Permit (18) * CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: P 3/2005 -00073
,13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/3/2005
SITE ADDRESS: 09392 SW TIGARD ST PARCEL: 2S102AB -01902
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: I -P
BLOCK: LOT: 055 JURISDICTION: TIG
CLASS OF WORK: ADD GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI, add (1) service sink.
Owner:
FEES
ATLAS LAND COMPANY Description Date Amount
9380 SW TIGARD
TIGARD, OR 97223 [PLUMB] Permit Fee 3/2/2005 $72.50
[TAX] 8% State Surchari 3/2/2005 $5.80
Phone : Total $78.30
Contractor:
BRUNER PLUMBING
PO BOX 23985 REQUIRED ITEMS AND REPORTS
TIGARD, OR 97281
Phone : 503- 624 -4880
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 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 OUNC by
calling ) 24 -6.99.
I
•
ssue By: �.Ag Permittee Signatur •
Call (503) 639-4175 by 7:00 P.M. for an inspection the next 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.
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY •
City of Tigard Received '7 A
`, g Date/By: ,,:e,). L fi Permit No.: I R
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 kr , t Date/By: Other Permit No.: j4 r 0�(
24- Hour Inspection Line: 503.639.4175 • I y r„
www.ci.tigard.or.us �.. Date Ready/By: ! S See Page 2 Information
Internet: www.ci.ti
g Notified/Method: / //06 J Supplemeotallnformation
TYPE OF WORK - FEE* SCHEDULE-2 "':
For special information use checklist.
❑ New construction ❑ Demolition
Description ( 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
❑ 1- and 2- family dwelling Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/latchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION . Site utilities
Job site address: CI ....° Z S AJ -61504---4 S c Catch basin or area drain 16.60
City/State/ZIP: M ,v J. n Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: �) 1 S (, ) Footing drain (no. linear ft.: ) Page 2
l0 (v
Cross street/directions to job site: 'M Manufactured home utilities 110.00
mot `� ( � S� 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
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
4 S I N Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I . ki TENANT Drinking fountain 16.60
Name: 9Le L v , , � Ex tan 16.60
� Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: (SO)) c{9- (j (p 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 7 2..k gc
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
. CONTRACTOR . Water closet 16.60
Business name: ,Z.'rc�y► e ,,,, �� � I Water heater 16.60
1`
Address: 0 , P 2', e S Other:
City/ State/ ` ZIP: U Subtotal
5 �6t--,k. �
/ Minimum permit fee: $72.50 7a Sv
Phone: (S� ( Lc f V Fax: (s 4-1) G 2 V 2 ( -7 3 Residential backflow minimum permit fee: $36.25
CCB Lic.: K ( 1?- ' Plumbing Lic. no.:2 - yys-e4 Plan review (25% of permit fee)
State surcharge (8% of permit fee) 66. SC---
Authorized signature:
.::: Vo TOTAL PERMIT FEE 7 3 Print name: (N\ ,�l t/t1.y)� Date: 3/ S� ' This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
is\ Building \Permits\Pt.M$- PetmitApp.doc 12/03 440.4616T( 10/02/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: r 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
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
Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee::
$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 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
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:
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
Fixture Type: Replace
New Moved Existing Capped. Comments regarding fixture work:
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
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures: •
i: \ Building \Pemtits\PLM- PemtitApp.dot 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005.00073
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/3/2005
Phone: (503) 639 -4171 � �,�; �l
Inspection Requests (24 Hrs.): (503) 639 -4175 ` __..
INSPECTION WORKSHEET FOR DATE: 3/17/2005 TIME: 7:13AM PAGE: 122
SITE ADDRESS: 09392 SW TIGARD ST CLASS OF WORK:
SUBDIVISION: NO.TIGARDViLLE ADDITION AMEND. LOT #: 055 TYPE OF USE:
PROJECT NAME: LLOYD'S INK
DESCRIPTION: Plumbing TI, add (1) service sink.
OWNER: ATLAS LAND COMPANY, PHONE #:
CONTRACTOR: BRUNER PLUMBING • PHONE #: 503-6244880
Inspection Request Scheduled For: Date: 3/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 001970.01 503 -624 -4880 N
Corrections /Comments /Instructions:
Ae. _ i./ Al _. -/. • • . _,(4%, ."- �1'
0 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /y7).-- Date ---' Phone #: (503) 718 -