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Permit
y A CITY OF TIGARD PLUMBING PERMIT ikAtipi� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00307 -!,L .. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/1/2004 SITE ADDRESS: 16364 SW 72ND AVE B -08 PARCEL: 2S113AA -00200 SUBDIVISION: OREGON BUSINESS PARK I ZONING: I -L BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS: 5 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: Demo permit: capping 5 floor drains and 1 sink FEES Owner: Description Date Amount PACIFIC REALTY ASSOCIATES 15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 7/1/2004 $99.60 PORTLAND, OR 97224 [TAX] 8% State Surcharl 7/1/2004 $7.96 Total $107.56 Phone : Contractor: • ADDISON PLUMBING 17506 SE RIVER RD. MILWAUKIE, OR 97267 REQUIRED INSPECTIONS Phone : 503 - 785 - 1840 Final Inspection Reg #: LIC 151754 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- 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 - 6699. Issued B 4.. Permittee Signature: (5 ) 639 -4175 by 7:00 P.M. for an inspection needed the next usiness day Building Fixtures . . Plumbing Permit Application FOR OFFICE USE ONLY • City of Tigard Dat Y Permit No. t�an"i Y 7 / O 3o7 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �� Phone: 503.639.4171 Fax: 503.598.1960 itro ;I Date/By: Other Permit No.: a� 24- Hour Inspection Line: 503.639.4175 _. - Date Ready/By: funs: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information TYPE OF WORK - FEE* SCHEDULE ❑ 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 R 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: ib - sgca SW - 12.....4. , qv .e Catch basin or area drain 16.60 City/State/ZIP: %.,..k ‘,..„A_ Off. GI '17..."2_4 Drywell, leach line, or trench drain 16.60 Suit ld .apt. no.: B Project name: Footing drain (no. linear ft.: ) Page 2 f Ao.� QS.�S. Po rk_ ( Manufactured home utilities 110.00 Cross street/directions to job site: 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 Backflow preventer Page 2 br�+..o. - Z Ftr _ Sw.t,- ) 3 Flr. Oro;,.,. I V..-Ir.... Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 ❑' PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Ejectors /sump 16.60 Name: Qc>c_ Expansion tank 16.60 Address: l S 3 SU Sw S vo i ca Q Kwy . 30r) Fixture/sewer cap 16.60 City/State/ZIP: � 0 c\-\ ZZj Floor drain/floor sink/hub , Cfrps 16.60 Phone: (Sb1 )1,2_4 - 63o° Fax: ( ) Garbage disposal 16.60 ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60 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: ( ) I Fax: : ( ) (Sin�sin/lavatory CR f " / 16.60 Tub /shower /shower pan 16.60 E -mail: Urinal 1 6.60 • CONTRACTOR Water closet 16.60 Business name: 0 Vh.» -A,;‘ LL L Water heater 16.60 Address: l'l�oto SE' R-aA� C-a Other: Subtotal City/State/ZIP: 0.. \‘,..),,. ,'. e O g _ . q- IZ,b --t Minimum permit fee: $72.50 r nn Phone: (Sow - ,S ) 7gs' tvio Fax: ( ) 78(. - 04 7 Residential backflow minimum permit fee: $36.25 -("l, & , O CCB Lic.: I S, 4 -7 S Plumbing Lic. no.: 3 .. -.} f q C6 Plan review (25% of permit fee) State surcharge (8% of permit fee) .q l Authorized signature: ( ,. � t- TOTAL PERMIT FEE yp 7.5-0 Print name: .j,..„.% V..),ar-¢.. Date: 7_ 0 t _ d .- ic 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 \Pemrits\PLMF- PermitApp.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 Square 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:. 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 and including $50,000.00. specially requested inspections - per hour 72.50 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 * . _ Quantity 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" i -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 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/Lavatory Quantity Total - Bradley Ce j Isometric or riser diagram is required if fixture quantity Service 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: \ Building \Peimits\PLM•PamitApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line; (503) 639 -4175 INSPECTION DIVISION Business Line:. (503) 639 -4171 MST BUP Received Date Requested -7 J AM BUP Location // oZ Suite MEC Contact Person /�p 3 1, y • _ Ph ( ) T7'0 - g PLM ;2 4 f -D O 30 7 Contractor / Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: - SIT Post & Beam y ° � ✓ 1 ! f Aron Ext Shear Sheath/Shear th / ear MOW eah/h Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof thZ64) 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: oi xi17 1 AP PAS 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 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 �J r I Approach/Sidewalk Date Inspector V E7ct 1-7 Other: Final 0 N T REMOVE this Inspection record from the job site. PASS PART FAIL . 0 © © 4 8 B AYS AT : 1< 1 1 A I - , IIIII I _ • A g ;� ELECTRICAL PANELS TO REMAM f ' 11 a - I III I i 0 4, 0 ki - Ir it II I - / . \ WTN� 131.01/ \ \ 7 r \ , � / I r.. 0 ii lea ill \ 111 �\ \ !1 p 1 / 5 SMKS \ / 1 I o 2 TOILETS i4 \\ // r - J ;. 2 FLOOR SMIG9 ■ z 2 FLOOR DRAM 1 \, o o I DISHWASHER Ii I WATER HEATER I / II - De 4 1 1 BOILER IW BLOt III / FLOOR 54;. RF]1p / \ 6l - �.,.... J FLOOR DRAM // \\ 1 1 I 11 / \ \ • A I I 11 rT7 7 • if f �j I S�� I \ ♦ SLOPED AREA AND / / ■ }TLS \ \POUR BACK FLAT 81.413 \ / � � \ 1 \ / r _a E_'— 1 \ / \ �1 \\ / 11 11 ■ II \ 11 ' \ Ih FLOOR DRAM ! , // FLOOR $11•14‘ 1 / / \ \ 1 / \ / \ r i �'1 r- f, . F 0 v DEMOLITION PLAN ED SCALE 1/16" = 1' -0" N p