Permit ,Vw CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00109
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/19/2007
PARCEL: 1S126BC-01506
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 560 ZONING: C - G
SUBDIVISION: ONE EMBASSY CENTER LOT: JURISDICTION: TIG
PROJECT: GRESS LAW FIRM
Project Description: TI - cap and relocate (1) 2" floor drain.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 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
Owner: FEES
PORTLAND OFFICE ASSOCIATES Description Date Amount
BY TC PORTLAND, INC
8930 SW GEMINI DR [PLUMB] Permit Fee 3/19/2007 $72.50
BEAVERTON, OR 97008 [TAX] 8% State Surcha 3/19/2007 $5.80
Phone : Total $78.30
Contractor:
D P PLUMBING /DARREN T PLACEK
15825 NE SPRINGBROOK RD
NEWBERG, OR 97132 REQUIRED ITEMS AND REPORTS
Contact # : FAX 538 -4306
PRI 537 -9492
Reg #: LIC 110612
PLM 36 -70PB
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 Notific. ••• Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these r -s or direct • . -stions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issue • = yy: // d///
,4't —� Permittee Signat �, �,
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall 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 roll orrlct: t•s1. o\l.,
City of Tigard Received J 9 ' LI
Date/By. Permit No.: uI „ 00( Ed
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit No.:
Inspection Line: 503.639.4175
T I G A R l) Date ReadyBy. J El See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental latorma
TYPE OF WORK FEE* SCHEDULE
`C 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 (I) bath 249.20
❑ I- and 2 -family dwelling IE Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑� Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: tjQ SW (4)041,1301.x.4. S Catch basin or area drain 16.60
City / State/ZIP: r t Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 560 I Project name: &r 1, 44A) Firm 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: I Lot no.: Water service (no. linear ft.: _) Page 2
Future or Item
Tax map/parcel no.: Absorption valve 16.60
b1 (( DESCRIPTION OF WORK Back flow preventer Page 2
hs'IYA •,14 . 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 I 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: De P I u mIt I1'�( Tyt�. Water heater 16.60
Address: ISQZ NE rot,k Other: _
. / ��/ Subtotal
City/State/ZIP: 11VV If�
Minimum permit fee: $72.50 7 .50
Phone:
( ) - g - 4 rq 2 F ax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: i 1D6 Plumbing Lic. no.: 34.76 isR Plan review (25% of permit fee)
State surcharge (8% of permit fee) cj t V)
Authorized signature: t110(1,1A P &4I TOTAL PERMIT FEE 7 . 50
Print name: V 0.P tf, In Date: 3/ i A /�)) This permit application expires if a permit is not obtained within
I! 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Pamiu\PLM- PermitApp.doe 06/26/06 410- 4616T(I0/02/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 2,00 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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof to and
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 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 - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
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
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Exiting ❑ 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
Drinking Fountain Isometric or Riser Diagram
Eye Wash • ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink -2" • r I that meet the qualifications above.
-3"
-4"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower 'rang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradley fees assessed for the sewer increase must be paid before the
-Commercial
- Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is \&cldmg\Permib\PLM- PermitApp.d« 09/22/06
' CITY OF TIGARD • .
- BUILDING DIVISION PERMIT #: PLM2007 -00109
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/19/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/29/2007 TIME: 7:00AM PAGE: 5
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 560 CLASS OF WORK:
SUBDIVISION: ONE EMBASSY CENTER LOT #: TYPE OF USE:
PROJECT NAME: GRESS LAW FIRM
• DESCRIPTION: TI - cap and relocate (1) 2" floor drain.
OWNER: PORTLAND OFFICE ASSOCIATES, PHONE #:
CONTRACTOR: D P PLUMBING /DARREN T PLACEK PHONE #: 5379492
Inspection Request Scheduled For: Date: 3/29/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 045696-01 503-706-3211 N. -
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (7) t J i t 11 tom— Date: 3 I o 7 Phone #: (503) 718-
CITY OF TIGARD
•
BUILDING DIVISION PERMIT #: PLM2007- 00109
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/19/2007
Phone: (503) 639 -4171 4n t
Inspection Requests (24 Hrs.): (503) 639 -4175 `
INSPECTION WORKSHEET FOR DATE: 3/28/2007 TIME: 7:00A1V1 PAGE: 4
' - SITE ADDRESS: •09020 SW WASHINGTON SQUARE RD 560 CLASS OF WORK:
SUBDIVISION: ONE EMBASSY CENTER LOT #: TYPE OF USE:
PROJECT NAME: GRESS LAW FIRM
DESCRIPTION: TI - cap and relocate (1) 2" floor drain.
OWNER: PORTLAND OFFICE ASSOCIATES, PHONE #:
CONTRACTOR: •D P PLUMBING /DARREN T PLACEK PHONE #: 537
. Inspection Request Scheduled For: Date: 3/28/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 045590.01 503-706-3211 Y
Corrections /Comments /Instructions: .
mrr
•
•
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
xi FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: d t 1 t-✓ 1 1 1 n°"z— Date: 3 1 /0) . Phone #: (503) 718-
•
• .
CITY OF TIGARD
,•
BUILDING DIVISION
PERMIT #: PLM2007-00109
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/19/2007
Phone: (503) 639-4171 .1.%4114
Inspection Requests (24 Hrs.): (503) 639-4175 ‘4 IL
INSPECTION WORKSHEET FOR DATE: 3/21/2007 TIME: 7:02AM PAGE:
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 560 CLASS OF WORK:
SUBDIVISION: ONE EMBASSY CENTER LOT #: TYPE OF USE:
PROJECT NAME: GRESS LAW FIRM
DESCRIPTION: TI - cap and relocate (1) 2" floor drain.
OWNER: PORTLAND OFFICE ASSOCIATES. PHONE #:
CONTRACTOR: D P PLUMBING/DARREN T PLACEK PHONE #: 537-
Inspection Request Scheduled For: Date: 3/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough-in 045187-01 503-519-7448
Corrections/Comments/Instructions:
4111.7A /
JAW
st /4. 4,4
•
•
S 0 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
• FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
( )1( 1
Inspector: AA 1-1 ' Date: 3 ri Phone #: (503) 718 4'fl