Permit 0 0/06, ' e_62-44..c.d...1
C ITY OF TIGARD PLUMBING PERMIT
f DEVELOPMENT SERVICES PERMIT #: PLM2005 -00595
- - 1 1 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639-4171 DATE ISSUED: 10/27/2005
PARCEL: 1S136DD-03400
SITE ADDRESS: 11740 SW 68TH PKWY ZONING: MUE
SUBDIVISION: TIGARD TRIANGE COMMONS LOT: 008 JURISDICTION: TIG
Project Description: Building 4. Site utilites for new office building. 56 feet of. storm, (1) catch basin & (1) manhole.
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 1
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: 56 ft
Owner: FEES
PACIFIC NW PROPERTIES Description Date Amount
ATTN: PAUL GRAM
P.O. BOX 2206 [PLUMB] Permit Fee 10/27/200f $88.20
BEAVERTON, OR 97075 [PLMPLN] Plan Review 10/27/200: ' $22.05
Phone : 503 - 626 -3500 - [TAX] 8% State Surcharl 10/27/200: $7.06
Total $117.31
Contractor:
COFFMAN EXCAVATION LLC
PO BOX 687 REQUIRED ITEMS AND REPORTS
OREGON CITY, OR 97045
Contact # : PRI 503- 656 -7000
Reg #: LIC 146689
PLM 3 -407PB
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 51 . • 699 or 1-800- 332 -2344.
Issued y: /1,, _ « -,_, _ Permittee Signatur —d .
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.
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Bui ').ling I s i
k
Plumbing mit Application G �w 0 FOR OFFICE t. SE ()NIA
City of Tigard Received P ermit Na: 13125 SW Hall Blvd., Tigard, OR 97223 Date/BY to �a� 2 r ~ 1 ic059 5
Phone: 503.639.4171 Fax: 503.598.1960 i ? u.,.:.. Date/By I011_4 S�LJ Other P
ur
24 Ho Inspection Line: 503.639.4175 O C, Date R turi l0 See Page 2 for
Internet: www.ci.tid.or.us ••-` 0
E� V‘i B r , 1 0� N o tifi ed/Me' � 45 /� t G , Supplemental laformatioo
TYPE OF WOR`O1�G D,v1v ✓I� 11y / 4 FEE* SCHEDULE
❑ New construction I DDemolition / 7 For special information use checklist
cription 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 ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ O ther: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCA ON
Site utilities
Job site address: 1 150 (07 t` " 14-(� E, 117 L/0 j ( Catch basin or area drain i 16.60 /640
City / State/ZIP: ,IT(vAg."D , O 2 q7 ay5 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.:
Pro ect name: I Footing drain (no. linear ft : Page 2
J , I a44b t � � � " �� HO ~ Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes / 16.60 lie • !oO
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _____) Page 2
Storm sewer (no. linear ft.: 3 ,50) Page 2 c6.0
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: 151 '517)-0 - 0346 0 14 pp OS3 i Fi:tore or item
! ) s
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER ❑ TENANT Ejectors sump 16.60
Name: F d`. E } i.Jfh� NOiZT nn t �D/"fJQn £✓ Expansion tank 16.60
Address: t 4e..1
POD , l e5* AL) E � 1•A -1.Tf 17 7 Fixture /sewer cap 16.60
City/State/ZIP: th , J , bg, el 7 Floor drain/floor sink/hub 16.60
Phone: (5 ) k Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
lit APPLICANT I- CONTACT PERSON
Business name:
- 7 7 h . L PPt./ Co>, sc.c - r r.4, C C 1penr Ice maker 16.60
?Jet/Ls Interceptor /grease trap 16.60
Contact name: " v2_l. 11‘012_0(...14 I A i. . Medical gas (value: $ ) Page 2
Address: 7/ Sit, dw Pas D`tLk1,,,S1) 6.I.... .1.4..1 100 Primer 16.60
City/ State/ZIP: Taft it., 64_ q a7- 3 Roof drain (commercial) 16.60
Phone: ( ) 44(.3 .. ?� Fax: : ( ) Sink /basin lavatory 16.60
E-mail: k�Of Tub /shower /shower pan 16.60
0.J' -fMrt4Qf,Y. _ Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: c,FM , €4,„ eA 0 f} Tim Water heater 16.60
Address: / 3pg4 0,1„,„404 g.D En Other:
� ?-- Subtotal
City /State/ZIP: 04 6,z,,3 CI Ty Cl I g 7nc[, Minimum permit fee: $72.50 Cg ne
Phone: ( 503) /45 - -- TQOD Fax: (503) (j5 j0.. 0410 Residential backflow minimum permit fee: $36.25 DLL
CCB Lic.: (Li Le 4, s -1 1 4 01 Plumbing Lic. no.: Plan review (25% of permit fee) v . • a 5
I - State surcharge (8% of permit fee) 7.00
Authorized signature: TOTAL PERMIT FEE / / 7. 3
Print name: t
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.doc 06/05 4404616T(10/07/COM/WEB)
'flu ibine Permit Application - City of Tigard r
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 2,001 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
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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 Back How 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: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes ", ' • A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition I
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- lacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor Drain sink - 2" Submit 2 sets of plans with any of the above.
-3"
-4"
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work: `
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial
- Service _
Swimming Pool Filter
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Washer - Clothes *Note: If the fixture work under this permit res in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
iMuilding \Pennits\PLM- PcnnitApp.doe 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005.00595
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/27/2005
Phone: (503) 639 - 4171'
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/2612007 TIME: 7:00AM PAGE: B1
SITE ADDRESS: 11740 SW 68TH PKWY CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGE COMMONS LOT #: 008 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS
DESCRIPTION: Building 4. Site utilites for new office building. 56 feet of storm, (1) catch basin & (1) manhole.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503.626 -35Q0
CONTRACTOR: COFFMAN EXCAVATION LLC PHONE #: 503 - 656-7000
Inspection Request Scheduled For: Date: 2/26/2Q07 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 043851 -01 503- 545 -0243 N
Corrections /Comments /Instructions:
rPf-
\ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
M s'/ � Inspector: , / Date: Phone #: (503) 718 -2� --#714
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CITY OF TIGARD 0 •
BUILDING DIVISION PERMIT #: PIN:M06.°0695
A
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1011
Phone: (503) 639-4171 .4kolgot (A.
Inspection Requests (24 Hrs.): (503) 639-4175
0
INSPECTION WORKSHEET FOR DATE: 216/2006 TIME: 7:02AM PAGE: • 63
!ago LA) S rbf ptiO\
SITE ADDRESS: rSWtH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: TIGARD TRi ANGLE. COMMONS
DESCRIPTION: Site Wailes for new office building. 56 feet of storm, (1) catch basin & (1) lhole.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 603
CONTRACTOR: COFFMAN EXCAVATION 1.1.0 PHONE #: 503
Inspection Request Scheduled For: Date: 2/6/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 026296- 01 503-710.0938 N
S"tb
Corrections/Comments/Instructions:
/
. _... 4' .1 .41411IN A e 1Jirial. II 7 I I I I 7
•
- SS PARTIAL APPROVAL L1 CANCEL El NO ACCESS
FAIL 111 CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED
. Inspector: •rde
rtn Date: (.2 , 1 Phone #: (503) 718-
-.
CITY OF TIGARD
BUILDING DIVISION- = �?i' PERMIT #: PLM2005-00595
13125 SW Hall Blvd., Tigard, OR 97223 '41 DATE ISSUED: 10/27/2005
Phone: (503) 639 -4171 .''II1i -•� -
Inspection Requests (24 Hrs.): (503).639-4175 s.�+� :... .
INSPECTION WORKSHEET - FOR DATE: 11/15/2005 TIME: 7:02AM PAGE: 101
SITE ADDRESS:_, 11 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: TIGARD TRIANGLE COMMONS • -
DESCRIPTION: 'Site utilites for new office building. 56 feet of storm, (1) catch basin & (1) manhole.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503. 626.3500
CONTRACTOR: COFFMAN EXCAVATION LLC PHONE #: 503 - 656 -7000
Inspection Request Scheduled For: Date: 11/15/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm, drain 021177 -01 603- 710 -0938 N
Corrections /Comments / Instructions:
❑ PASS ❑ PARTIAL APPROVAL NCEL ❑ NO ACCESS
•
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: YVVV_____ Date: ,/i Phone #: (503) 718-
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