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Permit ;4 CITY OF TIGARD PLUMBING PERMIT A.1 DEVELOPMENT SERVICES PERMIT #: PLM2003 -00444 . .� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/21/03 SITE ADDRESS: 13535 SW 72ND AVE 100 PARCEL: 2S101 DC -00200 SUBDIVISION: 72ND AVE OFFICE BUILDING ZONING: C -P BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: 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: Tenant Improvement - relocate one sink FEES Owner: Description Date Amount PACIFIC NW PROPERTIES LTD PTNSHP 9665 SW ALLEN BLVD STE 115 [PLUMB] Permit Fee 8/21/03 $72.50 BEAVERTON, OR 97005 [TAX] 8% State Tax 8/21/03 $5.80 Total $78.30 Phone : Contractor: DP PLUMBING 904 S. CHEHALEM NEWBERG, OR 97132 REQUIRED INSPECTIONS Phone : 503 - 537 - 9492 Final Inspection Reg #: PLM 110612 LIC 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 Issued By: ' /L _da• /' Permittee Signature: �� V Call ) by 50 639 -4175 b 7:00 P.M. for an inspection needed the next busine day ( Building Fixtures Plitmbing Permit Application FOR OFFICE USE ONLY N Received Plumbing Q Date/By: 160 I I a 3 i Permit No.: oWP3' if y City of Tigard Planning Approval Sewer Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 //� Post - Review Land Use ++ Date/By: Case No.: � Internet: www.ci.tigard.or.us ■ ( �� Contact Juris.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 - - Name/Method: Supplemental Information. (3 ' a i 3 - a ) 40 TYPE OF WORK FEE* SCHEDULE (for special information use checklist) ❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total lgi Addition/alteration /replacement ❑ Other: New 1 - & 2 - family dwellings CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) SFR (I) bath 249.20 ❑ 1 & 2- Family dwelling Cornmercial/Industrial SFR (2) bath 350.00 ❑Accessory Building 0 Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2 Job site address: I 3,S1S SW -0,4d. Site Utilities Suite #: IQ 0 I Bldg. /Apt. #: Catch basin/area drain 16.60 Pro ect Name: Drywel bleach line/trench drain 16.60 1 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: 1 Lot #: Storm sewer (no. linear ft.) Page 2 • Water service (no. linear ft.) Page 2 Tax map /parcel #: Fixture or Item DESCRIPTION OF WORK Absorption valve 16.60 cifi Si vt k lA I T Z Backflow preventer Page 2 Backwater valve 16.60 �, � rr he yn o4� 11 � Clothes washer 16.60 16.60 CJCn� I'OUyN- n ID D 1'y Dishwasher �/ V Drinking fountain 16.60 ❑ PROPERTY OWNER 1 fATENANT Ejectors/sump 16.60 Name: .S f l (_ S 1°I? Expansion tank 16.60 Address: Fixture/sewer cap 16.60 City /State /Zip: Floor drain/floor sink/hub 16.60 _ Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 _ ❑ APPLICANT I ❑ CONTACT PERSON Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 . Primer 16.60 City/State/Zip: y p Roof drain (commercial) 16.60 Phone: I Fax: Sink/basin/lavatory ( 16.60 E -mail: Tub /shower /shower pan 16.60 CONTRACTOR op Urinal 16.60 Business Name: pi to J cLi-t . Water closet 16.60 Water heater 16.60 Address: atb y $. ( ka'rtA, L ii other: City /State /Zip: Nti,door 11/t. Other: j i $ Phone: "3) - a Kqp . Fax: ,c - ipa )Plumbing Permit Fees* Subtotal $ CCB Lic. #• i l Di (7, Plumb. Lic. #: [ - 708 Minimum Permit Fee $72.50 $ Authorized Backflow Minimum Fee $36.25 Signature: D Pik PIJtLJ" Date: Plan Review (25% of Permit Fee) $ State Surcharge (8% of Permit Fee) $ (Please print name) TOTAL PERMIT FEE $ 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. i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 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 2,001 to 3,600 $160.00 • 3,601 to 7,200 $220.00 Sewer - 1st 100' 55 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 additional $100.00 or fraction thereof, to and Fixture or Item Qty. Fee (ea) Total 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 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: 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 Comments regarding fixture work: Fixture Type: Replace New Moved Existing Capped 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 *Note: If the fixture work under this permit results in an Garbage -Domestic Disposal -Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach./Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar/Lavatory / 1 - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i :\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 ; INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received - Date Requested q S AM PM BUP Location 1 3 5 - vi Suite / 6 6 MEC Contact Person Ph ( ) PLM 3 i l Contractor Ph ( ) 5 7 `1 — 7 `f 4 /r SWR BUILDING Tenant/Owner . ELC Footing ELC Foundation 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 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 / Manhole Storm Drain Shower Pan Other: • PART FAIL ANICAL 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 ❑ Please call for reinspection RE: 0 Unable to inspect — no access Fire Supply Line /► ADA Approach/Sidewalk Date / �v Inspector Ext Other: • Final DO NOT REMOVE this inspection record from -the Job site. PASS PART FAIL CI` ' ®F TIGARD 24-Hour LDING°N • Inspection Line: (503) 6394175 MST INS • = = DIVISION Business Line: (503),63 171 — `� 48uP'3 - ' U d - 3 Received Date Requested – Z Z AM PM BUP Location / 3 .S3.' 4.1■W Suite l d U MEC Contact Person Ph ( ) 7 <o S(3 ® 3-09 4 P-fit Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation 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 Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab eRcig — eP Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: F' cR6S9 PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final D 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 Date fit' 1211 d 1 Inspector rrb I 1 Ext Approach/Sidewalk Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL