Permit (202) CITY I G RD PLUMBING PERMIT
A l DEVELOPMENT SERVICES PERMIT #: PLM2004 -00116
�:��� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/19/04
SITE ADDRESS: 12254 SW GARDEN PL BLD1 PARCEL: 2S101 BB 01500
SUBDIVISION: CROW PARK 217 ZONING: C -G
BLOCK: LOT: 003 JURISDICTION: TIG
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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI, adding (1) new lay, (1) water closet, (1) primer & (1) water heater. Relocating (1) 2" floor drain.
FEES
Owner:
Description Date Amount
SPIEKER PROPERTIES LP
4380 SW MACADAM AVE STE 100 [PLUMB] Permit Fee 3/19/04 $83.00
PORTLAND, OR 97201 [TAX] 8% State Surchari 3/19/04 $6.64
Total $89.64
Phone :
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005 REQUIRED INSPECTIONS
Phone : 643 Rough -in Insp
Final Inspection •
Reg #: LIC 12889
PLM 34 -4PB
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: � " % � , ' � i Permittee Signature: 56
—
Call (50 639 -4175 by 7:00 P.M. for an inspection needed the next business day
- Adcumulative Sewer Tally Parcel # 2S101 BB -01500
t
Tenan Name: Independent Electrical Contractors . This SWR# N/A
Site Address: 12254 SW Garden PI This PLM# 2004 -00116
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery /Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 U 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
-3inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) - 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 1 2 1 2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 1 6 1 6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0.5 8
TOTALS 0 0 0 0 2 8 2 0
Current Fixture Value 0 divided by 16 = 0.0 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change 0 divided by 16 = 0.0 over (under) $ -
Enter EDU Change Here 0
Notes. Sewer credits from 104 were applied to this permit 12254 & 12256 SW Garden Place are on the same
meter per Jamie in III
• Sig ature: �y!' �. �� � Date: !I 1
Build g Division
Note The property owner all retain the ORIGINAL sewer tally record If credits exist, this document will serve as a voucher
which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges
I \Building \Sewer Tally \SewerTallySheet.xls 11/19/03
Accumulative Sewer Tally Parcel # 2S101 BB -01500
Tenant Naive: Associated Building Contractors This SWR# N/A
Site Address: 12256 SW Garden Place. This PLM# 2004 -00104
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery /Font 4 0 0 0 -- ` 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking - Fountain 1 0 -- 0 0 - 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
VVater Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 1 . 6 0 -1 -6
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 8 0 0 -2 -8
Current Fixture Value -8 divided by 16 = -0.5 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -8 divided by 16 = -0.5 over (under) $ (1,200.00)
Enter EDU Change Here -0.5
Notes SEWERCREDJ,
�� ,
ignature: ��tWiliW Date: „JRBY
Buildr_g Division
( Note The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher 7
which must be submitted_to_the City _of_Tigard Building Division_to redeem credits towards future system development charges. 7
i:\Building\Sewer Tally \SewerTallySheet xls 11/19/03
1 rt
QiuLato m-0-- * t p L1'taoo4 - On l l 6 0-A- 5-11q161(
151111Cling r oktures .
O'
Plumblitg Permit Application R ...;,
OFFICE USE NLY
Recei Ar Plumbing I
Date/B : of ' ' t5 Permit No.
Planning App-oval Sewer ,
City of Tigard Date/By: Permit No .
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date2By Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 „ Post-Review Land Use
Internet: www.ci.tigatd.or.us c:4/4"1/ Ale( Date/By. Case No..
el I Contact Juris : z See Page 2 for
24-hour Inspection Request: 503-639-4175 "'" "'" Name/Method: Supplemental Information.
41 e id Pew/ - 04408
1MtfrOfily.Ditiatoigwym,r,,;5r.:;', ""':,:::-i SCHEDULE 111 New construction El Demolition Description - t . Fee ( ea.) 1 F
Q 3' I ( ) Total I
, ddition/alteration/replacement K Other:
!,4ctii ` ;MAilidafialiOlidffillardalliiiilVf a11111ii'aiiiiiitlaMt#,V '
-' A '' eL : 0 ■ :Z2 : ;Vi:OA r tgG ' C/AYiVkr,etiNSVgtOriONZK;NTPK:N?
SFR (1) bath 249.20
0 1 & 2-Family dwelling 3 Commercial/Industrial
SFR (2) bath 350.00
LAccessory Building Li Multi-Family SFR (3) bath 399.00
0 Master Builder _El Other: Each additional bath/kitchen 45.00- -
iiiiillaigAltol$1;F:.-4:- Fire sprinkler - sq. fl.: Page 2
Job site address: /2-Z 9-/ sk) (4.'7/ R....., , aNzteNg'p,ilnak-.8-tailliitio-ii-mmoviRralmag:10.
I Suite #: I Bldg./Apt.#: Catch basin/area drain 16.60
----EC Drywell/leach line/trench drain 16.60
J .
Project Name: .
Footing drain (no. linear 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
T Water service (no. linear ft.) _ Page 2
ax map/parcel #: i:r.liq?,a& Kf . !,A1Z 4 ISi:Kiig:FfiliTi,i , 'Aii v iliejiiP170
7 :ANWENAW:
- ..7-;i:AlgiRMI'arS
l:IACWItrON O
:JEMOItl at',R4;t'W-.71';IM •
, Absorption valve I I 16.60
,/ r2t (264k1261),-1 Backflow preventer Page 2 _
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain I 16.60
:-: NI l'it-WIMM.VikrtitA0313 a X.ETNIANIMIVO.,?AaWN Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: 4( Fixture/sewer cap II • 16.60
Cif y/St ate/Zip: Floor drain/floor sink/hub /4....-z t 16.60
Garbage disposal 16.60
Phone: 5J_7 Fax: Hose bib 16.60
qamiptlemirm itt ;1°,1. ,CO.N ',':',',-.: Ice maker 16.60
Name: Interceptor/grease trap 16.60
Address: Medical gas - value: $ Page 2
1 16.0
City/State/Zip: Primer
Roof drain (99Qmerci 16.60
al) 16.60
Phone: Fax: Sink/basi a ator / I 16.60
E-mail: Tub/shower/shower pan 16.60
OONTIWG.TitAtlitVM: ' ;=' Urinal 16.60
Business Name: Oc- 01
Address: .5 1/1C- Water closet / 1 • 16.60 1( 4° ,
i
Water heater I 16.60
i'Sko Ski ' 2 7 V /1/1.) Other:
City/State/Zip:'5 C•a‘ ''' Other: g -S
Phone: (6274/ Fax: ,.:".
/
-)
CCB Lic. #: / in , Plumb. Lic.# c/. Subtotal I $ k'3
. , -..4 f ,, Minimum Permit Fee $72.50 $
Authorized O - 4 .
Residential Backflow Minimum Fee $36.25 ...-
Signature: Date _31/PAy Plan Review (25% of Permit Fee) $ / 07 ,1
.,
JDrp-) 1b,)(.t State Surcharge (8% of Permit Fee) $ ---
(Please print name) TOTAL PERMIT FEE 1 $ #2, a5
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.
1:\Dsts\Permit Forms\PlmPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Lint': (503) 639 - 4171 MST
BUP
Received Date Requested 9 f 4 P AM PM BUP
Location / 3 -5 - /L 4leta _ MEC
Contact Person Ph ( ) PLM / - 00 / / (6)
Contractor Ph ( ) ^ 76;1 9 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 � PP-
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 I Manhole
Storm Drain
Shower Pan
Other:
d if fr 40
• PART FAIL
HANICAL
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 El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL