Permit CITY OF TIGARD
PLUMBING PERMIT
?iT + DEVELOPMENT SERVICES PERMIT #: PLM2005 -00283
61 DATE ISSUED: 6/24/2005
1 3125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112DC -01400
SITE ADDRESS: 15865 SW 74TH AVE 105 ZONING: I -P
SUBDIVISION: CREEKVIEW INDUSTRIAL PARK LOT: 004 JURISDICTION: TIG
Project Description: Building fixtures: Relocated or capped.
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES
PACIFIC AMERICAN PROPERTY EXCHAN Description Date Amount
PACIFIC SANTA FE CORP
17700 SW UPPER BOONES FERRY RD [PLUMB] Permit Fee 6/24/2005 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surcharl 6/24/2005 $5.80
Phone : Total $78.30
Contractor:
GRIDLINE PLUMBING + HEATING
4343 SE 37TH AVE , REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97202
Phone : 771 - 8790
Reg #: LIC 00074105
PLM 26 -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 qu -stio Is to OUNC by
calling 503-2,-9699 or 1- 800 - 332 -2344.
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.
Plumbing Permit Application
Date received:0/(7 D 9 1 Permit no (Jyl j05-0,o ,' 3
0 i v , City of Tigard 6 E i? _�
e • .j r ! Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd; Tigard, OR" 97223
City of Tigard Phone: (503) 639 -4171 p ,, , Project/appl.no.: Expire date:
Fax: (503) 598 -1960 ,,' e" iv, • Date issued: By (g6 Receiptno.:
Land use approval: ,: r fi r- TIPAc Case file no.: �� Paymenntttype: .
Ta7
rnn n3' :.fA now :C' ,- 111
T YPE OF PERMIT
• ❑ 1 & 2 family dwelling or accessory ) J Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction Ca Addition /alteration/replacement ❑ Food service ❑ Other:
t b , ° JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) , .j
Job address:
15865 SW 7 4t Description Qty. Fee (ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: IBlock: Subdivision: SFR (2) bath
Project name: Cocm ax -_ SFR (3) bath
_City /county: wa - ZIP: E additional bath/kitchen
Description and location of work on premises: EX /14.5,00, Cr /, y Site utilities:
En' ST Slab DF 1 10 Sfit'J 7% I ' Catch basin/area drain
Est. date of completion/inspection: Drywells /leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
1 Manufactured home utilities
Business name: Gridline P11imhi nggr htsgDnnc.an._- &t__._.t Manholes
Address: 4343 Se 37th a v Duncan Ind Rain drain connector
City: Portland I State: o p ZIP: 9 7 n2 Sanitary sewer (no. lin. ft.)
Phones 03-771-87 0-x: 771 ] mail: Storm sewer (no. lin. ft.) -
CCB no.: 7 41 0 5 sly, /U Plumb. bus. reg. no: 26,_1 4 9 p Water service (no. lin. ft.)
City /metro lic. no.: 17'25
f, ,/� - / - Fixture or item:
Contractor's representative signatu�ti`�l%.-i Absorption valve
Back flow preventer
Print name: John Duncah/' Date: _ . • a - 1 ^ Backwater valve
- CONTACT PERSON Basins /lavatory
Name: John Duncan Clothes washer
Dishwasher
Address:
same Drinking fountain(s)
City: I State: I ZIP: Ejectors /sump
Phoned 71 _8790 Fax. 1; E -mail: Expansion tank
OWNER -• • Fixture /sewer cap
Name (print): Floor drains /floor sinks/hub
Mailing address: Garbage disposal
• b Hose bibb
City: I State: I ZIP: Ice maker
Phone: I Fax: I E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roo drain (commercial
employee on the property I own as per ORS Chapter 447. (s basin(s) ays(s) 7
Owner's signature: Date: P
ENGINEER Tubs /shower /shower pan
Urinal
Name: Water closet 1
Address: Water heater
City: State: ZIP: Other:
Phone: Fax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ 7).,
❑ Visa 0 MasterCard expires if a permit is not obtained Plan review (at %) $
Credit card number: f / within 180 days after it has been State surcharge (8 %) .... $ 4 5 .- --f G
Expires TOTAL $ '7 S • ?)0
Name of cardholder as shown on credit card accepted as complete. $
Cardholder signature Amount 440 -4616. (6/00 /COM)
PLUMBING PERMIT FEES: ,
•
PRICE TOTAL . --New 1 and 2 family dwellings only
FIXTURES (individual) ; CITY y° _(ea) AMOUNT ° (Include all plumbing in PRIC TOTAL 3
Sink 1 16.60 "the dwelling and the ;,first100 ft ,, - QTY (ea) ;AMOUNT
Lavatory 16.60 .for.:each utility.connection) , -
ry _II One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 1 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE .
Dishwasher 1 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain /Floor Sink 2° 16.60
3" 166.660 0 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 , Cuantity b Work =P '
Gas piping requires a separate mechanical Flxture `° New o
Mved , Replaced •.Removed/
- - p -- - -- - -- -- - .. r. .M -_._ _.., _. _, :Capped....- -
MFG Home New Water Service 46.40 Sink 1
MFG Home New San/Storm Sewer 46.40 Lavatory 1
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet 1
• Urinal
16.60 Other Fixtures (Specify) 16. Dishwasher
_ 1
Garbage Disposal
_ Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3 .,
•
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40 .
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections _ per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60 _ _ _ ._
QUANTITY TOTAL
Isometric or riser diagram is required if z ;
Quantity Total is > 9 _ *SUBTOTAL ,�. _ .
8% STATE SURCHARGE '77
**PLAN REVIEW 25% OF SUBTOTAL .
Required only if fixture qty. total is > 9 M
TOTAL _ $
* Minimum permit fee is. $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
* * All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms \plm- fees.doc 10/10/00
Accumulative Sewer Parcel # tPLM2005,00283,r , '_�.�'! `a
t ' : �1 Tally * g This SWR # CREDIT k ' 1
Tenant N ame�C;ognex�:��� .,.�, - {,...,�. �, , .�:•zw .. ��.� � t WaSi, k..
Site q 15865;SW 74th Ste ,105 ,,, This PLM# 2005 , li ,>.,k, �,' *'
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 f
Bath - Tub /Shower 4 , ,, , 0 .mow w 0 •'IY 5.. 0 0 0
- Jacuzzi /Whirlpool 4 Tfri, 0 0 `,r , v< 0 0 0
Car Wash - Each Stall 6 . `�� .�., : 0 0 ,, ,, ,, s 0 0 0
- Drivethrou h 16 ! 0 0 0 0 0 •
Cuspidor/Water Aspirator 1 , ' 0 0 0 0 0
r
Dishwasher - Commercial 4 0 0r 0 0 0
- Domestic 2 m 0 0 A, a 0 0 0
Drinking Fountain 1 ,' 0 0 0 0 0
Eye Wash 1 i z�.w 0 %
P ..t. 0 0 0 0
Floor Drain /Sink - 2 inch 2`al` 0 I -,r. 0 ; 0 0 0
3 inch 5 0 i.,,, ` .:, 0 . 0 0 0
- 4 inch 6 1 . 0 0 i. °s 0 0 0
- Car Wash Drr 6�� 0 , 0 4204 0 0 0
Garbage Disposal
Domestic (to 3/4 HP) 16 a r >, 0 0 0 0 0
• - Commercial (to 5 HP) 32 : y 0 0 �f 4 0 0 0
- Industrial (over 5 HP) 42 Olgi 0 A F x 0
, 0 0 0
Ice Machine /Refrigerator Drain 1 ;ta 0 01.5.iVi 0 M.,: 0 0 0
Oil Sep (Gas Station) 6 � x .,kV 0 aiN 0 0 0 0
Rec. Vehicle Dump station 16 '�S,; 0 x,, 0 ,,,,,,„. 0 0 0
F 0 . ' 0 raa 0 0 0
Shower -Gang (per head) 1 *Z IA �;
0 0
h
Stall 2 0 � Ty 0 , 3.. .
Sink - Bar /Lavatory 2 • vo ' 0 0 0
.�A r r 1 2 1 2
- Bradley 5 ; �' 0 FedS, 0 r , J 0 0 0
- Commercial 3 MIMI 0 A ,s 0 4 0 0 0
Service 3 rt : 0 `, 0 �' n t , '„ 0 0 0
Swimming Pool Filter 1 9 °``�''' 0 0 MM 0 0 0
Washer Clothes 6 ;,. O F 0 _'��% 0 0 0
Water Extractor 6 ;M� g 0 t
0 .A' , .. 0 0 0
Water Closet - Toilet 6 ' ti 0 ,. '1 6 5
�' , ,, � 0 -1 -6
Urinal 6 0 0 , 0 0 0
Previous EDU Count f
,P , 0 0
Capped EDU Credit 0
TOTALS 0 0 1 6 1 2 0 -4
Current Fixture Value - divided by 16 = -0.3 Current EDU 1 EDU = $ 2,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change - divided by 16 = -0.3 over (under) $ (750.00)
Enter EDU Change Here _.`0 3
Notes:
-----
Signature: Date: ( O �.
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.
i:\Building\Sewer Tally \SewerTallySheet.xls 7/1/04
W
CITY OF TIGAR
BUILDING DIVISION PERMIT #: pLM200S -00283
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/24/2005 ,I
Phone: (503) 639 -4171 /�nailgp f l ,
Inspection Requests (24 Hrs.): (503) 639 -4175 `_L
INSPECTION WORKSHEET FOR DATE: 7/26/2005 TIME: 7 :07AM PAGE: 45
SITE ADDRESS: 15865 SW 74TH AVE 105 CLASS OF WORK:
SUBDIVISION: CREEKVIEIN INDUSTRIAL PARK LOT #: Q04 TYPE OF USE:
PROJECT NAME: COGNEX EXPANSION
DESCRIPTION: Building fixtures: Relocated or capped.
OWNER: PACIFIC AMERICAN PROPERTY EXCHAN, PHONE #:
CONTRACTOR: GRIDLINE PLUMBING + HEATING PHONE #: 771-8790 -
Inspection Request Scheduled For: Date: 7/25/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 012153 -01 -503- 771 -8790 N
Corrections /Comments /Instructions:
/ Z .
, ./
/
-PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: //r2i Date: 4 - Phone #: (503) 718-