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Permit -- 4 CITY OF TIGARD PLUMBING PERMIT A.Arito os DEVELOPMENT SERVICES PERMIT #: PLM2002 -00073 ` - 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/1/02 SITE ADDRESS: 15862 SW 72ND AVE PARCEL: 2S112DD -00200 SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P BLOCK: LOT: JURISDICTION: TIG CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: 2 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of (2) trench drains on south side. FEES Owner: Type By Date Amount Receipt PACIFIC REALTY ASSOCIATES PRMT CTR 3/1/02 $72.50 27200200000 15350 SW SEQUOIA PKWY #300 -WMI 5PCT CTR 3/1/02 $5.80 27200200000 PORTLAND, OR 97224 Total $78.30 Phone 1: Contractor: DEAN WARREN PLUMBING 3111 SE 13TH PORTLAND, OR 97202 REQUIRED INSPECTIONS Phone 1: 236 -4152 Rough -in Insp Reg #: LIC 172 Final Inspection PLM 26 -83PB 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 -0080. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. - -tea Iss ed By: ./. �� .. ,/ , (A) Permittee Signature: y/ 9-1/ kaaae-t."-d a 503 -4175 by 7:00 P.M. for an inspection needed the next business day • "A Plumbing Permit Application Date received: jiglIM Permit no. g i ; ,, M ,4 <.. ,.: City of Tigard I I' g Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: Fax: (503) 598 -1960 Date issued: By: 1 Receipt no.: Land use approval: Case file no.: Payment type: T1 'PE OF I'I:RNI11' 0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 0 Tenant improvement 0 New construction 0 Addition/alteration/replacement 0 Food service 0 Other: JO13 SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: ) S g (n a S 60 7 a ' Descri i tion 021 Fee(ea.) Total Bldg. no.: Suite no.: New 1- and 2- family dwellings only: atft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: 6 ' AL S •Ec ALZ7 J= S • I i .SFR (3) bath • ______ _ _ _ City /county: T & ! ZIP q — ]aa Each additional bath/kitchen Description and location of work on premises:,Sr7t �T11 L l�rr_ ' Siteatillties: . go .._ - . 1.1__ , t• ruC.L., a .: t atch basin/area drai Est. date of completion/inspection: 3 (g Drywells/leach line/trench drai 1'LU�1131NG CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities — Business name: EA•v L'— AttZ.,) IP L1Q 6. Manholes 3 k 1\ S E. 1 3 Rain drain connector City: PO R TY- 4n,d I State:og I zIP:q ? Ra Sanitary sewer (no. lin. ft.) Phone3 — Fax: E -mail: Storm sewer (no. tin. ft.) CCB no.: O 1 7 a Plumb. bus. reg. no: a ($ 3 P B Water service (no. lin. ft.) City/metro lic. no.: 9 g' Fixture or item: ■ Absorption valve . 1 1 .T 1 1 • v' .(1 ' 1: . 11 ' ,. �, 4.1k I. tirlif.. Back flow preventer Print name: N Iv € LLot...+S Date: 3 1 O a Backwater valve CON l CT PERSON Basins/lavatory Name: - L)_NVV y ec-, 5 Clothes washer Address: Dishwasher Drinking fountain(s) City: I State: . 1 ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank II 011 NCR Fixture/sewer cap M Name (print): PA. c_ TR H 5 'r s� �l E 3 60 Floor drains/floor sinks/hub � -- Mailing address: f 5 50 .. (,v SEQttp VO. P Kw y H ose bib 1 •sal Hose bibb ME City: `J 6-,q �0 I State 4ZIP: g 7a o, i( Ice maker Phone: ivory — k, 3 etp I Fax: E-mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) 1 Owner's signature: Date: Sump 1N( 1 N l: E R Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: 'State: I ZIP: Other: Phone: 'Fax: I E -mail: Total Minimum fee $ 7a — ° Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application 0 Visa 0 MasterCard Plan review (at _ %) $ expires if a permit is not obtained a 8 State surcharge Credit card number: / / within 180 days after it has been arS ( 8% ) "" $ ` Expires accepted as complete. TOTAL $ 78 ..- Name of cardholder as shown on actin card $ Cardholder signature Amount 440 -4616 (ti XWCOM) PLUMBING PERMIT FEES: PRICE TOTAL • New 1 and 2- family dwellings only: FIXTURES (Individual) QTY (ea) AMOUNT (Includes all plumbing fixtures In PRICE . • TOTAL Sink 16.60 the dwelling and the first100 ft. QTY , (ea) AMOU( 16.60 for each utility connection) Lavatory One (1) bath $249.20 Tub or Tub/Shower Comb. 16.60 Two (2) bath $350.00 Shower Only 16.60 • Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL , Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE: 3" 16.60 ' 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed Gas piping requires a separate mechanical Fixture Type: New • Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink MFG Home New San/Storm Sewer 46.40 Lavatory • 16.60 Tub or Tub /Shower Hose Bibs Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet 16.60 Urinal Other Fixtures (Specify) Dishwasher A Reid D 2A i (R At H 1.44.Ert '-) a Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Sink: 2" Sewer - 1st 100' 55.00 3" Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Stone & Rain Drain -1st 100' 55.00 AP EA DRAT r, a Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 • Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram Is required if Quantity Total is > 9 *SUBTOTAL - 7,2 l 8% STATE SURCHARGE 5 "PLAN REVIEW 25% OF SUBTOTAL . Required only if fixture qty. total is > 9 TOTAL $172 .0e * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which Is $36.25 + 8% state surcharge. ** All New Commercial Buildings require plans with isometric or riser diagram and plan review. 1:ldstsVormslplm- fees.doc 10/10/00 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST / �. BUP Received Date Requested �7/ AM PM • BUP Location ' / S 86 2 7 /y41 Suite MEC r� Contact Person - - Pz:gx4A__." Ph ( ) J- . 6, — ' f (S� PLM Oc - 6 - 0(') 7 3 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Ftg Drain Access: ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam l�iyt� Shear Anchors Ext Sheath/Shear r =� �•� 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: S ASS 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 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 77 Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL CITY OF TIGARD 24 -Hour BUILDING,,, Inspection Line: (503) 639 -4175 INSPECTIOIIVISION Business Line: (503) 639 -4171 / Received Date Requested 3 — 2-1( AM�� M BUP Location V a, 7 . Suite MEC Contact Person Ph ( ) PLM �O �� 00073 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: /11-77-1 � SIT Post & Beam Shear Anchors Ext Sheath/Shear Vf t._ a Ina Sheath/Shear � rn Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: Final PASS • ; RT FAIL •• -:am - - - -- Under Slab Rough -In Water Service Sanita ewer - ain D -•- Catch Basin / Manhole Storm Drain Shower Pan Other: C MS 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 Please call for reinspection RE El Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date j J� / ?/ u Z Inspector Ext Other: Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL