Permit -
C ITY OF TIGARD PLUMBING PERMIT
A k DEVELOPMENT SERVICES PERMIT #: PLM2003 -00155
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/30/03
SITE ADDRESS: 10865 SW WALNUT ST PARCEL: 2S103AA -00101
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: El FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 0
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 4 GREASE TRAPS:
LAVATORIES: 8 OTHER FIXTURES: 0
TUB /SHOWERS: SEWER LINE: 0 ft
WATER CLOSETS: 8 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft •
Remarks: Remodel existing staff & student restrooms. Relocate or replace (7) lays, (8) toilets and (4) urinals. Add (1)
new lay.
FEES
Owner:
Description Date Amount
SCHOOL DISTRICT NO 23 J
13137 SW PACIFIC HWY [PLUMB] Permit Fee 6/30/03 $332.00
TIGARD, OR 97223 [PLMPLN] Plan Review 6/30/03 $83.00
[TAX] 8% State Tax 6/30/03 $26.56
Phone : Total $441.56
Contractor:
PORTLAND MECHANICAL CONTRACTOR
6521 SE CROSSWHITE WAY
PORTLAND, OR 97206 REQUIRED INSPECTIONS
Top -out Insp
Phone : 788 - 5510 Final Inspection
Reg #: LIC 151807
PLM 3 -425PB
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
Issue : �il • � � � i!,.ii
y: �� J; • � , p Permittee Signature:
Call (50 ) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
1
Building Fixtures
Plumbing Permit Uc ion
Received FOR OFFICE USE ONLY
Plumbing i
-Hi ,,�� �r ' Date/By: S / 0 3 Permit No.: 11
1 - 5'c1/S
Planning Approval Sewer 4- ` n � - ���
City of Tigard Date/By: Permit No.:
13125 SW Hall Blvd. ,:, \ &a CI �. Plan Review / I06 Other
Tigard, Oregon 97223 Date/By Permit No.:
Phone: 503- 639 -4171 Fax: 503C59�Sy19:0 T I j,,�� Date/By: view Case Noe
Internet: www.ci.tigard.or.us "119 DI�C' Off` � � Contac 0s.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 - Name/Method 7 /� Supplemental Information.
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition Description 1 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) 0
SFR (1) bath 249.20
❑ 1 & 2- Family dwelling al. Commercial/Industrial --"Z'
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: ID tiz6 S W I,jpttol -hrr 1 -[1(),Aac►b Site Utilities
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: FD LAX M5 f4►7h J Mab Footing dr line/trench . linear drain 16.60 Page
Footing drain (no. liar ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: 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
?\
(gt)'ID 1'Ki(. ig.X► Si) N6 ear i Backflow preventer Page 2
tJ 1`V Yo Kest ' DIAS Backwater valve 16.60
5E //o ag._ 4.141 /2iCLoe r4 re. c X Tu 24.E t Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60 ///
❑ PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name: - [itrpd2Yj - - r'wst,b1114 SC 44001., lot ST Expansion tank 16.60 cH....k..„
Address:
&VA SW 604K17 td,urets. s Fixture /sewer cap 16.60
City /State /Zip:' (44;J� 0{2 C1 7123 Floor drain /floor sink/hub 16.60
Garbage disposal 16.60
Phone: 4 5b3 - 451 - 4 boo- Fax: 411 -1 I 0-4 Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Roof drain (commercial) 16.60
Phone: Fax: Sinl /basi avato R 16.60 M. g°
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60 (p, ,4/0
n24-e/. . -� Water closet 16.60 /;t. $o
Business Name:
�/ Water heater 16.60
Address: /7 /�f/ X / ,..2/ Other:
City /State /Zip: e /z ,./s (22 970/ Other:
Phone: -74/a) 1 Fax: 66--,-C-.376/ Plumbing Permit Fees*
0
5,5 CCB Lic. #: /S /7C7 I Plumb. Lic. #: Subtotal $ � a co
Minimum Permit Fee $72.50 $
Authorized 4 ., '('' Residential Residential Backflow Minimum Fee $36.25
Signature: Date: I{ 5 Plan Review (25% of Permit Fee) $ XTWt `7bWw PuIt' State Surcharge (8% of Permit Fee) , $ (0
(Please pnnt name) TOTAL PERMIT FEE $ 1i' (. 54,
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.
r:\Dsts\Permrt Forms\PlmPermrtApp.doc 01/03
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 - to 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' 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
additional $100.00 or fraction thereof, to and
Fixture or item Qty. Fee (ea) Total 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
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 $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 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
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 / 7
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet u •
Urinal ! •
Other Fixtures:
i:\Dsts\Permit Forms \PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested U �� AM F F PM BUP
Location )1 R(0,c k) Suite MEC
Contact Person C./7? 4c ) Ph ( ) 8V3 — l35 c PLM 3 - Dd /6
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation 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
Rough -In
Water Service
Sanitary Sewer
Rain Drains
• Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
_ j_ PART FAIL
M ANICAL V
Post -& Beam
Rough -In -
Gas Line
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 Date p /��f Ins ector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL V