Permit u CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00586
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/13/2006
PARCEL: 2S1 12 D C - 00100
SITE ADDRESS: 15705 SW 72ND AVE ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK 111 LOT: 002 JURISDICTION: TIG
Project Description: NIKE GOLF BALL LAB.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
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: ft
Owner: FEES
PACIFIC REALTY ASSOCIAT Description Date Amount
15350 SW SEQUOIA PKWY #300
TIGARD, OR 97224 [PLUMB] Permit Fee 12/13/200E $72.50
[TAX] 8% State Surcha 12/13/200E $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.
Issued By: Permittee Signature 0111°_,,;. ��
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.
r Building Fixtures
Plumbing Permit AimlicatEECEIVED I.OIL OEPIC[: US,.: ()Ni.,
1114 City Of Tigard DEC 1 3 2006 e i ve d ya J3 t06 R%J -- Permit N(5? l Zad(� GQ >i 6
q 13125 SW Hall Blvd Tigard, OR 97223 Plan Review
C : Phone: 503.639.4171 Fax: 503.5 V °OF TIGARD Date/By.. Other Permit No.:
T 1 G A R U Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: lutist ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method T Supplemental Information
TYPE OF WORK FEE* SCHEDULE
Cif 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 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
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
•
. , Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / rj 2„0 S 5 (A.) 72 N D / rij L_ Catch basin or area drain 16.60
/ I
City /State/ZIP: e � r) Q 9 7 2 2 ci / Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: A.)) k 6 0 LF aspc L C A j Footing drain (no. linear ft.: Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: -72_,,,,/ A-a_s i 1,./I_ ,
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 Back flow preventer Page 2
4i7Di 11 ok) Q- M 00 t1 LLI nt. fl7 w SJ l u( - Backwater valve 16.60
1M (JO t Pi c.04- 1'1 4) r1/41 s � /v �, /A-L, �L
Clothes washer 16.60
--- A-0 b 1 s`s11 c (4 , 0 0 1 5-1e 47 _
( e.-1.4..) L t N Dishwasher 16.60
ra PROPERTY OWNER I 1 ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: r pig -nfl4..) ST Expansion tank 16.60
•
Address: Fixture /sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone: 61,1 Co Z (1 - (D 3 of, Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: ilj l f,L 1 xi e. Interceptor /grease trap 16.60
Contact name: �„ t C,. r S, USN % I 7 Medical gas (value: $ ) Page 2
Address: ( f (Jyt) .., 1^'t A-y Clo lei-- Primer 16.60
City / State/ZIP: A b � ,t) p -I*Z. cj7 005 (o tF S3
Roof drain (commercial) 16.60
Phone: 6 7, 3 ) Co-7 j - Z �Q7r' (�j3) (07 1 C
Sink/basin/lavatory 16.60
Fax: _
Tub /shower/shower pan 16.60
E -mail: E/Lt L, So5e4...› Q N 1 ke.. . C d v.... Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: () L -L, () fie» f 51 /(.4-) G.TZ x..7 Water heater 16.60
Address: � 5lQ ( $4 A1/2_ r S .- I, O Other:
City /State/ZIP: .D C)(2._. (? 2_ c.) 1 Subtotal
Minimum permit fee: $72.50
Phone: 1,, ,3) 277 - (o 3({3 J Faxib7.) Z Z 29 3 S Residential backflow minimum permit fee: $3625
CCB Lic.: 5?p / ' Plumbing Lic. no.:37'q f 3 Pe Plan review (25 %ofpermit fee)
� State surcharge (8% of permit fee)
, i �;
Authorized signs ' - 1 7 -' -4/
��� : ,,�� TOTAL PERMIT FEE
Print name: f j #t 7 s E-A..) 1 Date: Jz -/ 3 ..0 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 \Pamits\PLMF- PamitApp.doc 04/06/06 440-4616T(I0/02/COM/WEB)
Plumbing Permit Application - City of Tigard • ``l
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - I' 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
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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof; to and
�/ including $10,000.00.
`f ,
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 flow 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 buildin • • " •
Fixture Type: Replace ❑ . Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with 'installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures. .
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/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 •
•
Washer - Clothes • 'Note: If the fixture w under thi permit results in an
Water Extractor p
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. • ,
i:\ Building \Pertnits\PLM- PennitApp.doc 07/06/05
T - : ■
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006.00��B6
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/13/2006
Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 7 1111 _..
INSPECTION WORKSHEET FOR DATE: 1/26/2007 TIME: 7 :OOAM PAGE: 47
SITE ADDRESS: 15705 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK III LOT #: 002 TYPE OF USE:
PROJECT NAME: NIKE
DESCRIPTION: NIKE GOLF BALL LAB.
OWNER: PACIFIC REALTY ASSOCIAT, PHONE #:
CONTRACTOR: APOLLO SHEET METAL INC PHONE #: 503 -222 -6343
Inspection Request Scheduled For: Date: 1/2612007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 042652 -01 503- 545.0337 N
Corrections /Comments /Instructions:
7 cn t4 S + -- 614 —
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kANNAI vv---.\6 4-C1,-*--4_,12 — c,..,,S5 j2
6
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` j: -ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
\; i �z (� /v 2 --) Inspector: Date: Phone #: (503) 718 - 7