Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: %0
13125 SW Hall Blvd., TigardOR 97223 503 - 639 -4171 DATE ISSUED: 6/7/20
PARCEL: 2 S 113AD -01800
SITE ADDRESS: 16798 SW 72ND AVE B14 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT: 011 JURISDICTION: TIG
Project Description: Capping fixture.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: 2 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 5
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 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 6/7/2005 $72.50
[TAX] 8% State Surchari 6/7/2005 $5.80
Phone : 503 624 - 6300 Total $78.30
Contractor:
ADDISON PLUMBING
17506 SE RIVER RD. REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97267
Phone : 503- 785 -1840
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 503-24 :99 o 1-800 -332- 4.
Issued By rI / Q� E Permittee Signatur
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.
Bat' Ming Fixtures . • 8 , O -Q/ d0
Plumbing Perm • l 1 w lE D FOR OFFICE USE ONLY
City of Tigard r Date/ay. Received (� � /O5 Permit No?I j11 Z
i s
13125 SW Hall Blvd., Tigard, OR 9722 . `,I / 2005 Plan Revie /
Phone: 503.639.4171 Fax: 503.598.1960 / / 4 1x4;)41 1 I 'i � Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.CLfr OF TIG 4RD c 11 Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us BUILDING DIVISIO' Notified/Method: Supplemental Information
TYPE OF WORK :. FEE* . SCHEDULE .. -
❑ New construction a Demolition For special information use checklist
Description I 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 ® 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 ct, S‘,..) 1 Z. A Catch basin or area drain 16.60
City/State/ZIP: QC�\ \ate cm, Drywell, leach line, or trench drain 16.60
Suit; . r : apt. no.: I y- [ Project name: Goc* -S0`.. Footing drain (no. linear ft.: ) Page 2
CO • 'lan L 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: l 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
O e.w...o :. 1 1,4.0.,-).... 5:,..ti- 1 \ -1 eoe....po-rltw..,.._ 5:,...K , I - *....0 t S .„ r Backwater valve 16.60
1 - Fl aia! S: >\< , 1 - ftjo, 'b.02,..., Clothes washer 16.60
Dishwasher 16.60
Of PROPERTY OWNER . ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: is,,_Tw_sk Q' R �r !y Expansion tank 16.60
Address: tS 3 5 o w S e■, -a :0- Q -...r 4 ' -3c Fixture /sewer cap 16.60
City/State/ZIP: eo•c. \ci,..A. OK,.. _'Floordrar- or +� sin hub �f /1 16.60
Phone: (So 3 ) 62.....k- 63,..---:, Fax: (Scs'? ) 0, 2.4 - 7 7S 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: : ( ) • in/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
' CONTRACTOR • . Water closet 16.60
Business name: 4 QV.�..- c......‹) (-L c- Water heater 16.60
Address: 1 •i0'1 �o u.. S e \o. - c,� Other:
City/State/ZIP: \,.\` (... celo3 c6 Subtotal
Minimum permit fee: $72.50
Phone: ( so 3 ) -785- - t g et Fax: ( ) gist - 470 l Residential backflow minimum permit fee: $36.25 ?„„q..,
CCB Lic.: /3 Plumbing Lic. no.: g 7 f g Plan review (25% of permit fee)
State surcharge (8% of permit fee) ! b 0
Authorized signature: ■r-r4y_. TOTAL PERMIT FEE 75 6
Print name: .S tl`A oov a Date: 6 - 7 - o\ 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 \Permits\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 Qt . 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
Storm &Rain Drain - 1st 100' 55.00 Valuat • . - , Permit Fee:
$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 * .
Quantity* (Fixture) Work Performed
Fixture Type: Replace
New Moved Mating 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 0
-3 „
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
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
SC',.Qrtmerc;al s y 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: tv..o Sink 1
i: \ Building \Penniu\PLM- PertnitApp.doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00249
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/7/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 • ,„_t4- :_..
INSPECTION WORKSHEET FOR DATE: 6/8 /2005 TIME: 7:12AM PAGE: 76
SITE ADDRESS: 16798 SW 72ND AVE B14 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK! LOT #: 011 TYPE OF USE:
PROJECT NAME: COOKSON
DESCRIPTION: Capping fixture.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503. 6246300
CONTRACTOR: ADDISON PLUMBING PHONE #: 503- 785 -1840
Inspection Request Scheduled For: Date: 6/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 008685 -01 503 -740 -: • : Y
Corrections /Comments /Instructions:
30,
spy-- r
•
r.1 -ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Q Phone #: (503) 718-