Permit (68) C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00523
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/27/2007
PARCEL: 2S 115AB -01900
SITE ADDRESS: 16200 SW PACIFIC HWY E ZONING: C -G
SUBDIVISION: TIGARD TOWNE SQUARE LOT: JURISDICTION: TIG
PROJECT: GREAT CLIPS
Project Description: TI - Replace (3) existing sinks. No change in EDU's.
CLASS OF WORK: ALT 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: 3 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS:
•
WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
BIT HOLDINGS LTD PARTNERSHIP Description FORUM PROPERTIES INC escription Date Amount
FIVE CENTERPOINTE DR STE 290 [PLUMB] Permit Fee 11/27/2007 $72.50 .
LAKE OSWEGO, OR 97035 [TAX] 8% State Surcha 11/27/2007 $5.80
Phone : Total $78.30
Contractor:
VALLEY PLUMBING & HEATING INC
PO BOX 64
GALES CREEK, OR 97117 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 357 -0606
Reg #: LIC 103628
PLM 34 -242PB
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 ru : = • • • : questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Is ed By: 1 `s %! Permittee Signature
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
Building Fixtures FOR OFFICE USE ONLY
City of Tigard Received // 27 a 7 / Permit No.: h L / Zo 7 --0057.a_3
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
Inspection Line: 503.639.4175 Date Read /B iris!" 0 S ee G It D Internet: www.ti ard -0r. ov y Y' � ( Page l Information
g g Notified/Method: gel. Supplemental aformatioa
TYPE OF WORK FEE* SCHEDULE
❑ 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 (1) bath 249.20
❑ 1- and 2- family dwelling jin Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder ❑Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: I ( . W fkU4:L Awy Catch basin or area drain 16.60
City/State /ZIP: - .)._1 S 0 a Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Z. Project name: Gi rez ,4 C I y S Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: no r &1 Rd 7 /:wr
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
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
1/', )0t -crk +'L f . L g ;LAIC x t Backwater valve . 16.60
.‘ Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER 0
Drinking fountain 16.60
/,
� �` Ejectors /sump 16.60
(.
Name: .� I O L1> t o o , G,,_-r-0 Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: ( r ec k St (...4.■ u ; t M Interceptor /grease trap 16.60
Contact name: b,.,_ 6,, 4 f� Medical gas (value: $ ) Page 2
Address: j '7c9 S S In) it, /1, Primer 16.60
City/State/ZIP: Roof drain (commercial) I 16.60
y C3ra,..�,�„� OR �7
Phone: (,So 3) 78f,_ 78f77) Fax: : ( 923 ) t 2 Si asin / lavatory 16.60
,S9/ 7 S Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: VcJ 14.,y Div rhb%., S t 1 �1+1 Water heater 16.60
Address: / / [/ t J Other:
d vo G I r), 1 0. c En-Irr r•• s.eS _ -
City /State /ZIP: (4 S (.C k S 7 / / 7 Subtotal
Minimum permit fee: $72.50
Phone: ( 513) Li 0 7 -7.30 2_ Fax: ( ) Residential backflow minimum permit fee: $36.25 ...,?..c)
CCB Lic.: Plumbing Lic. n : Plan review (25% of permit fee)
- State surcharge (8% of permit fee) 6
Authorized sign TOTAL PERMIT FEE ,5 0
Print name: Date: 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.
I:\ Building \Permits\PLMF- PermitApp.doe I2 /27/06 440- 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 - 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 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 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 futures? 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 it 0 engineer.
Previous Capped Added Existin ❑ 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" 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 3 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\PLM- PermitApp.doc 12/27/06 - '
FROM : CREEKSIDE CONSTRUCTION PHONE NO. : 503 579 +6351 Dec. 05 2007 10:09PM P1
CITY OF TIGARD
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Plumbing Signature Form
IMPORTANT PERMIT NOTICE
VALLEY PLUMBING & HEATING INC
PO BOX 64
GALES CREEK, OR 97117
Permit #: PLM2007 -00523
Date Issued: 11/27/2007
Parcel: 2S115AB -01900
Site Address: 16200 SW PACIFIC HWY E
Subdivision: TIGARD TOWNE SQUARE
Lot:
Jurisdiction: C -G
Zoning: T1G
Project Name: GREAT CLIPS
Description: TI - Replace (3) existing sinks. No change in EDU's.
. .
T. Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433. �.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
BIT HOLDINGS LTD PARTNERSHIP VALLEY PLUMBING & HEATING INC
BY FORUM PROPERTIES INC PO BOX 64
FIVE CENTERPOINTE DR STE 290 GALES CREEK, OR 97117
LAKE OSWEGO, OR 97035
Phone #: Phone #: 503 -357 -0606
Reg #: LIC 103628
PLM 34 -242PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X - ! � � " /r' �oc �
Si.' ature of Authoriz -d - ber Name (printed)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: P1.M2007- 00523
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/27/2007
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 12/27/200 TIME: 7 :00AM PAGE: 18
SITE ADDRESS: 16200 SW PACIFIC HWY E= CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE:
PROJECT NAME: GREAT CLIPS
DESCRIPTION: TI - Replace (3) existing sinlz. No change in EDU's.
OWNER: BIT HOLDINGS LTD PARTNERSHIP, PHONE #:
CONTRACTOR: VALLEY PLUMBING & HEATING INC PHONE #: 503. 357 -0606
Inspection Request Scheduled For: Date: 12/27/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 062201 -01 503 -788 -7701 N
Corrections /Comments /Instructions:
C►.rc.. fib L,,, 9A")
•
XPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C3 Date: ( 2t / 6 •- ") Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION • PERMIT #: PLM2007-00523
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/21/2007
Phone: (503) 639 -4171 .11 j�
Inspection Requests (24 Hrs.): (503) 639 -4175 ..'!!J R_ ..
INSPECTION WORKSHEET FOR DATE: 12/14/2007 TIME: 7:01AM PAGE: 22
SITE ADDRESS: 16200 SW PACIFIC HWY E CLASS OF WORK:
SUBDIVISION: TIGARD TOWNE SQUARE LOT #: TYPE OF USE:
PROJECT NAME: GREAT CLIPS
DESCRIPTION: TI •- Replace (3) existing sinle . No change in EDU's.
OWNER: BIT HOLDINGS LTD PARTNERSHIP, PHONE #:
CONTRACTOR: VALLEY PLUMBING & HEATING INC PHONE #: 503 - 357 -Q606
Inspection Request Scheduled For: Date: 12/14/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 061558 -01 503-789-7781 Y
Corrections /Comments / Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: QtAvtNA--A1 Date: /21/00 Phone #: (503) 718-