Permit ,
1
CITY OF TIGARD 181Raglia PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2003 -00618
.. II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4 DATE ISSUED: 12/11/03
SITE ADDRESS: 09930 SW WALNUT ST PARCEL: 2S102BD -02100
SUBDIVISION: NO. TIGARDVILLE ADDITION ZONING: C -G
BLOCK: LOT: 038 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: M 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: Install commercial backflow preventer.
FEES
Owner:
Description Date Amount
LIM, KYUNG S AND YONG H
2330 MICHAEL DR [PLUMB] Permit Fee 12/11/03 $72.50
WEST LINN, OR 97068 [TAX] 8% State Surcharl 12/11/03 $5.80
Total $78.30
Phone :
Contractor:
BRUNER PLUMBING
PO BOX 23985 -
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone : 503 - 624 - 4880 RP /Backflow Preventer
Final Inspection
Reg #: LIC 81837
PLM 26 -445PB
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
Issued By- ' Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures
Pluming Permit Application Received FOR OFFICE Plumbing USE ONLY. .
nl 7 )17P' R G �/ \\'I DateBy 121/1 /1 d Permit No
o m / '
D3 -06 to
City of Tigard 1�� Planning Appr66bbval Sewer
`J g f \ Date/By Permit No
13125 SW Hall Blvd. DEC 1 1. ? iC Plan Review Other
Tigard, Oregon 97223 Date/By Permit No
Phone: 503 -639 -4171 Fax: 503 - 598 -1960 q Post- Review Land Use
Internet: www.ci.tigard.or.us
C Or F �t' -a ,P Date/By: Case No.:
t 1�Jr R) e Contact Juns ® See Page 2 for
24 -hour Inspection Request: 503- 6391 Name/Method• _1`� Supplemental Information.
"TYPE OFWORK . . . FEE* SCHEDULE (for special information use checklist) .
❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
Addition/alteration/replacement ❑ Other: _ _ New 1 - & 2 - family dwellings • •
' CATEGORY OF CONSTRUCTION : (includes 100 ft. for each utility connection) . • . •
SFR (1) bath 249.20
❑ I & 2- Family dwelling XCommercial/Industrial 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 LOCATION - Fire sprinkler - sq. ft.: _ Page 2
Job site address: ct 9 3 0 S(, /J U f ` - • ' " I Site Utilities • ' " ••.
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: m 1 C� o S� e � Footing (no. linear drain 16.60
�' Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: nn Manufactured home utilities 110.00
� C(
eit Ft c- ?• �� W !r�'(� 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
j 0 .C� lam. 3cz c.i.< 5-tc) l.. J Backflow preventer ( Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER " ' I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /Zip: Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: I Fax: Hose bib 16.60
❑ APPLICANT CONTACT PERSON Ice maker 16.60
Name: R i eL) i e4-- J ° (n a� /v7 L. Interceptor /grease trap 16.60
Address: c� fl o z3 c3e Medical gas - value: S Page 2
(
City /State /Zip: j ' �,e Primer 16.60
Roof drain (commercial) 16.60
r, Phone: 62__y-4 o o I Fax: (,Z - Z( - 73 Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
Business Name: Din , vim et. e G Water closet 16.60
4. Water heater 16.60
Address: Other:
City /State /Zip: Other:
Phone: Fax: . • • . • Plumbing Permit Fees *.
�( S ' 3 7 z Vi/ 5�� S S
CCB Lic. #: Plumb. Lic.#: 6 Minimum Permit Fee $72.50 $
Authorized
Signature: Date: Residential Backflow Minimum Fee $36.25
Plan Review (25% of Permit Fee) S
State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $ f $, 3V
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.
I \Dsts \Permit Fonns\PlmPermitApp doc 01/03
Plumbing Permit Application - City of Tigard `o''_
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l e 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' 5500 $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 4640 • $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 $ I.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 fixture s 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 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. /Refng 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
BUII- -DING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received 12 11/ /, 210 /gate Requested , Z • : M PM BUP
g93c9 0 Location I / Suite MEC
Contact Person 3 zo ?g--4 PIO OP 2 —00(0 / 8
Contractor L 47 7 /4/625/2.0 i Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain 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:
Final
PASS PART FAIL
PLUMBING
Post & Beam _
Under Slab i Ale Rough -In i
Water Service A - - '
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
PART FAIL
M CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: ❑ Unable to inspect - no access •
Fire Supply Line
ADA �/� Approach/Sidewalk Date / Inspector Wli Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL