Permit CITY TIGARD PLUMBING PERMIT
A 0 r;t DEVELOPMENT SERVICES PERMIT #: PLM2001 -00385
� a 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/15/01
SITE ADDRESS: 16112 SW 72ND AVE B -18 PARCEL: 2S113AA -00500
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: OOA JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of (2) sinks.
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT CTR 8/15/01 $72.50 27200100000
15350 SW SEQUOIA PKWY #300 -WMI
5PCT CTR 8/15/01 $5.80 27200100000
PORTLAND, OR 97224
Total $78.30
Phone 1:
Contractor:
POWER PLUMBING CO
P BOX 23144
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone 1: 244 -1900 Rough -in Insp
#: L IC 52378 Top -out Insp
Reg Final Inspection
PLM 34 -150PB
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 : '_, /_ _ / Permittee Signature) t`" \ \
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business ( day
•
l'Ili
Plumbing Permit Ap 'on
At '-" / , Datereceived: Permit no.: a l ..450 -404.
' - ' City of Tigard , , ;
g
i Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tiga tt, OR- 9/223
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: OM Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERiIIT
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family 'enant improvement
0 New construction )Addition/alteration/replacement 0 Food service 0 Other:
.1011 SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: I ( s . 1 . - A ve.. Description Qty. Fee(ea.) Total
Bldg. no.: / 8 C QTR't /28 New 1- and 2- family dwellings only:
Su ite no.: (includes 100 (t. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: 'Block: I Subdivision: SFR (2) bath
Project name: & g SFR (3) bath
City/county: I ZIP: Each additional bath/kitchen
Description an son of wo on remises: Apo 3 sw./� Site utilities:
I. ' Catch basin/area drain
Est. date of completion/inspection:
Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.) —
C Manufactured home utilities
Business name: owen- \... , a Manholes
Address:' -,p . lgykt, Rain drain connector
City`a e r,.„e I State:O I ZIP: 9 280 Sanitary sewer (no. lin. ft.)
Phone: aN4 - 19pp I Fax ; I E-mail: Storm sewer (no. lin. ft.)
CCB no.: 513"18 I Plumb. bus. reg. no: 34 -l5D Water service (no. lin. ft.)
_
City/metro lic. no.: I (02 Fixture or item:
'-
Absorption valve
Contractor's representative signature �� �"l Back flow preventer
Print name: c , b\oe r Date: 6-1—Di Backwater valve
CONTACT VEItSON Basins/lavatory
\ - Clothes washer
Name: Jo DtA ok Dishwasher
Address: p, `3pX 1q� \a Drinking fountain(s)
City:',„ A ,,N ‘ 1 State:OR ZIP: Qi 1 a500 Ejectors/sump
Phone :stc f -(qoo I Fax $$2S I E -mail: Expansion tank
Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): Garbage disposal
Mailing address: Hose bibb
City: I State: I ZIP: Ice maker
Phone: I Fax: 1 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) .2. /6. b-°— .13.
Owner's signature: Date: Sump
Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other.
Phone: I Fax: I E -mail: Total
Na all jurisdictions accept credit cards, please call jurisdiction for more information Minimum fee $ 7- • $°�
Notice: This permit application
O Visa O MasterCard expires if a permit is not obtained Plan review (at %) $ ._,
Credit card number: / / within 180 days after it has been State surcharge (8 %) $ S.
Ex TOTAL $ '70
Name of cardholder as shown on credit card accepted as complete. $
Cardholder signature Amount 440-4616 (6A0/COM)
Aligir
PLUMBING PERMIT FEES:
'S"
PRICE TOTAL New 1 and 2- family dwellings only: tv,-
FIXTURES. (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE • 'TOTAL
Sink 16.60 3 . 21, the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
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 3 2" 16.60
3" ' 16.60 PLEASE COMPLETE:
3^ '
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 3-
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 .
Other Fixtures (Specify) 16.60 Urinal •
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
( Speciy)
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 (72 .*-
8% STATE SURCHARGE -
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $ 7613
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $38.25 + 8% state surcharge.
** AII New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i:'.dsts\forms\plm- fees.doc 10/10/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP - -
Date Requested AM PM BLD
Location / (0 1 I . 2 and / k/ Suite MEC
Contact Person 951-A/l/L/ Ph ) / 9 0 v PLM 0 0 1 o o 3
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall 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
Susp'd Ceiling
Roof
Misc:
Final
- c RT FAIL
lereft ' (
Post & Beam
Under Slab
•
Top Out
Water Service
Sanitary Sewer
Rain Drains
S 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
PASS PART FAIL
SITE
Backfill/Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA r \
Approach/Sidewalk Date (c ��) Ins Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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1 CUR' NTLY USED H'
THIS ENANT WILL SE
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UP TM E HAMS WAY N
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1 ! REMOVE SLIDING DOOR- MAN
1 ! PILLL O EXISTING OPEN NN O _D.
OR NEW DOOR 4 PRAMS NI VG
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I REMOVE DOOR 4 PRANIIE 1 /
FOR USE IN NEW LOCArI ON R G OOR�
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