Permit CITY OF TIGARD PLUMBING PERMIT
I . COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00461
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/11/2007
PARCEL: 2S112DC -00100
SITE ADDRESS: 15675 SW 72ND AVE ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK III LOT: 002 JURISDICTION: TIG
PROJECT: NIKE SOCKS
Project Description: TI - add clothes washer and indirect drain. Other fixture: hose bib.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: F2 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WMI Description Date Amount
PORTLAND, OR 97224 [PLUMB] Permit Fee 10/11/2007 $72.50
[TAX] 8% State Surcha 10/11/2007 $5.80
Phone : Total $78.30
Contractor:
APOLLO SHEET METAL INC
2300 SW 1ST AVE #104
PORTLAND, OR 97201 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 222 -6343
FAX 503- 222 -2935
Reg #: LIC 56241
PLM 37 -413PB
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 503.246.6699 or 1.800.332.2344.
It
Issue Permittee Signature: ' e fe 01.Verte_
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.
(; o1P 24) 0 - 00 cs-
Plumbing Permit Application M R O1.1 It 11 1 s.1, OyI
III City of Tigard Received 0 IIMINIE Permit No.: • ° (.41 , Lop,. i • c • 13125 SW Hall Blvd., Tigard, OR 97223
C Plan Review � ^ ,
Phone: 503.639.4171 Fax: 503.598.1960 Pla Re Other Permit No.: 7�(( 9
Inspection Line: 503.639.4175 Date R /e M See Pa 2 for
Internet: www.ti
I' I ,\ I: I? -0r. ov Ready /By:
F g Notified/Method: 11, Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 R for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
❑ 1- and 2- family dwelling 51CCommercial/mdustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/ldtchen 45.00
❑ Fire sprinkler (_ sq. ft.) Page 2
6' 7 6 JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: ' S ' -"'" S k 'Z, N b /v- ,� Catch basin or area drain 16.60
City/ State/ZIP: '-- l (,.. A 6 6 Drywell, leach line, or trench drain 16.60
/
Suite/bldgJapt. no.: I Project name: N 1 Vl+- C--017--1? Footing drain (no. linear 1t : ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: ` ` 549 3 4 r • • 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.: 0251/ Ate► -- Fixture r D� Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Plc (.AU e%-s l4- -12 'zj14�.4.., p Backwater valve 16.60
ham) to t I , � �Z.4. t 7-0 Clothes washer 1 - 16.60 I (p . t� Q
_
c , ! s�j cS � , S 1 �� - Dishwasher 16.60
�/` ❑ -- PROPERTY OWNER
1 ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name:
Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: 4( Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( )
Garbage disposal 16.60
Hose bib I 16.60 I (.9 , (i O
$ APPLICANT ❑ CONTACT PERSON
A Ice maker 16.60
Business name: Abs--P CV t- 0 c ri•-dr>JCT. S��.42 01. C. Interceptor /grease trap 16.60
Contact name: _\ p ,_f 6 {j{, LI Medical gas (value: $ ) Page 2
Address: ^..0-8, 0i) S t.Jo 1 GA- AN., e_ , ‘-re_. 1 U C(-- Primer 16.60
City/ State/ZIP: f 0 yt:rt -y -ts j o Of_ Q '5 ZU l Roof drain (commercial) 16.60
�3 !'Z -6.3(4 3/ I ZZZ Z q 3 Tub/shower/shower
Sink/basin/lavatory 16.60
Phone: Fax: Tub /s pan 16.60
E -mail: J g 0 y Q .44./2 C. C-S rl� (. ov... a Urinal 16.60
I CONTRACTOR Water closet 16.60
Business name: -4 S A y I4 ' s Water heater 16.60
Address: Other:
City/State/ZIP: Subtotal
Minimum permit fee: $72.50 74.56
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $3625
CCB Lic.: 5 (e Z (.../ I Plumbing Lic. no.: 3 7 -q 1 3 17,(3 Plan review (25% of pennit fee)
- State surcharge (8% of permit fee) 5,0
)
Auth := _ '� / TOTAL PERMIT FEE , 30
Print name -", /�a�`�' Date 0 ( 1 � I This permit application expires if a permit is not obtained within
iirr r , 180 days after it has been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
Iaauildi • - ". -, • - PaiutApp.doc 06/26/06 440.4616T(10/02/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: P1.M2007- 0 @�C'1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: lon11 /20117
Phone: (503) 639 -4171 /amaq �d,
Inspection Requests (24 Hrs.): (503) 639 -4175 �.' I �..
INSPECTION WORKSHEET FOR DATE: 10/23/2007 TIME: 7:00AM PAGE: Q9
SITE ADDRESS: 16675 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK Ill LOT #: 002 TYPE OF USE:
PROJECT NAME: NIKE SOCKS
DESCRIPTION: TI - add clrathes washer and indirect drain. Other fixture: hose bib.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: APOLLO SHEET METAL INC PHONE #: 503..722 -6343
Inspection Request Scheduled For: Date: 10/23/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
309 Plumbing final 0513120.01 503.545.0337 Y
Corrections /Comments /Instructions:
Care E( Y1/4-
•
I , PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ai Nt 4 ^^^- --- Date: E (2,3 ID7 Phone #: (503) 718-