Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00451
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/19!2008
PARCEL: 2S112DA-01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 190 ZONING: I -
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: 002 JURISDICTION: TIG
PROJECT: DIANA HARRISON CPA
Project Description: TI
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 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
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [PLUMB] Permit Fee 12/19/200€ $72.50
[TAX] 12% State Surch 121191200€ $8.70
Phone : Total $81.20
Contractor:
DEAN WARREN PLUMBING & REMODEL
PO BOX 14701
PORTLAND, , O R 97293 REQUIRED ITEMS AND REPORTS
OR
Contact # : PRI 503- 236 -4152
FAX 503- 296 -2218
Reg #: LIC 154919
PLM 26 -736PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: IA n ( i 1 J j C A,D Permittee Signature: 47i
Call 503.639.4175 by 7:00 a.m. for an inspection tha siness day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applicati RECEIVED "
Building Fixtures FOR OFFICE USE ONLY
City of Tigard DEC 1 9 2008 Received P ermit No.: 4 1 /n '/
13125 SW Hall Blvd., Tigard, OR 9722 Date/By: /R / 9 O$ (Oab U aelo�'�d `T 57
e Phone: 503.639.4171 Fax: 503. �F TIGARD Plan Review
�/� �, �,y / /
DateBy: Other Permit No.:c5a) 0 C.16 -id /� �`'
T 1 G n R D Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: Ju See Page 2 for
Internet: www.tigard - or.gov Notified/Method: �j Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For spedal information use checklist
Description I Qty. I Ea. I Total
w Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ 1- and 2- family dwelling Ir 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: / S3 5 S r1., 5c U o , ro r<.,1 Y Catch basin or area drain 16.60
City/State/ZIP: pG fi e- 0 n • 5 , 2 2 c/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Hast.,� Footing drain (no. linear ft.: ) Page 2
S 0 ,4../
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
09 d 4 /area S poem Cr0 4 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Ac. trc Sr Expansion tank 16.60
Address: / s co S t..- S `0 9 U c r of P...1 L'( Fixture /sewer cap 16.60
City /State/ZIP: Ao ri., 0 2 • 9 '7 Zy9 Floor drain/floor sink/hub 16.60
( )
Phone: ( ) Fax: Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
/ Ice maker 16.60
Business name: 0e a W U/e1TY'e, y ,, 0i,� 4, 'al 4- 4e4416,4 / Interceptor /grease trap 16.60
Contact name: t e 2 J a7 Medical gas (value: $ ) Page 2
Address: /". O, Adp■ /Y7c/ Primer 16.60
City/State /ZIP: Aryi-/j,,.cf Gj2 9 72- $ 3 Roof drain (commercial) 16.60
Phone: (5 7 $ p - 9y a 6 Fax: : (503 ) 2 C- 221 Sink/basin/lavatory / 16.60 I& •6
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: 5 . 3 147 Water heater / 16.60 I t . ( 9()
Address: Other:
City /State /ZIP: Subtotal
Minimum permit fee: $72.50 SD
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 ' "
CCB Lic.: /6-7../ 9 f7 Plumbing Lic. no.: _2, C - 6 l°8 Plan review (25% of permit fee) --(9--- Authorized signature / ( State surcharge (12% of permit fee) e. 70
/ TOTAL PERMIT FEE g . `f o
Print name: / Date: / 2 , / 9- oo 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.
1: \ Building \PermitsWLMF- PermitApp.doc 12/27/06 4404616T(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 - 1 st 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 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Commercial Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial •
- Domestic
Drinking Fountain Isometric or Riser Diagram •
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
Car Wash Drain
Garbage -Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) •
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley *Note: If the fixture work under this permit results in an
- Commercial increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
•
i:\ Building \Permits\PLM•PermitApp.doc 12/27/06
-,- --.,,-4 .
BUILDING DIVISION
CITY OF TIGARD If" PERMIT #: PLP142008-00461
13125 SW Hall Blvd., Tigard, OR 97223 Alko ISSUED: 12m2008
4 k V I
Phone: (503) 639-4171 it,Apvitilli
Inspection Requests (24 Hrs.): (503) 639-4175 .4.9■ A n. q 5u
INSPECTION WORKSHEET FOR DATE: 1/21/2009 TIME: 7 PAGE: r
J
SITE ADDRESS: i 560 SW SEQUOIA PKWY 190 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: 002 TYPE OF USE:
PROJECT NAME: DIANA HARRISON CPA
DESCRIPTION: TI
OWNER: PACIFIC.REALTY ASSOCIATES, PHONE #:
CONTRACTOR: DEAN WARREN PLUMBING & REMODEL PHONE #: 603-236-4162
. . x
Inspection Request Scheduled For: Date: 1/21/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Mes
• ■ I . )
399 numbing final 079893-01 503-780-9486 V ..
/ 1_
ts/
Corrections/Com nInstructions: 0 7
ra 6 / K3 it
„/-0..."2(i L.-v.. .5":„...v.- tc ...... , • u 1 O .M.
V )el
AHDAss- n PARTIAL APPROVAL n CANCEL El NO ACCESS
I I FAIL El CALL FOR INSPECTION I l ADDITIONAL FEES ASSESSED
€.•;. ______
2,cf ?c-
Inspector: Date: V Phone #: (503) 718-
CITY OF TIGARD - -
BUILDING DIVISION
Ak P #: I Lh�1200&.0l f;1
13125 SW Hall Blvd., Tigard, OR 97223 DA • .UED: 1 19/ 008
Phone: (503) 639 -4171 'll�vi � i O
Inspection Requests (24 Hrs.): (503) 639 -4175 `'. / -----
INSPECTION WORKSHEET FOR DATE: •12/29/7008 TIME: 7.00 PAGE: 4
SITE ADDRESS: 16350 SW SEQUOIA PKWY 190 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: 002 TYPE OF USE:
PROJECT NAME: DIANA HARRISON CPA
DESCRIPTION: TI
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: DEAN WARREN PLUMBING & REMODEL PHONE #: 503 -236 -4152
Inspection Request Scheduled For: Date: 12/29/2008 �� Pour Time: PO
Code # Inspection Description Confirm # Contact # Mes-
p P
:aate,
321
Plumbing rough - 079733-01 603-780-9486 Q U
- cos - c1 ' - .
Corrections/Comments/Instructions:
D
W4.4e—re— -- et<
•
&PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: �� Date: 1 ?-/ 2JG Phone #: (503) 718 -