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Permit
C ITY OF TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2001 -00252 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/15/01 SITE ADDRESS: 15957 SW 72ND AVE BLDG -A PARCEL: 2S112DC -00701 SUBDIVISION: OREGON BUS. PARK III ZONING: I -P BLOCK: LOT: 038 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M 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: Addition of 1 kitchen sink. No sewer permit required due to remaining EDU credit for this building. FEES Owner: Type By Date Amount Receipt PACIFIC REALTY ASSOCIATES PRMT CTR 6/15/01 $72.50 27200100000 15350 SW SEQUOIA PKWY #300 -WMI 5PCT CTR 6/15/01 $5.80 27200100000 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. Issued By j % • Permittee Signatur- • L ` Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day • /✓2 Say.2. / Q_c. i7 Ed � , Plumbing Permit Application • Date received: 6//5/0/ Permit no.:1L/1„ /00 / -e0 2s ° ` City of Tigard Sewer permit no.: Building permit no.: ' " I ! `J g 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: Ilipril Receipt no.: Land use approval: SGf/" x-200 /- Doi'? Case file no.: Payment type: 0 1 & 2 family dwelling or accessory Commercial/industrial 0 Multi - family 0 Tenant improvement 0 New construction ) Addition/alteration/replacement 0 Food service 0 Other. JOB SITE INFORi19ATION FEE SCHEDULE (for special inform use checklist) Job address: J 5C/ S W ?02 � Description Qty. Fee(ea.) Total Bldg. no.: A Suite no.: New 1- and 2- family dwellings only: Tax no.: map/tax lot/account no.: (includes 100 ft. for each utility connection) SFR (1) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: N & ¶ALLAIQI E SFR (3) bath / City /county: / � Q.g ZIP: Each additional bath/kitchen Description 4nd-location of work on premises: ; A .l7 Site utilities: - k i 'Td t,e 5. wK Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: .1= /,,, 1,,,,Rize, / ;2426. Manholes Adds : 3111 S g 1 A t Rain drain connector City: w _ • ..,,,, State:Q/Q ZIP: ,,, . Sanitary sewer (no. lin. ft.) PhoneQ3L, —Ili SR Faxa3(, -477 E-mail: Storm sewer (no. lin. ft.) CCB no.: 01 7 a_ I Plumb. bus. reg. no: 9. ( 3 P.8 Water service (no. lin. ft.) City/metro lic. no.: J 9 1 Fixture or item: Contractor's representative signature-:2 Absorption valve Back flow preventer Print name: Le,..".. E LLow S Date: Backwater valve Basins/lavatory Name: (�— p /A Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank Fixture/sewer cap Name (print): c_ 77 l t, 5 % $1c az 3 ©p Floor drains/floor sinks/hub Garbage disposal Mailing address: / ,i S ,Q rA ,ok Hose bibb City: 7 - 1 I Statec /e ZIP: 9.-7,1._./. , Ice maker Phone: ( q —4,30 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) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other. Phone: I Fax: I E -mail: Total .gy Not all jurisdictions accept credit cards. please call jurisdiction for more information Notice: This permit application Minimum fee $ �( i ew at _ 0 $ 0 Visa 0 MasterCard Plan revi ( expires if a permit is not obtained 8% a 5 Credit card number. / / within 180 days after it has been State surcharge (8%) ) "" $ 5 �� Expires TOTAL Name of cardholder as shown on credit card accepted as complete. 78' 3- $ $ Cardholder signature Amount 440-4616 (6/00/C'OM) PLUMBING PERMIT FEES: • PRICE TOTAL New 1 and 2- family dwellings only:. . <-•e FIXTURES (individual) QTY ' (ea) AMOUNT_ (includes all plumbing fixtures in PRICE • TOTAL I Sink I 16.60 , �- the dwelling and the first100 ft. QTY (ea) AMOUN 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 3" 16.60 PLEASE COMPLETE: • 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 Tub or Tub /Shower 16.60 Hose Bibs Combination tit Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Urinal Other Fixtures (Specify) 16.60 Dishwasher 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) Storm & Rain Drain - 1st 100' 55.00 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 •- J� 8% STATE SURCHARGE **PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $. * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Beddow Prevention Device, which is $38.25 + 8% state surcharge. ** M New Commercial Buildings require plans with isometric or riser diagram and plan review. is dsts\forms\pim- fees.doc 10/10/00 r Accumulative Sewer Tally �/ Tenant Name: AMA 77t'JE - 57 - G This SWR# Address: S9S 7 .0 & X02 `' This PLM #: DD/— D002.5 Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New # Value Capped off value added # added #s total Count off #s count value values Baptistry/Font 4 Bath - Tub /Shower 4 - Jacuzzi/Whirlpool 4 Car Wash - Each Stall 6 - Drive Through 16 Cuspidor/Water Aspirator 1 Dishwasher - Commercial 4 - Domestic 2 Drinking Fountain 1 Eye Wash 1 F loor Drain /sink - 2 inch 2 - 3 inch 5 - 4 inch 6 - Car Wash Drn 6 , Garbage Disposal 16 - Domestic (to 3/4 HP) - Commercial (to 5 HP) 32 _ - Industrial (over 5 HP) 48 , Ice Machine /Refrigerator Drains 1 Oil Sep (Gas Station) _ 6 Rec. Vehicle Dump Station 16 Shower - Gang (Per Head) 1 - Stall 2 - Sink - Bar /Lavatory 2 - Bradley 5 - Commercial 3 - Service 3 / Swimming Pool Filter 1 Washer - Clothes 6 Water Extractor 6 Water Closet - Toilet 6 Urinal 6 TOTALS - - 5 mineewSE Total fixture values: c2 / 49 divided by 16 = /3 , S EDU = / -s ' ..... , o Ge�a - - . 5 AvegewrF HISTORY .3 EZ u e4a, • . ,Q,..5 #2 ,y v,atc-- efec2irs PLM # /99 QU /a5 EDU# /3 SWR # /5 9-600 ?3 PLM# 95 D /3f EDU# /4, SWR #95'- 0af'f PLM #1P -000 EDU# /3 SWR# 9 ?-Doors PLM# EDU# SWR# PLM#r4, -oaf / EDU# /3 SWR# n - Ora so PLM# EDU# SWR# PLM# 94 - Do g/ EDU# /a SWR #96 - 00 53 PLM# EDU# SWR# i:\dsts\swrtaly.doc A/ '5/00/ • - CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested ? /�'T AM PM BLD Location 1 S 9 5 7 -) - :v 1 1x. Suite MEC Contact Person Ph a 3 6 - '// SZ PLM 00/ - D 6 , 2 Contractor 11 ) Ph SWR - r I'v BUILDING Owner (4 F i ELC Retaining Wall 0 ELR Footing Access: Foundation FPS Ftg Drain SGN Crawl Drain Inspection Notes: Slab SIT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm R Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service Sanitary Sewer Rain Drains PART FAIL �!�!� NICAL Post & Beam Rough In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough In UG /Slab Low Voltage Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ 1 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ 1 Please call for reinspection RE: [ 1 Unable to inspect - no access Fire Supply Line ADA , c /�o� Approach /Sidewalk Date / v Inspector ' " //1 " t' ' Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.