Permit CITY TIGARD PLUMBING PERMIT
I4c DEVELOPMENT SERVICES PERMIT #: PLM2004 -00455
,. I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/2004
SITE ADDRESS: 15883 SW 72ND AVE BLDG -B PARCEL: 2S112DC -00500
SUBDIVISION: FANNO CREEK ACRE TRACTS ZONING: I -P
BLOCK: LOT: 040 JURISDICTION: TIG
CLASS OF WORK: ALT 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: 1 SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace (2) existing lays with new fixtures, demo (1) laundry tray.
FEES
Owner:
Description Date Amount
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 9/30/2004 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surcharl 9/30/2004 $5.80
Total $78.30
Phone :
Contractor:
ADDISON PLUMBING
17506 SE RIVER RD.
MILWAUKIE, OR 97267 REQUIRED INSPECTIONS
Phone : 503 Top -out Insp
Insp existing /capped fixtures
Reg #: LIC 151754 Final Inspection
PLM 3 -449PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved
plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 -000 -0_ •0. You may obtain copies of these rules or direct questions to OUNC by calling (503)
2 - 699.
ssued By: � i / /, i j/ Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures .
•
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Rece�vey 50 45,. Permit No.: 6 4,t4 : 9610 -60 '15 S
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 knoµ ,, i \ Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 a�. �'_f Date Ready/By: J ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: / la, Supplemental Information
-
. - TYPE OF .WORK .. FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
® Addition/alteratio replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling a Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB. SITE INFORMATION AND LOCATION ' Site utilities
Job site address:, 5$ S3 <w 7Z,.d A, e Catch basin or area drain 16.60
City/State/ZIP: qomil q, O E Drywell, leach line, or trench drain 16.60
no.: e%d I Project name: Evo» - Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt.
� 6 J Co- �wr;c�t,.t Saks � 1ptiore
Manufactured home utilities 110.00
Cross street/directions to job site: ' ^ 7
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.: a ......005-06 Fixture or item
l �C- Absorption valve 16.60
DESCRIPTION_ OF WORK Backflow preventer Page 2
R.e:1tiUVa_ z. - £K∎S +- /aus it IZep f(Lce to/ tit et.) Backwater valve 16.60
t' i - (-A -sAdvi {vw -- Dzv....o P l�.w.1°.1 (wf' .•,. ..aa� \\) Clothes washer 16.60
Dishwasher 1 6.60
El PROPERTY OWNER _ I ❑ TENANT Dunking fountain 16.60
Ejectors /sump 16.60
Name: QoL Tvv,.5+ Expansion tank 16.60
Address: 1 3 S c, f. w S e qu.o ;� `PAW Fixture/sewer cap ( 16.60 / (Q .6 f)
City/ State/ZIP: p 0 . lj 1 Floor drain/floor sink/hub 16.60 I
Phone: (go; )1, 24 _ 63� Fax: (f.'0 3 ) - 77.55 Garbage disposal 16.60
APPLICANT Hose bib 16.60
❑ CO NTACT PERSON
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/ State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) Sink/basin((avatoty` . 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Sa� Ql.+ -wb , , , , _ „ 1 4-C- Water heater 16.60
Address: Other:
17Sz34, S € g i��.t ��
City/ State/ZIP: z...(...? Subtotal ?3.z..:, W� \wa.+`Fa a U� 91 Minimum permit fee: $72.50
Phone: (cr? )7ci -s, t ttp Fax: ( ) 7i,. e.i47 Residential backflow minimum permit fee: $36.25 7).,. 57)
CCB Lic.: 7S1 7 S�/ - Plumbing Lic. no.: 3 - et-47 pit Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5, 8
Authorized signature: 4 i al � TOTAL PERMIT FEE fig- 5 C3
Print name: 30_, V.o�r ,e Date: c - 3o - o-/ This permit application expires if a permit is not obtained within
a 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Permits\PLMF•PamitApp.doc 12/03 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
•
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities - Qty. Fee (ea) ' Total S quare 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
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40
Valuation: Permit Fee::' 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.
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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
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 * .
Quetta by (Fixture) Work Performed
•
Fixture Type: Replace
New Moved Existing Capped Comments regarding fixture work:
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
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains p
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar�Lavato
Quantity Total
- Bradley
Commercial Isometric or riser diagram is required if fixture quantity
total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ Building\Pemtib\PLM- PemitApp.doc 3/03
Accumulative Sewer Tally Parcel # 125`112D, 00500 P ` E x
Tenant t -ne .Evans Ca vright : i r ', ` ,k This SWR# 4 . E N/A 1 ` ° ' ,
Site: Address x4588. vo2nd^Qve :s:: ", - "; This PLM #'20040Q45 :: 4` , `
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 H: 0 . 0 t 0 0 0
Bath - Tub /Shower 4 r 0 Y . . , 0 5 0 0 0
- Jacuzzi/Whirlpool 4 0 0 ' ' ` .• 7 0 0 0
Car Wash - Each Stall 6 ,,w, 0 '',„.,:;;;''.'1'4'.:„. - 0 f , ; . , 0 0 0
- Drive through 16 ,x 0 ,,,. &;, 0 ; 0 0 0 •
Cuspidor/Water Aspirator 1 r ,' x 0 0 ' 0 0 0
Dishwasher - Commercial 4 :, 0 1 ..`: , ; 0 `'` 0 0 0
- Domestic 2 h ' • .. 0 ",,n.' �`;`x 0 ` .,, 0 0 0
Drinking Fountain 1 „, ' : .. 0 . ` 0 ^? ,,. 0 0 0 •
Eye Wash 1 ' .. 0 "„: �: 0 ` . 0 0 0
Floor Drain /Sink - 2 inch 2 4 " ' ' <. 1 0 ws, 3 , 0 y: 0 0 0
- 3 inch 5 i 0 0 -: „; 0 0 0
- 4 inch 6 I :; "_ 0 1 ' z 0 ` . R . .. : .. 0 0 0
- Car Wash Drn 6 i 0 0 , 0 0 0
Garbage Disposal
Fa s °• z . �, , , 0 ;. 4. 0 0 0
- Domestic (to 3/4 HP) 16 • ,�:;:�;° 0 . r .;� �. _:
- Commercial (to 5 HP) 32 � + • r 0 x F a:� : r' 0 , ;`« ;, 0 0 0
- Industrial (over 5 HP) 42 . s 0 s. , u ` r� , ;1 0 0 0
Ice Machine /Refrigerator Drain 1 , Y . ' . 1 0 _' "V; . 0 ,, s a t 0 0 0
Oil Sep (Gas Station) 6. -+° 0 , ' + °r 0 .: 0 0 0
,; ; ; 0 , ;; ; 'a 0 -, S . ; =�
Rec. Vehicle Dump station 16 4 _ 0 0 0
Shower -Gang (per head) 1, = 0u u 0 kh,`
0 0 0
- Stall 2 ,; 0 ? . ' .. 0 0 0 0
Sink - Bar /Lavatory 2 :, ': 0 , 2 ; " 4 ' ' ' 4 0 0
- Bradley 5 ! :, -.. _ 0 . i 0 mss ' 0 0 0
- Commercial 3 -. 0 T, 0 , `; 0 0 0
- Service 3 = ' ` . 0 , ,,..4.. :. r ' 3 -:;; ; 0 -1 -3
Swimming Pool Filter 1
Washer - Clothes 6 q::::. 0 ,l"ls k 0 .,,, ` 0 0 0
Water Extractor 6 ` • ' ` 0 0 ° c . 4:1: 0 0 0
Water Closet - Toilet 6 ' ;,;'. 0 l'1705?.,-...:,,, . 1 i 0 0 0
�
0 � E , : F
Urinal 6 1 " , 0 •ri.= 0 r n, 0 0 0
Previous EDU Count " `'; . X' , ,. . `. 0
Capped EDU Credit , . 0
TOTALS 0 0 3 7 2 4 -1 -3
Current Fixture Value -3 divided by 16 = -0.2 Current EDU 1 EDU = $ 2,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -3 divided by 16 = -0.2 over (under) $ (500.00)
Enter EDU Change Here =02`.
Notes: CREDITS!!!
J ignature: f Date: 9/�D�
Building Division 11
Note: The property owner snarretain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
lwhich must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
is \Building \Sewer Tally\SewerTallySheet.xls 7/1/04
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received c � Date Requested // AM PM BUP
Location / 5 g o 7_ a Suite MEC
Contact Person Ph ( ) 2 � U / � ° PLM � bo41
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
Ftg Drain Access: 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
Oth:
PART FAIL
CHANICAL
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 0 Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
A ll /3 iV
pp Date / Inspector Ext
Approach/Sidewalk
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL