Permit CI TY OF TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: PLM2003 -00613
�� + 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/23/04
SITE ADDRESS: 07555 SW HERMOSO WAY PARCEL: 2S101AB -01501
SUBDIVISION: HERMOSO PARK ZONING: MUE
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BLOCK: LOT: 021 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 1
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 400 ft
Remarks: Site utilities for new 7,250 sq. ft. office building. Work to include 400' of footing drain. Septic tank is to be
pumped & filled. Water service and backflow preventor to be done under separate permit.
FEES
Owner:
Description Date Amount
LIONELL LLC
BOB DAVIDSON [PLUMB] Permit Fee 1/23/04 $460.00
14285 SW PACIFIC HWY [PLMPLN] Plan Review 1/23/04 $115.00
TIGARD, OR 97224 [TAX] 8% State Surcharl 1/23/04 $36.80
Phone : 503 - 620 - 5203
Total $611.80
Contractor:
GRAY PURCELL INC
PO BOX 23516
PORTLAND, OR 97281 -3516 REQUIRED INSPECTIONS
Phone : 503 Sewer Inspection
Water Line Insp
Reg #: LIC 79018 Water Service Insp
Rough -in Insp
Underfloor /Underslab
Top -out Insp
Storm Drain Insp
Crawl Drain
Rain Drain Insp
RP /Backflow Preventer
Insp existing /capped fixtures
Final Inspection
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
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I / /
Issued By: i P ermittee Signature: o: •
y � I « � g
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Site Utilities
r i r� .� : n r r �. . - •. -. FOR OFFICE . USE ONLY . i
Plumbing Permit App i i ttio'�n Received S 2 Plumbing
Date/By: / "7 7 A Permit No.:/ _L6aZe 1. -}
/3
490
City of Tigard DEC 6
N., Planning Approval ���� DDate/By: Sewer y: Permit No.:
13125 SW Hall Blvd. Plan Review Other 0,2401 _4066/
o
Tigard, Oregon 97223 CITY OF TIGAR D /By: Permit o.:
C '
Post - Review Land Use
Phone: 503- 639 -4171 Fax: 5Q 5 i$1 � Date /By: Case No.:odbbl 8
Internet: www.ci.tigard.or.us ■ y, �. Contact Juris`':"'�� ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 hti2 W Name /Method: ' 776-) Supplemental Information.
w -;X' 4 $; ha^ ✓. ' :r;'r, "sa9:$ :s . °x )1 k :,tc .-„,cam- ... riri8 ` "sC etd ` ='`�, �
� °�- �,',� ��TtYPE�`OF WORK ' °.t. <r..,� .. ��A ».FEE� o t►onu ,.. .._)a..�,��i•
New construction ❑ Demolition Description I Qty. 1 Fee(ea.) I Total
❑ _ New 1 & 2 family7dwelhngs n; ` °` = �:�wT.
Addition /alteration/replacement ❑ Other. . 3 ".; �� : �.� i �. < iii '=` ' ° , ;- .h ,.
�� a � , tgcludes,100 ff�for each utility co'n "nection �; s-
CATEGORY .F`CONS = 4' R " (' )A
TRIJCTIOIV. 6 ;_`:X;,. :d-
° :. " 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 lam'
['Master Builder ❑ Other: Each additional bath/kitchen 45.00
:, - 1:
x•..^ �JQBiSITE °'I1V °FORIVI'': �_ N and0OCAT_IONt �� Fire sprinkler - sq ft.:
a e
...�. al:R am'.`�.;�i s , s :� . . ie - » ,� : Win", t h ;: ,�u
� ..
Job site address. 7 SI,J 1 f e/ni oS'� W +fi p Si "e'; t -. � ;A;
;: .. ,.
Suite #: Bldg. /Apt. #:
Catch basin /area drain / .,.. 16.60 /69
// Drywell /leach line /trench drain 16.60
Project Name: jv i n ll'r.A' PrCSS O1' +90(4 Footing drain (no. linear ft.) Ike Page 2� /944 A
Cross street/Directions to job site: J Manufactured home utilities 110.00
Manholes 16.60
S W 13evejG.,A . x-4' Rain drain connector _16.60
Sanitary sewer (no. linear ft.) /06 (.1Page_D 5S. of
Subdivision: o 0, pa cit. Lot #: Storm sewer (no. linear ft.) '/ee-r Page 2 j q , /,
Water service (no. linear ft.)ittA it / Pe. M. '• ^3.-evG °iii
Tax map /parcel #: ).S I v J A %SO I _ ;. : +, ` _ "`''�'` Ti
- - ��,��.�, ;`DESCRIPTION�OE�W,.ORiC����° . ��" �� �:� ,�� =m'� c � . � '�" , ,.'Fixture orsitem`��;�� >;v`x {;:�e , �,': �:`� :.��'
� .,> ��' ' a Absorption valve 16.60
COASi'fu l4 /Ueea die f iJt
.J/ Backflow preventee CQ/y/L/Exc./4 ( Page 2
�Cr,oi� ex,S4, fe S�c(- �(� Backwater valve u�,,fez. r &vierd �1&:60'
Clothes washer 16,60
Dishwasher 16.60
t - Drinking 16.60 '
l PROPERTY ,OWNER b�..:; ❑.TENANT; ^ `d >; Ejectors /sump 16.60
Name: L i o nc i t , LLC ir60 8 2 J/ L' 5O Expansion tank 16.60
Address: 1 y gS' st9 Pr,L cf. L 14-7 Fixture /sewer cap 16.60
Cit City/State/Zip: Floor drain /floor sinlc /hub 16.60
y p: �11y��1 . R 97 flu Garbage disposal 16.60
Phone: 503 6 ,o 5103 Fax: 5 6,10 SSO3 Hose bib 16.60
PPLICA °N,TE', zrozor '
T ACTePERS ON ; a : :; Ice maker 16.60 _
Name: l o t ) /a n -t5 Interceptor /grease trap 16.60
Address: - ,L1 (49y NE I ,),1-10 Medical gas - value: $ Page 2
Primer 16.60
City /State /Zip: Ne, pa Q7/,3� Roof drain (commercial) 16.60
Phone: So) 537 aoo2. Fax: 503 S 0671 Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan • 16.60 _
M' ?11 a i " " CON 0170R °tE '; Urinal 16.60
Business Name: 6i-,, p,,ecetr 6
Inc Ine Water closet 16.60
Water heater .60
Address: PO PDx 4.3S lb Other:
City /State /Zip: o 41 4 02 97.4)'-33J., Other: a C 1 P�>"00 4' '� °qt F
u aP� x+�g*�G3�; #y`y`ti � _ i F`�,�x ; �ri: �t'.4 +�:��r'�
Phone: moo) 639 6la.1 Fax: So3 634- 61)0 .,. <,. ., - PlR llb:►n �,gP,Qiiri 4 :v. ..ea..n...,
Subtotal $
CCB Lic. #: 79013 Plumb. Lic. #: Minimum Permit Fee $72.50 $ p / 00 •
Authorized /�-� Residential Backflow Minimum Fee $36.25 7
Signature: d / V �71 - Date: a-44) Plan Review (25% of Permit Fee) $ / / 5 - Uer
/r t k . keleor State Surcharge (8% of Permit Fee) $ 036 . so I
(Please print name) TOTAL PERMIT FEE $ (/J / / , yv
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric 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.
' is \Dsts\Permit Forms\PlmPermitApp.doc 01/03
/ COACT/7C 7'" e 4C)^/g/--. J / . / iee -z y 771 /SS u• �'
Plumbing Permit Application - City of Tigard 1.
,Page.2 :- Supplemental Information \ .
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Fee Schedule: Residential Fire Suppression Systems:
' StteiTtiltties ty areiviot Total Square FOOfagei =;`, P,errrut Fe'e;
Footing drain- 1" 100' I 55.00 55 F 0 to 2,000 $115.00 _
Footing drain - each additional 100' 3 46.40 /57, ,..e) 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' V} 55.00 56 --- . 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 v "a1itatt0II ' , d , z ITIIt E ee:, ` - ,- _.„
Storm & Rain Drain - 1st 100' i 55.00 5"6",e° $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 3 46.40 / 59,do $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
«m "` "� x t Fee ea Tota14- additional $100.00 or fraction thereof, to and
r PIRVIe o :. ,.;„ EQ Y, EY:O �� �) , �, x„ including $10,000.00.
Commercial Back Flow Prevention Device -_-•.=••• 46.40 44fivfrit, $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
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 first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof.
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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 *.
#i r Quantit >by (Fixture) WorkPerformed` Comments regarding fixture work:
Fixture Type . _, i Replaces -F R XI J1- re �+
;v.e, -6 ba �o t ed 04 S )fit
, z__ ? .,� sNwwer
Moved ,,., It .Existing. Cap g; J
Baptistry/Font
Bath - Tub /Shower •)- A
-Jacuzzi/Whirlpool -- l V .
Car Wash -Each h Stall tall
-Drive Thru -
C
IFSEM
uspidor /Water, • • irator
Dishwasher -Co • ercial - 10_`_.MMIN
-Dom .tic - Na�1�� I
Drinkin: Fountain _- ]� WAN -
E e Wash ■-IIMINIMSIM4111
Floor Drain /sink - 3,,
`�,Q"t
Car Wash Drain --��-
Garbage
-Domestic *Note: If the fixture work under this permit results in an
Disposal - Commercial pwiR 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 plumbing permit can be issued.
Oil Separator (Gas Station)
A Rec. Vehicle Dump Station
Shower -Gang
-Stall
Bar/ "II la
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet 6)l
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour.
BUILDING Inspection Lirte: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 9— aZ,i AM PM t UP
Location 7 S S / L 2A/✓y1 Q� Suite 1 zc9 3- a U 6/ 3
Contact Person Ph ( ) - SoZ 03 PLM 440 3--0,0 6 /
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain
ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing �� � ✓� - r PLM 2 Do 3- 00c /3 Grp /oy )4 M RS.
Insulation
(
Drywall Nailing K d)cz Eavk r I'w Pfe ✓�L{ 1 cc.
Firewall PI ' Pe fw.! T P L 6 03-006N. i .• •a I c.a� 6 1 / 1c- / o / Mi i'
Fire Sprinkler `` I, �5
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING Re 06 orA -L. p (L.�I.,; ter ��S �.# I A w a- I r.
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 Hail, 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 9 I ?3 ) c`4 Inspector QrD Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION • Business Line: (503) 639 - 4171 MST
BUP
Received Received Date Requested ` / AM PM BUP
Location 745 Suite MEC
Contact Person Ph ( ) s 7 ?,,S" PL c O 2 3 —00
Contractor —71W1(1 Ph ( ) rn ��3 – GO r T
BUILDING Tenant/Owner (Y) Ct,V\ ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
lnt Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall a
Fire Sprinkler
Fire Alarm �^ ' C. •
Susp'd Ceiling /R
Roof
Other: • 1
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:
' 'r PART FAIL
HANICAL
Post& Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final El Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE E Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector U PP Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL