Permit Alto CITY OF TIGARD PLUMBING PERMIT
d r� DEVELOPMENT SERVICES PE
DEVELOPMENT PLM2006 -00410
Anuti
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/6/2006
PARCEL: 2S 113AB -01201
SITE ADDRESS: 16535 SW 72ND AVE BLDG F ZONING: I -L
SUBDIVISION: PACTRUST BUSINESS CENTER LOT: JURISDICTION: TIG
Project Description: Cap 1 drinking fountain, (1) sink. Add (1) drain, relocate, replace (9) fixtures. Other fix. is drinking
fountain.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: 1 GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [PLUMB] Permit Fee 9/6/2006 $199.20
[TAX] 8% State Surcha 9/6/2006 $15.94
Phone : 503- 624 -6300 Total $215.14
Contractor:
ADDISON PLUMBING
1407 HOMESTEAD PLACE
MOLALLA, OR 97038 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 785 -1840
FAX 503- 829 -9701
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 or 1- 800 - 332 -2344.
Issued By: i " ,O Permittee Signature: ,s2--
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
a P-13 •7
Plu bin! Permit Application .
• I c,lt t�l r!� -r: �1 c)�1.�
City of Tigard Permit No.: , % c
Dat ham
Date1y - -Y 0 elf 9 - op a
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi-
Phone: 503.639.4171 Fax: 503.598.1960 :.., R;;. - Date/By. Other Permit No.:
24- Hour Inspection Line: 503.639.4175 !
Internet: www.tigard-or.gov ��y r Fa See Page t for
Notified/Method: i Supplemental lnformadon
TYPE OF WORK • . , •. - FEE* SCHEDULE -
❑ New construction ❑ Demolition For special information use checklist
• Desat,tion ay . Ea_ Total
21.Addition/alterationheplacement 0 Other:
New 1- 2- family dwellings (includes 100 R for each utility connection)
- CATEGORY OF CONSTRUCTION ' . SFR (1) bath 24920
❑ 1- and 2-family dwelling .Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2 _
JOB SITE: INFORMATION AND LOCATION Site utilities
Job site address: /cos) s S4-w 72.4 6.,-q- Catch basin or area drain 16.60
City /State/ZIP: Qc.,-•00 a OYZ- Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: fI/(7 JO I Project name: °CC Zw.0..1 i sf , c.c Footing drain (no. linear ft: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear R: ) Page 2
Subdivision: I Lot no.: Water service (no. linear R: ) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Back flow preventer Page 2
ea- o w1o6.0-k e= Z we, / 8 kyew,_ S', ),,,k Backwater valve 16.60
/Le-pi a.c,e I - 0...v-:-03.9. n...-d t - w c- Clothes washer 16.60
� � co.--a- Dishwasher I 16.60
ca.f <IT 1 - B` kraow- S:r.1G, [ - ori-. -k 6Q,....
PROPERTY OWNER I ❑TENANT
I] Drinking fountain 1 16.60
Ejectors/sump 16.60
Name: PGcgw -S{ Expansion tank 16.60
-
Address: Fixture/sewer cap 16.60
City /State/ZIP: ('loon floor sink/hub 1 16.60
Phone: ( ) I 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:( ) Fax::( )
Si s•. r avato y 4 16.60
Tub/shower/shower pan 16.60
E -mail:
Urinal 1 16.60
CONTRACTOR Water closet 3 16.60
Business name: 1i,&�AA`sov._ Q1..........1„,,,, W heater - 16.60
Address: 1€40-1 (4ov+ -e ?k6-.C..4., Other: 1 City /State/ZIP: laN Subtotal
�`�\�� �� Minimum permit fee: $72.50
Phone: (Sal ) 7 n -(-40 Fax: (Sa3 ) gZq-1`EE,9 Residential backflow minimum permit fee: $36.25 /9yp�
CCB Lic.: (S t7 St/ Plumbing Lic. no.: 3 - 8 1 / 0 " 4 Plan review (25% of permit fee)
( � l • State surcharge (8% of permit fee) / j, y,
�
Authorized signature: °`I TOTAL PERMIT FEE .,216' . 'T
Print name: J° 94 ,0 a4-e. I Date: q - G-66 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 \Pamita\PLM- PamitApp.doc 11/30/05 4404616T(IdO2COM/WES)
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 5115.00
Footing drain - each additional 100' 46.40 2.001 to 3,600 5160.00
3,601 to 7,200 5220.00
Sewer - 1st 100' 55.00 7,201 and greater 5309.00
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 55,001.00 to $10,000.00 572.50 for the first 55,000.00 and $1.52 for each
Fixture or Item Qty. Fee (a) Total additional $100.00 or fraction thereof to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 510,001.00 to 525,000.00 S148.50 for the first 510,000.00 and 51.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof to
(minimum permit fee $3625) 27.55 and including 525,000.00.
Rain Drain, single family dwelling 65.25 525,001.00 to 550,000.00 5379.50 for the first 525,000.00 and 51.45 for
Inspection of existing plumbing or each additional 5100.00 or fraction thereof to
specially requested inspections - per hour 72.50 and including 550,000.00.
Subtotal: 550,001.00 and up 5742.00 for the first 550,000.00 and $1.20 for
each additional 5100.00 or fraction thereof
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Future Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher Commercial ❑ Any new residential building containing three (3) or more
- Domestic
Drinking Fountain 1 dwelling units.
D ye Wash ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Floor i sink Q / Submit 2 sets of plans with any of the above.
-3"
-4"
Car wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refiig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink -B avato e+
- Bradley
- Service
Swimming Pool Filter
Washer -
Water Extractors *Note: If the fixture work under this permit results in an
Water Closet - Toilet 3 increase of sewer EDUs, a sewer permit will be issued and
Urinal 1 fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
\ Building \Pennits\PLM- Penni*App.doc 07/06/05
Accumulative Sewer Tally Parcel # 2S113AB -0
Tenant Name: CE IMAGISTICS This SWR#,na CREDITS
Site Address: 16535 SW 72ND.. This PLM #;2006 -004
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 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 1 1 0 -1 -1
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 1 2 1 2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash D 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
.... Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial 3 0 1 3 0 -1 -3
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 4 1 2 -1 -2
Current Fixture Value -2 divided by 16 = -0.1 Current EDU 1 EDU = $ 2,700
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
-- - -- - -Chan a -2 divided by 16 = -0.1 over (under) $ (270.00)
Enter EDU Change Here -0.1
Note(SEWER CREDITS
Authorized Name /Signature: BARBARA BUTLER Date: ; 9/6/2006
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
is \Building \Sewer Tally\SewerTallySheet.xls 7/1/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM7006.00410
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/6/2006
Phone: (503) 639 -4171 ol J
Inspection Requests (24 Hrs.): (503) 639 -4175 e l I ..
INSPECTION WORKSHEET FOR DATE: 10/2/2005 TIME: 7:03AM PAGE: 9
SITE ADDRESS: 16535 SW 72ND AVE BLDG F CLASS OF WORK:
SUBDIVISION: PACT RUST BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: OCE
DESCRIPTION: Cap 1 drinking fountain, (1) sink. Add (1) drain, relocate, replace (9) fixtures. Other fix. is drinking
fountain.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 - 6246300
CONTRACTOR: ADDISON PLUMBING PHONE #: 503- 785`1B40
Inspection Request Scheduled For: Date: 10/212006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 037503 -01 503-956-6290 N
Corrections /Comments/ Instructions: AL I r, - _
. , /
S �� 1 _ , All
A
•1/ [II CANCEL ID NO ACCESS
PASS ❑PARTIAL APPROVAL
VI ' IL W.. ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V Date: /6 2 1 Phone #: (503) 718-
CITY OF TIGARD
• BUILDING DIVISION PERMIT #: PLM2006- 00410
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/6/2006
Phone: (503) 639 -4171 °
Inspection Requests (24 Hrs.): (503) 639 -4175 &- 1.L
INSPECTION WORKSHEET FOR DATE: 11/1/2006 TIME: 7:O3AM PAGE: 53
SITE ADDRESS: 16535 SW 72ND AVE BLDG F CLASS OF WORK:
SUBDIVISION: PACTRUST BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: OCE
DESCRIPTION: Cap 1 drinking fountain, (1) sink. Add (1) drain, relocate, replace (9) fixtures. Other fix. is drinking
fountain.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 624 - 6300
CONTRACTOR: ADDISON PLUMBING PHONE #: 503-785.1840
Inspection Request Scheduled For: Date: 11/1/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 039097 -01 503-956 -6290 Y
Corrections /Comments/ Instructions:
•
R � El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Pi/ ( Dat 1 // Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006-00410
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/&2006
Phone: (503) 639 -4171 / ? (
Inspection Requests (24 Hrs.): (503) 639 -4175 I �..
INSPECTION WORKSHEET FOR DATE: 9/8/2006 TIME: 7 :0OAM PAGE: 26
SITE ADDRESS: 16535 SW 72ND AVE BLDG F CLASS OF WORK:
SUBDIVISION: PACTRUST BUSINESS CENTER LOT #: TYPE OF USE:
PROJECT NAME: OCE
DESCRIPTION: Cap 1 drinking fountain, (1) sink. Add (1) drain, relocate, replace. (9) fixtures. Other fix. is drinking
fountain.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 -624 -6300
CONTRACTOR: ADDISON PLUMBING PHONE #: 503- 785..1840
Inspection Request Scheduled For: Date: 9/8/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 036251 -01 503 - 740 -8116 N
Corrections /Comments/ Instructions:
•
K PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: OD M." , �{\ _w Date: 0 1 VZ(° Phone #: (503) 718-