Permit go-49 71- 6-4e6441:4—ei-p--E,-LZ •CZ-.-47
C LUMBING PERMIT
CITY OF TIGARD
I7 . : COMMUNITY DEVELOPMENT Permit #: PLM2009 -00119
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/13/2009
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15495 SW SEQUOIA PKWY 150
Subdivision: Lot: 0
Project: Acceleration Chiropractor
Project Description: TI - Adding (2) fixtures.
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY 1 ea Clothes Washer 05/13/2009 $16.60
#300 1 ea Sink 05/13/2009 $16.60
PHONE: 1 12% State Surcharge - 05/13/2009 $8.70
Plumbing
Contractor: 39 ea Minimum Fee Adjustment 05/13/2009 $39.30
CASCADE PLUMBING CO, 2630 N HAYDEN - Plumbing
ISLAND DR #3
PORTLAND, OR 97217 •
PHONE: 503 - 289 -7095
FAX: 503 - 283 -9514
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
•
Total $81.20
Required Items and Reports (Conditions)
•
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 through OAR 952- 001 -0100. You may obtain a copy of the rules
Issued By: Permittee Signature:
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.
•
•
CITY OF TIGARD PLUMBING PERMIT
?PI
8 COMMUNITY DEVELOPMENT Permit #: PLM2009 -00119
T I GAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/13/2009
Parcel: 2S112DD01600
Jurisdiction: Tigard
Site address: 15495 SW SEQUOIA PKWY 150
Subdivision: Lot: 0
Project: Acceleration Chiropractor
Project Description: TI - Relocating (2) fixtures. No change in EDU's
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
ATTN: N PIVEN, 15350 SW SEQUOIA PKWY 1 ea Clothes Washer 05/13/2009 $16.60
#300 1 ea Sink 05/13/2009 $16.60
• PHONE: 1 12% State Surcharge - 05/13/2009 $8.70
Plumbing
Contractor: 39 ea Minimum Fee Adjustment 05/13/2009 $39.30
CASCADE PLUMBING CO, 2630 N HAYDEN - Plumbing
ISLAND DR #3
PORTLAND, OR 97217
PHONE: 503 - 289 -7095
FAX: 503 - 283 -9514
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N ' cation Ce - . Those ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
Is ued By: ( / • Permittee Signatu 6 21_,...2 42 /2 / lc9
ate,. /LLW�
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept In a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Mbu . 11 2009 4:27PM HP LASERJET FAX p.1
RECEIVED
Plumbing Permit Application MAY 1 � r 1 r 20009 /� 1ill? ( )I I.1( .. , +)'\I•) of Tigard OF 1 IGARD Delve . II D-( A Permit Na.: 1 1.11 4a 0 7 - 00 I I ,
aty 13123 SW Han Blvd„ Tigard, OR - 4. p1� (ipvrew
._-
. 1312$ Phone: 503 639.4171 Pax: 503.5' • .ii 1 ING DIVISION n ,,,B Other Parmir Nc aQ 9009 /` --
r r t; .III inspection Line: 303.639.4175 Date Ready/Sy hula
Internet www.tigard-or.gov ; NotitledtMettrod +t: i ,..,,�a'tN 7 :r. .s: crs� :;" ea _ •
y :' N v =e:nlaTf�E , qi. k`ti t - iF..i, r. 1�` (i Ari ,.] ' , _ �..' �'; r:: eJ tl '° ; .''�;
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I ,,yy,t 1 11I I' 1' . =''I. �:.{...: 7i ,::i ha- ry a -h,.! . + .', u ,i�a:. 1 f' N. :,m us. 11n1�,..�i:r_•ar.
� {,� ?����b��r;:J�1F....ry e ��3{ t. 4�: d�a� ¢.�tyG�.Ef1t`..e�tir�ir•i.., a. § ... f ,.1: .. f _ :,a,,,n rr. u•..
❑ New constitution 0 Demolition For speciallpJbrmaalon au checklist.
Description I Qty -1 Pa. 1 Total
'':4 • ddidon/alteratiou*eplacemcnt ❑ Other: New 1.3- family dwellings (includes 100 ft, for each utility connection)
t r t w a n_c 4J Y ; Q .. ftt7 t , r i fi l9M ' a Cti'/7 ' 1 , r ,!4o r; :r. SFR (l) bath 249.20
_
ip,F � � 1 A' ,p It'ol I B r u . 'Inc � -,/,,‘. "\%
" C�' �P��l�i^5b�`?51.'D,�tL14`•�1� ±,. ti ,�y� ...rc�;,firrct'�,S � i,.{ nJts�r'tai•.?�e4.��:r53N�1.•.,, . +, -1 + y r : � ` - ` .
❑ I- and 2•thm(ly dwelling 1:_,[e •mmerc /industrial SFR (2) bath NM 350.00
❑ Accessory building ❑ Multi-family Stet (3) bath 11.1. 399.00 r Each additional bath/kitchen ■ 45.00
❑ Master builder ❑ Other _ sq. ft.) Pagc 2
„. li'F °irk A ar: 1 ,i fd frr, r{ F
t l' � ti
: W''.?d. o MY a��.1 et.: ,, „aa,st ?`j 'kl �• Fire sprinkler (
Ski i / �7 / , I k Iii' i t , , JICII 1, U r) i n c i 13 u, 1, x
s'1i6��a.k' .',',ntl�l_rst xrr un;1., o-ul.��:1.�t, u._.9.1M*sai. k.ao-n:r,�l9r�iSmnkl{ 1r�ur:.�• s a ; . B •, t'� site utilities
Job site address: S 'r a? A fi r- . la Catch basin or area drain MEI 16.60
City/State/ZIP: - et e, 0 Drywall, leach line, or trench drain 16.60
7 Fooling drain (not linear ft.: _ Pttgle 2
Suite/bldg./apt. no.: , ► Project name: Manufactured home utilities 110.00
Cross street/direetlons to job side: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear R.: _J Page 2
Storm sewer (no. linear ft.: _J Pagc 2
-
Subdivision: I Lot no.: Water service (no. linear R: __) page 2
- Picture or Item
Tax map/parcel no.: Absorption valve 16.60
r�iJ"'' :,, v .° J j A h r t' ;rc \ t.�4 1 ^ tl ul .FJ II rt'k! 1 lap ac's - 'r ape y 4 v,: •F-
k .-,P , ; "� w I . , I r r p i� e k r ,. 5 .&" ' (t '� Back revenue
• �iL`w k (+.,ai ' Yt r. • ur,..., s mu:lt tyl 9 I4Y I:1 M1J uE' p
'4" DV / .. • .r Backwater valve 16.60
1111 r/ Ja ` !mil! IMO = Clothes washer . 16.60 IP I
� • - - Dishwasher III 16.60
a rr ? .."...if Drinking fountain 16.60
hl V i l Lr t� j cw�r' j y,. iY i��? kt 10 ..- Fr','cs''a.iFI Ej eetoresump 16.60
aE.i;... a11.dk:.krnt �n c I ��i n K MJ
tlec ,i
Name: Expansion tank 16'60
Address: Fixlure/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
( ) Phone: ( ) Fax: Oerbagc disposal 16.60
16 60
,� t y r ���� ; t _ti �,:ko,,{ :rriwA�l is n'tr< ; , -a fiL "Mr •,.f, • Hose bib
� r(�elit .. \:J 7 ��1{ •i' n31 I :41.12 H9�3 y' 't
In`�S7 uL�£ 1e, ���.- ''riiV'tiWinY• �r118«•� ice maker 16.60
Business name: ,ii.. � Interceptor /grease trap 110 16,60
Contact name: 1 • :• Medical gas (value: $ ) Ern
f jab tO { Prima 16.60 -
City/State/ZIP: / • Roof drain (commercial) _ 16.60
� �../ � ` 3inlsink/basin/lavatory .ap
I 16.60 I .p
Phone: (�fp ) Y r �Ql� //�-7 Fax: �J3 ) O '‘ � Tub/showeNahowerpan ' _ 16.60
&mail; Urinal 16.60
'� �• Ji �u "J ✓5 ufi; f7:t )CMG "ru��t. ��,''b'c� \�' Pi,.t
l�;y4 •�di"':i ���a•�1MrrI 1ft', rr �yf 1u1, ��o� '•$: :,i. �I�,,`;�w . c�. '
.r,..; Water closet 16.60
�Iti. raf3.�CF�NV,',�i{ t ���!,.` 1. h.. l.` :S`:.du��'3.v:.�'itii�ati9,xRla' �r e .., M :i'�1:J� '' ., �4�,:
Business name: / .' f ^� ;0� Water heater 16.60
1 Other:
Address: •,-, _ , ` . _ y Subtotal 4�
City/State/ZIP: � _ _ "`7 . Min imum permit Hoc $72.50
�� Phone: ( ) ) r , Fax: ( a,) E . I Residential beckflow minimum permit fee: $36.25 7� •SD
• a r Plumbing Lie. no.: q •4 { Plan review (25% of permit fee)
\�j � l State surcharge (12% of permit fee) � ; .7 0
C IA' Authorized signature: J ��1L "�'t/a1•NW / I I (I _ TOTAL PERMIT FEE g... d
Friel name: t l ne.S Date: , • i I - This permit application expires If a permit is not obtained within
r p_kntA...4-- 10days a dustry e
•pee m ethoddology set ct 6y Triunry B BulldI ilding g Industry Servnv ice Sosrd,
I: tt�aildlnslpamdtctPt .MJennlcApp 06r2N 440.46t6T110/02l0OMIWBB)
:.M4 2009 4:27PM HP LASERJET FAX p.2
lam inn Permit Apnhication - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su • • ression S stems ]��y 2 p� �J*{`y
j+1 Y:vi j ,�P• '11%•, , ,� .� ♦ 4t .'• 'i i i ffii e.t{!Lpi' JI'
� � . I � i � 9e 7�Yt(� F7 1:n'� "' -? ���IJA4 �� 1 i x�[�i�33���'�1 .... . � _, .• &�..� : i
... ',.. . �
Foottns drain - 1 100' 55.00 0 to 2 000 51 19.00
2 001 to 3 600 $ i 60.00
Footing drain • cash additional 100' 46.40 3 0 601107 00 'J
War- lot 100' 111.11 55.00 111111.1 1 201 and : eater •309.00
Sewer - each additional 100' r 46.40
Water Service • 1it 100' 111.1 51.00 IMIll Medical Gas Sptems:
aver Service • each additional 100' 46.40 " -. ern }'l . } f r � ei:
'
PI .' � r • F ' .SS1.r) t� t 7 i r , . . ' i' ti . °,P i. r' � ,... -',.
Storm & R e, , n • let 100' 55 $1.00 to $5,000.00 ~ Minimum foe 72,50
Storm Rain Dann each additions! 100' 46.40 $5,001.00 to $10,000.00 572,50 for the uat 55,000.00 and $ 1.52 for each
•.r • 'e,,,, '''e i ry �q M F „'1 additional $100.00 or fraction thereof, to and
I' .• :' .,, ; , :,' 1+` 3iJ4.?.4i G:..c.': r':'i: Jf. ; . y.1. -L' aVe,. including $10,000.00
Comm - a1 Rack low vendor Device r 46.40 110,001.00 to 525,000.00 $143.50 for the first $10,000,00 and 51.54 for
Residential deck low prevention Device each additional $100.00 or fronton thereof, to
27.95 and including $25000.00.
iniDr ' ` ' $25,001.00 to 150,000.00 5379.50 for the first $25,000.00 and $1.45 for
Rain Dnti a, singll e family dwelling 65.25 each additional 5100.00 or fraction thereof, to
on ofex ring plumbing or and Including 550,000.00.
• . Wall • tasted . • .aliens - . er hour 72.50 S50,001.00 and up $742.00 for the first $50,000.00 end $1.20 for
IIIIII each addillotmlll00.00 or fraction thereof. ,
r
Fixtu Work: n .+ - 1 , 1♦rn,� YR ,r, ray 'W j W( T V
.'x'Y� nora�i ..: r ..4 fy .�:.`,, •e.- i.I .. ') : , ,, , \. '.
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.
❑ Any new commercial building with water service 2^ and
• accurate re • , rt fixtures could result in increased sewer fees*. greater, except systems designed and stamped by licensed
S . !!: , "11 lb J';l F.. �'' . , 'ij ! T∎ 71'.fl • engineer.
1 ; �� + tl f ` f } �� "1 J Y ❑ Any new exterior plumbing site utilities.
❑ Medical gas and vacuum systems for health care facilities.
MEM rSilliiiiiii= ❑ Any multipurpose fire sprinkler system.
MIMIN IIMIMI ❑ My complex structure as defined in OAR918 - 780 4040.
Car Wash "Seen Stall ,
•Drive 1111=1 - 111111•11 Submit &seta of plans with any of the above,
C ;•idortWater ..• IIMEN11111111111=11111=11111111•111111 rj.9'i' �° F l r7 !} 7 :'t.1 y 1M V U
Dishwasher - Cumnerolal ���� �oc � ; ti ..',,. I, 1' , a, y;
- Demotic MUM o
���� • • Isometric or riser diagram is required for new buildings
a err Wand „ that meet the • ualificatiens above.
E a
Floor Drai sink - " NMI. 1.111=1111111.11
•3- iNIMIN Comments regarding fixture work:
Coo esed e -• Beale r -Commercial 1101M11 Garbage -Domestic'
��
-indoor's' ���
- m MaohlRefli: Drabs - --
Oil •_7• - Gas Station - --- Rec. Ve• ale D • Station � 1 IIIMIliMMI
Shower -Gang MINIIIIIIIIIIM *Note: If the fixture work under this permit results in an
-
- Stall 1111 • increase of sewer EDUs, a sewer permit will be Issued and
Sink •Bar/taratory ._ ��'"� fees assessed for the sewer increase must be paid belbre the
'Bradley INIONINIIMMIll plumbing permit can be Issued.
-Commend iMMIN .Seem co IMMil =MI
Swhrrmin: Pool Filter .
Washer - CI•thee IMMIIIIIMIN11-1=11I
Water extractor 1111111M/1111/11.1 OWE=
Water Closu• ���
Other Fixtures:
•._ ..- ....�..e. •._. nweenw
CITY OF TIGARD
BUILDING DIVISION PERMIT #: '? S ;level evel vvJJ y
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 / v at 1111 lk. i
Inspection Requests (24 Hrs.): (503) 639 -4175 .
INSPECTION WORKSHEET FOR DATE: 6/) €1/01 TIME: PAGE:
SITE ADDRESS: J Sq.) N vsA "Pkwy 150 CLASS OF WORK: Ai-
SUBDIVISION: LOT #: TYPE OF USE: Com
PROJECT NAME: AC - x) c i.4 SP-C; pA Ac
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 6A1/09 Pour Time:
Code # Inspection Description Confirm # Contact # Message N/,
3 Vi PLC M 6.rti4 Fla - J4L --c S Ssif °r..1 1 -1
Corrections /Comments/ Instructions:
/ii
a )44)444t A
[SASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: , 6 i 0 7 Phone #: (503) 718-