Permit CITY TIGARD PLUMBING PERMIT
.,r I DEVELOPMENT SERVICES 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT #: PLM2004 -00230
�.��I DATE ISSUED: 5/24/2004
SITE ADDRESS: 16650 SW 72ND AVE B -12 PARCEL: 2S113AD -01800
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
BLOCK: LOT: 011 JURISDICTION: TIG
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: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Re -rough and relocate EXISTING fixtures. Other fixture: primer.
FEES
Owner:
Description Date Amount
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 5/24/2004 $132.80
PORTLAND, OR 97224 [TAX] 8% State Surchari 5/24/2004 $10.63
Total $143.43
Phone:
Contractor:
DEAN WARREN PLUMBING & REMODEL
PO BOX 14701
PORTLAND, OR 97293 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Top -out Insp
Reg #: LIC 154919 Final Inspection
PLM 26 -736PB
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 By: 4 1 4 , , „ 4 4 ? . . /
Call (503) 639 -4175 by 7:00 P.M. for an inspection need d/he next business day
Building Fixtures
Plumbin Application N Permit A lication . .FOR O FFICE USE ONLY '' -'
Received of Plumbing, ,
2 DateBy': � q p r e Permit Ng k 2 �1 - i25'()
City f Tigard Planning Approval Sewer
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
- Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post Land Use
�r u �d� 11)1 ° '�I +I , Date/By: Case No.:
Internet: www.ci.tigard.or.us E. Contact J� El See Page 2 for
24 -hour Inspection Request: 503- 639,-4175 �� Name /Method: 7 �(P Supplemental Information.
itgk-r 1 _, _ ` a , ,', TYPE OF W®RIC ,, `, _ .,'. of i ` " F EE *' S,CHEDULE (for special nformation use ckiw ,;
111 New construction - ❑ Demolition Description Qty I Fee(ea) I total
t' � Additio n/alteration/replacement Addition/alteration/re lt ❑ Other: a , N ew 1 & 2 famty s �� ',
� � �� t �, • �� X100: ft;for;eachutilit , ��� �
x CATEGORYOF CONST�RUCTIONmE SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00
['Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
44V11; J®B SITE INKiliW ATION and LOCATION ' Fire sprinkler sq. ft Page
� a ` , y =, :3.. , . ,.` SttC, U.f ltttes"�; . � ...,� ' II �,. a ., `
Job site address: ���, S c: i f,1- -
Suite #: Bldg. /Apt. #: Catch basin /area drain 16.60
13AC�q -i,u 1 Drywell /leach line /trench drain 16.60
Project Name:
-1Nc- 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.) __ e 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel # Water service (no linear ft.) Page 2
..., tl „ , . .. , , �`. ,1,Sti tune' or Item `K.
; A ;'r , mA,, di T:=DESCiORTrtON OF WQRK ..,..::ViSi ' , . Absorpt valve 1 6.60
oil Re re it, 0, /<'�,v'lGe�.$ go(t?<Ai j Ft 7 'a Backflow preventer Page 2
�J Backwater valve 16.60
\ i �J ]Pt-1_,t1 Clothes washer 16.60
`v Dishwasher . 16.60
Drinking fountain 16.60
£R PROPERTI' OWNERS - ;., ". 1 El itt:NOtanatiRSA,A0 Ejectors /sump 16.60
Name: A ,) r Expansion tank 16.60
Address: l 53 rC! 5 c-- G
s'a Gd d / / cif iX , Fixture /sewer cap • 16.60
Floor drain/floor sink/hub / 16.60 / 6 .60
City /State /Zip: /J� G/11 9 r2,11 Garbage disposal 16.60
Phone: 6-03 6yu 630ef Fax Hose bib 16.60
4 13 APPLV`A N _ CONTACT PERSONS ' Ice maker 16.60
Name: /J0-61 (4,-eIer. , //J ,,,c.02e,n04/ Interceptor /grease trap 16.60
Address: P.O. 40g. 6y-)c4 Medical gas - value: $ Page 2
7 2-73
Primer b 16.60 f C,. 6
/✓� cl.
City /State /Zip: �a c Roof drain (commercial) 16.60
Phone: y 91-- 9- - Fax: 2, F 6- y 9' Sink/basin/lavatory 3" 16.60 i-/9. SO
E -mail: Tub /shower /shower.pan 16.60
i rt ". 3 ,, CONTRA CTOR;' '; < °.w..:;` Urinal 16.60
Business Name: f Water closet L 16.60 3`3 -?-
�-Q � � ��� Water heater • 16.60 1
Address: Other/
City /State /Zip: Other
N
Phone: Fax: AW r_ `, .. .., .. Plumbtng:Per lilaeefAa A.v a
Subtotal $ �� _
CCB Lic. #: /5 5f i Plumb. Lic. #: Le pis - Minimum Permit Fee $72.50 $
Authorized Residential Backflow Minimum Fee $36.25
Signature: ab . � Date: S rI`CAf Plan Review (25% of Permit Fee) $ _
r T kad4 State Surcharge (8% of Permit Fee) $ a:` : &5
(Please print name) TOTAL PERMIT FEE $ 4 3,44 i
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isofnetric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri -County Building Industry Service Board.
i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03
Plumbing Permit Application - City of Tigard
Page 2 ,Supplemental Information -' -
k
• Fee Schedule: Residential Fire Suppression Systems:
•
a. s Slte UtIlltleS ,. : ��3 Qty N FeeF(ea) 0 Total . . ot4ge •t K° _ 1 /
i k. S uare, Footage t . � gPerr mlt .,,.
Footing drain - l 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' 7 atr • 55.00 7,201 and greater $309.00
Sewer - each additional 100' ''" " 46.40
Water Service - 1st 100' c ,' 55.00 Medical Gas Systems: •
Water Service - each additional 100' 46.40 #
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
,„ additional $100.00 or fraction thereof, to and
,,� ; 14 a 10 10.0:6 ° „_" MCI : , Fe mm e (ea) Total including $10,000.00.
Commercial Back Flow Prevention Device 46.40 510,001.00•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
each additional $100.00 or fraction thereof_, to
Inspection of existing plumbing or and including $50,000.00. •
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the'fifst $50,000,00 and $1.20 for
- Subtotal: - each additional $100!00 or fraction thereof.
r:
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 *.
•
t Qtit'(Frxture) Work rm
Perfoed Comments regarding fixture work: •
,i Fixtu Typ ' " uany by
V ` r Rteplace ,' - , .' •
IF '' ..e... a l yew , k Movedt , C
,uapped WI
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"
3 -
4 „
Car Wash Drain *Note: If the fixture work under this.per results in an
Garbage - Domestic
Disposal - Commercial increase of sewer EDUs, a sewer. permit will be issued and
- - Industrial ' fees assessed for the sewer increase must be paid before the
• Ice Mach. /Refrig. Drains _ pl umbing permit can be issued.
Y
Oil Separator (Gas Station) •
Rec. Vehicle Dump Station 7 . , '
Shower -Gang . • .:,'�
-Stall _
• Sink o - Bar /Lavatory ' •
- Bradley ' ' '
, - Commercial
- Service
Swimming Pool Filter '. -
Washer - Clothes .
Water Extractor'' . -
Water Closet - Toilet ; ,
Urinal . - . -
Other Fixtures:
•
. is \Dsts\Permit Forms lmPermitAppPg2.doc 01/03 '`
CITY OF TIGARD 24 -Hour
BUILDING I nspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received Date Requested 7 -- / ' AM PM BUP
Location - . _41112 Suite 46 - 1 � MEC
Contact Person • Ph ( ) 786 _1 /R PLM 2O 20230
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam C3 i Q ./-c p.�-ec__ J
Shear Anchors e / - O v
Ext Sheath/Shear ti
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof / /-
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:
" -
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
Approach/Sidewalk Date 7//5/� t t Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL