Permit y CITY OF TIGARD PLUMBING PERMIT
.74 ° - COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00392
DATE ISSUED: 5/31/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134AB -03300
SITE ADDRESS: 10330 SW SCHOLLS FERRY RD ZONING: R - 12
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: MUSLIM EDUCATIONAL TRU
Project Description: Site utilities for placement of 3 modular classrooms.
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: El FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 1
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: 220 ft
WATER CLOSETS: WATER LINE: 30 ft
DISHWASHERS: RAIN DRAIN: 250 ft
Owner: FEES
MUSLIM EDUCATIONAL TRUST
10330 SW SCHOLLS FERRY RD Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/31/2007 $400.40
[PLMPLN] Plan Review 5/31/2007 $100.10
Phone : . 503 - 579 -6621
[TAX] 8% State Surcharl 5/31/2007 $32.03
Total $532.53
Contractor:
AIR 1 PLUMBING
9012 NE 834D CIR.
VANCOUVER, WA WA REQUIRED ITEMS AND REPORTS
Contact # : PRI 360 - 910 -0523
FAX 360 - 609 -8740
Reg #: LIC 170749
PLM PB146
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 OU NC by calling 503.246.6699 or 1.800.332.2344.
I
Issue By: /9 % L i! Permittee Signature: t \
■ i -- Ng% --
Call 503.639.4175 by 7:00 a.m. for an inspection that busi � • ay.
This permit card shall be kept in a conspicuous place on the job site until c• •Ietion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Site Utilities I oR Ofl lcr USE Oil
City of Tigard Received y g �2_ D - A Permit No a ti - f G _DD 39 2
III
0 13125 SW Hall Blvd., Tigard, OR 97223
Plan
Phone: 503.639.4171 Fax. 503.598 1960ey Review Other Permit No.
T CC n k D Inspection Line: 503 639.4175 Dale Ready/By 1 65 See Page 2 for
Internet: www.tigard or.gov Noofied/Method: /1 / 9 Supplemental Information
TYPE OF WORK FEE* / SCHEDULE
„ErNew 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
❑ I- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45 00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
• Job site address. 1 I e -2 St,,,) S 4I O LL S F 2 ' R p Catch basin or area drain I 16.60 !gi 0
�SG1 /L b
City /State/ZIP: 2 g 7) -) 3 Drywell, leach line, or trench drain 16.60 --
l (
Suite/bldg/apt. no.: Pro at name: Footing drain (no. linear fl.: _) Page 2
c
J ;..1v � t".4cnrSi..vN - mill ,
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 'A- 16.60 9 7, D
r
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: 20 Page 2 iyz 96
Storm sewer (no. linear fl.: Page 2 /L7.
Subdivision: Lot no.:
Water service (no. linear ft.:4')) Page 2 S.
Future or item
Tax map parcel no.: Absorption valve 16.60
• DESCRIPTION OF WORK
Back flow preventer Page 2
lA" l7 f2G0..r,v.'ri) FoR ?i_K( bMS A/7 OP Backwater valve 16.60
Mk) in 1 A a r.1 A ? ,•, 5
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I
Drinking fountain 16.60
El TENANT
Ejectors/sump 16.60
Name:
M T A-n- .• (ejA 7 T S A s I) Expansion tank 16.60
Address: /() -s-- 0 St A) SCNc, /K t6 X 2 }- 2 r1) Fixture/sewer cap 16.60
City /State/ZIP: Ta_6„ 1 0 a 9 ? , .) 3 Floor drain/floor sink/hub 16.60
Phone: (5 _ GG 2 Fax: (5 5 - 4 . , 0 - 0 / 0.2 Garbage disposal 16.60
I Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name. S A-M -
�Z Interceptor /grease trap 16.60
Contact name: Medical gas (value: E ) 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:
16.60
CONTRACTOR • Water closet 16.60
Business name: A ) '(Z 11 Water heater 16.60
Address: 9 2. NE_ g X. 0 ALL_ L. Other:
a -
-
city /state/LIP: J Co LA g 9, Su btoal .
Minimum permit fee: 572.50
Phone. (7o) 99/o 1s 5' ,2� Fax: ( ) Residential backflow minimum permit fee: $36.25 gDeI'
CCB Lic.: / 7074/9 G / / pl o g Plumbing Lic no.: /96/z/ Plan review (25 %ofpermit fee) ; J21 11,
Authorized signature: 7/i /0% State surcharge (8% of permit fee,/ • i,G - •
TOTAL PERMIT FEE - ! L
`
Print name:
Date This permit application expires if a permit is not obtain 1 within
180 days after it has been accepted as complete.
*Fee methodology set by Trl -County Building Industry Service Bowels.
I \Buildmg\Pamia\PLMU- PerrnnApp doc 06x26106 440.4616T(10 EB) .3"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 - l ° 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 5' 5' 7,201 and greater $309.00
Sewer - each additional 100' 46 40 3 g
Water Service - 1st 100' / 55.00 4--5—.9 Medical Gas Systems:
Water Service - each additional 100' 46 40 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' SS 00 55
$1 00 to $5,000.00 Minimum fee $72 50
Storm & Rain Drain - each additional 100' h 46 40 2 , V® $5,001 00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item •l Qty. Fee (ea) Total additional $100 00 or fraction thereof; to and
including $10,000.00.
Commercial Badt 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 Back flow 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
specially requested inspections - and including $50,000.00.
s
pec y eq sp 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: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
t2oeotitz by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic I or Riser Diagram
Drinking Fountain g
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain /sink - 2" that meet the qualifications above.
-3"
-4"
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal -Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- 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:
i \Building\ Permits kPLM- PumitApp doe 0922/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200G -00392
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/31/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/18/2007 TIME: 7 :00AM PAGE: 35
SITE ADDRESS: 10330 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MUSLIM EDUCATIONAL TRU
DESCRIPTION: Site utilities for placement of 3 modular classrooms.
OWNER: MUSLIM EDUCATIONAL. TRUST, PHONE #: 503-579 -6621
CONTRACTOR: AIR 1 PLUMBING PHONE #: 360-910-0523
Inspection Request Scheduled For: Date: 9/18/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm drain 055874 -01 503-490 -5555 N
Corrections /Comments/ Instructions:
0 s Al 12 " Co -4-c-A S ,. cv-- O efie.
Sw \ Cy 1 2 O T I C� ✓T� -Ll l �C �� 1.�'
• C
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6 6 1•1 Date: 9 j ) Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: PLM2006-00392
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/31/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/18/2007 TIME: 7 :00AM PAGE: 34
SITE ADDRESS: 10330 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MUSLIM EDUCATIONAL TRU
DESCRIPTION: Site utilities for placement of 3 modular classrooms.
OWNER: MUSLIM EDUCATIONAL TRUST, PHONE #: 503-579-6621
CONTRACTOR: AIR 1 PLUMBING PHONE #: 360- 910 -0523
Inspection Request Scheduled For: Date: 9/18/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
345 Culvert/catch basin 055874 -02 503-490-5555 N
Corrections /Comments /Instructions:
,n eL- Lt," 4 i 2- C . - ,
k PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I'/ + ( � f Date: ° I I ITIO7 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200Ct- 00392
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/31/2001
Phone: (503) 639 -4171 � 11
Inspection Requests (24 Hrs.): (503) 639 -4175 s_•
INSPECTION WORKSHEET FOR DATE: 9/13/2007 TIME: 7 :01AM PAGE: 40
SITE ADDRESS: 10330 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MUSLIM EDUCATIONAL TRU
DESCRIPTION: Site utilities for placement of 3 modular classrooms.
OWNER: MUSLIM EDUCATIONAL TRUST, PHONE #: 503579- 6621
CONTRACTOR: AIR 1 PLUMBING PHONE #: 360-910
Inspection Request Scheduled For: Date: 9/13/2007 / Pour Time:
Code # Inspection Description Confirm # Contact 41 Message
340 Storm drain 055645-01 503- 490 -5555 N
Corrections /Comments/ Instructions:
12 '' .3 o 3 Li O uT F CA -4-t L. E ot r To Y a - to L C 1
C O +r- k-t r 74 tee4 \.. 0,7-4 v -}- lLo oA-c„ Dv' . N• Co,,,,-..,.4;,-i6
C o , I,..-k-c 12 " .--t- 0 M a, 4 \., .4 Z d.., ca 11 '.o✓ ce I G zjrpe cA >ar.i.
❑ PASS 54 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t 1 l✓--A- Date: 9) 1,3 jcY") Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006 -00392
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/31/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .„.' - --..
INSPECTION WORKSHEET FOR DATE: 9/13/2007 TIME: 7:01AM PAGE: 39
SITE ADDRESS: 10330 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MUSLIM EDUCATIONAL TRU
DESCRIPTION: Site utilities for placement of 3 modular classrooms.
OWNER: MUSLIM EDUCATIONAL TRUST, PHONE #: 503-579-6621
CONTRACTOR: AIR 1 PLUMBING PHONE #: 360 -910 -0523
Inspection Request Scheduled For: Date: 9/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
345 Culvert/catch basin 055645 -02 503-490-5555 Y
Corrections/Comments/Instructions:
14 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: cr4 A, ,1' 1 rY-a- Date: 4 11 VI O7 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200G -00392
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/3112007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639- 4175±i-
INSPECTION WORKSHEET FOR DATE: 8/16/200 TIME: 7:00AM PAGE: 17
SITE ADDRESS: 10330 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MUSLIM EDUCATIONAL TRU
DESCRIPTION: Site utilities for placement of 3 modular classrooms.
OWNER: MUSLIM EDUCATIONAL TRUST, PHONE #: 503-579-6621
CONTRACTOR: AIR 1 PLUMBING PHONE #: 360-910-0523
Inspection Request Scheduled For: Date: 8/16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
505 Sanitary sewer 054129 01 503-780-1432 N
Corrections /Comments/ Instructions:
(" 363N Pvc La-k,, I A t o p�„ti(,
Ai 41 4 "!IlL ..� �A. ��- �.ar�.a� a.W�1 �._ �4. Cr is .
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P I O v -J -4 ✓ 4.4 j V TD -�F� J C ✓V'l G f
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: '`1� -�-- 1 1 / 0 ""'e- Date: g l 1 ) 07 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PL.MM12006- 00392
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/31/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .. ' l...--
INSPECTION WORKSHEET FOR DATE: 4/21/2008 TIME: 7:00AM PAGE: 15
SITE ADDRESS: 10330 SW SCHOLLS FERRY RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MUSLIM EDUCATIONAL TRU
DESCRIPTION: Site utilities for placement of 3 modular classrooms.
OWNER: MUSLIM EDUCATIONAL TRUST, PHONE #: 603 57B -6621
CONTRACTOR. AIR 1 PLUMBING PHONE #: 3€0 910.0523
Inspection Request Scheduled For: Date: 4/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
3518 Plumbing final 068665 -01 60 N
Corrections/Comments/Instructions: i ]� ^�'� J �
S+0 i �l.C..�C -mot: I/ S ( .%) \-i.- / e e ✓ a J 4- \ - C I I t- a ,z
t ` O� {�a✓t
_ .. I V.�l i.� v
c c- h./ti, Le,P
94,.)
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: q t A 1 — Date: -1 l•,\ \c k Phone #: (503) 718-