final Inspection
Reg #: L1C 147599
PLM 37 -505PB
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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
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Issued By:�(L -�� Permittee Signature: /e_.20(
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
ing Fixtures
bi Per o , � . at�'o FOR OFFICE USE ONLY
.1_ Received m N J
� C U ,,, DateBy: y:�M �y 03 1t r Permit No '-// ��OO� �O6 09
r SW of Tigard Planning Approval Sewer
DEC ^�"r Date/By: Permit No.:
Hall Blvd. l� Plan Review Other
, Oregon 97223 Date/By: Permit No.:
: 503 -639 -4171 Fax: �(;�E�- IIB�iQRp Post - Review Land Use
Internet: www.ci.tigard.or.t�UI DIVISIO - - Contact Contact CaseNo.:
24 -hour Ins ection Re uest: 503 -639 -4175 s me/ �� /k Su p e Page 2 for
P Q Name/Method: 'l Supplementallnformation.
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 I - & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includes 100 ft for each utility connection)
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (1) bath 249.20
['Accessory Building SFR (2) bath 350.00
❑ ry g ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: / Z t e8 5 SckobtS coy Site Utilities
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line/trench drain 16.60
Cross street/Directions to job site: Footing drain (no. linear ft.) Page 2
Lrl~ h i0 -CC "-Pc !Next to 4nfk Pi) 1 &-s Manholes home utilities 110.00
Manholles 16.60
/' _p e w Rain drain connector 16.60
lTr� y T��,,� C. ye. 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
DESCRIPTION OF WORK Fixture or Item
I f / Absorption valve 16.60
7 w,5 4i/ I ti tf 10o4(c c- �ck v�' K Backflow preventer Z ' Page 2 q kb
.r-H 5 " ti I / L 1DD W,B /c Cie J ' elve Backwater valve 16.60
cu.( T le-Vt5i9 1.--r..... Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I 0 TENANT Drinking fountain 16.60
} , Ejectors/sump 16.60
Name: �RR.S L.4. 5�ithrl dfr. i*(CG.e 4. t Expansion tank 16.60
Address: / p 2 51) 6fr%cch 4.4 4 go Fixture /sewer cap 16.60
City /State /Zip: o f 44 04 9•> 22-i Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: 45b3- Ayy, obg? Fax:5b3 .2P/ 03 4 g Hose bib 16.60
laAPPLICANT ❑ CONTACT PERSON Ice maker
16.60
Name: Tg t. I v ,n� 5 + m e�� , Interceptor /grease trap 16.60
Address: P ,Q, j y p� Medical gas - value: $ Page 2
City/State/Zip: (4 C7 Cy Primer 16.60 •
Cit
Y P 00� 1.'4. ��6 S / R oof drain (commercial) 16.60
Phone: 3bt .) yo -)) 0 I Fax: 360-) 7 )o 1 Sink/basin/lavatory 16.60
E -mail: ,. Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
Business Name: 1- . �Tdr f � ' Water closet 16.60
r u rn� V lk� * Water heater 16.60
Address: 1 0 0, (/& o x 1 yogi Other:
City /State /Zip: L 00 L , . , (Ad e/. 16) 6 )`/ Other:
Phone: 360 - )9D-7)O / Fax: 3 ,(,o -ND )) o Plumbing Permit Fees*
Subtotal $ 7A , re)
CCB Lic. #: ! v • Plumb. Lic.#:3 ,5- Minimum Permit Fee $72.50 $
Authorized Air" • y 24 OS `/ D 6 y Residential Backflow Minimum Fee $36.25
Signature: Date. I 2 3 Plan Review (25% of Permit Fee) $
i t w 60,1N,-)11 State Surcharge (8% of Permit Fee) $ 7 va,
(Please print name) TOTAL PERMIT FEE $ !DD , ate,
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.
is \Dsts \Permit Forms\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
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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
Sewer 3,601 to 7,200 $220.00
ewer - l st 100' S5 (�
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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
') t1 including $10,000.00.
Commercial Back Flow Prevention Device 2.. 46.40
q�S, 9 $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 $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 Eilstlng 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 P
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:
i:\Dsts\Permit Forms \PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /a -/O AM PM BUP
Location !2a8SS S'c..ollS 1e.,erj PI Suite MEC
Contact Person - 3 - 1 .h Ph ( 360) 55 $ 5 2- 3 -0060g
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: r, , ra SIT
Post & Beam �(
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm ei« /Li / i°
Susp'd Ceiling
Roof
Other:
Final E���1�� �=� _4l
' PART FAIL
- o : :eam
Under Slab — = ��� ilWaa `
Rough -In
Water Service
Sanitary Sewer --
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
earl (. o
Ar
4 \S PAR _ �
jh.,_ ∎ ICAL'
ost & Beam
Rough -In _ -
Gas Line / 40
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
Approach/Sidewalk Dat 1 D� Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL