Permit •
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00044
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/17/04
SITE ADDRESS: 15570 SW PACIFIC HWY PARCEL: 2S110DC -02200
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT: 011 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; 15 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 5 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: TI Building fixtures. Capping (2) lays, moving (1) lav,adding (2) new lays, moving (14) floor drains & adding
(1) new floor drain.
FEES
Owner:
Description Date Amount
TIGARD, CENTER LP
9777 WILSHIRE BLVD #609 [PLUMB] Permit Fee 2/17/04 $332.00
BEVERLY HILL, CA 90212 [PLMPLN] Plan Review 2/17/04 $83.00
[TAX] 8% State Surchar1 2/17/04 $26.56
Phone : Total $441.56
Contractor:
•
MSI MECHANICAL SYSTEMS INC
21195 NW EVERGREEN PKWY STE 20
HILLSBORO, OR 97124 REQUIRED INSPECTIONS
Rough -in Insp
Phone : 503 642 -1234 Underfloor /Underslab
Reg #: LIC 70032 Top-out lnsp
PLM 37 -421PB 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
Issued By: 410/ /' Permittee Signature: 1 4 / L
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
,\ (t c 1c1 c7 to a
Plumb' lication ()1 I I C ()
�/
Date received: / - 2-/C -1 .� Permit no.:.�L.1• '
City of Tigard
..;, �_�' L � Al t�)) Q_ Sewer permit no.: Building permit no.: •
Address: 13125 SW Bfv OR 97223
City of Tigard Phone: 543 639�t 1 Project/appl. no.: Expire date:
Fax: (503) 5 9 8 -1 b { OF TIGARD Date issued Rece no.:
- ....t
BUILDING DIVISION
Case file no.:
Land use approval: Payment type:
rl t'F. O1- I'FR0II l
0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration/replacement 0 Food service .13 Other.
NJ
.108SIIE I\ �II0;\ I'n SCIIE111 I.I. (for .pccialinformaliunua•ch &(kli:l)
Job address: IS 7Z) 5. Ii T,'c) C ki, p On Qty. Fee(ea.) Total
Bldg. no.: Suite no.: • d New 1- and 2-family dwellings only:
Tax map /tax lot/account no.: C 100 ft. for each utility comedian)
SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: 5 wAw ! 4 j/ 78 SFR (3) bath _ '�
City/county: j", ZIP: Each additional bath/kitchen
Description and loti a on of work on premises: Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Urywells/leach line/trench drain
Footing drain (no. lin. ft.)
1'1.1 11111 \Y; COQ rR M fOR Manufactured home utilities
Business name: M sr Y11 eclokuocal Styr 11,'L e S Manholes
Address: 5.. L l Sr S NW Eden $ smW Pk Sm. i �.. f l bG Rain drain connector
City:14:l1S /300 � State:a / ZIP: 47 12.4 San sewer (no. lin. ft.)
Phone p3 ''i3 7-1111 I Fax5 q.17 E -mail: Storm sewer (no. lin. ft.)
• CCB no.: 1" 14, D l S I Plumb. bus. reg. no:37 -4l.1 e(; Water service (no. lin. ft.)
City/metro lic. no.: Fixture or item:
Contractor's representative signs ‘ 1 `, Absorption valve
Print name: t Date: / LG o y _ Back flow preventer -
Backwater valve
CO \"I :ACI I' E II SO:\ Basins/lavatory
1 E
Name: An)a�e�o A l ✓aPad0 Ciaftrnaw) Clothes washer
Address: Dishwasher
City. I State: I ZIP: Ejectors/sump
fountain(s)
J P
Phan j -O g? Fax: E -mail: Expansion tank
Fixture/sewer a .t.o
Name (print): Si r et.4)Zy 2yo Floor drains/floor sinks/hub { 5 {L.& p 211.00
Mailing address: Garbage disposal
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 Primers)
will be made by me or the maintenance and repair made by my regular Roof drain (
employee on the property I own as per ORS Chapter 447. Sink(s), basin( , lays(s) 2 14,6 a y y, gn
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Name: Urinal
Address: Water closet
Water heater
City: I State: I ZIP: Other.
Phone: I Fax: I E -mail: Total
•.... Not all jurisdictions accept credit cards, place call jurisdiction for more information Minimum fee $ 1311°°
0 Visa O MasterCard Notice: This permit application Plan review (at o ' %) $ i 3. 00
expires if a permit is not obtained e —
Credit card number /o) $ . 2.6 .. A
r Expires within 180 da after it has been
Name of cardholder as shown on credit card accepted as complete. TOTAL $ _ �/�/ / • 540
$
Cardholder signature Amount
440-4616 (6/00/COM)
RECEIVED
•
• PLUMBING PERMIT FEES: JAN 8 2004 _
TIGARD •
PRICE TOTAL N � only.
FIXTURES (Individual) QTY (ea) AMOUNT S {� rl g it t res in PRICE TOTAL
Sink 3 16.60 41 'the dwelling and the firs 00 ft. QTY (ea) AMOUNT
for each utility connection)
Lavatory 16.60 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 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 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' (5 16.60 /Wq 60 PLEASE COMPLETE:
4' 16.60
Water Heater 0 conversion 0 I&e kind 16.60 - Quantity by Work 'Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Cpped
‘ MFG Home New Water Service 46.40 a j V.7 /ai.. /4 /1.
MFG Home New San/Storm Sewer 46.40 '60E//n;
Hose Bros 16.60 Tub or Tub/Shower '
Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Other Fixtures (Specify) 16.60 Urinal
Dishwasher
Fi 'cr,...,n. t ' 2 14.40 332e Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain/Sink: 2'
Sewer -1st 100' 55.00 3' / T J`1 y
Sewer - each additional 100' 46.40 4• /
Water Service - 1st 100' 55.00 Water Heater
Water Service -each additional 200' 46.40 Other Fixtures
JS ify)
Storm & Rain Drain -1st 100' 55.00 •
Storm & Rain Drain - each additional 100' - 46.40 -
Commercial Back Flow Prevention Device 46.40
Residential Bacldlow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 62.50
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 it 0
Quantity Total Is > 9 -,
'SUBTOTAL: 322.a •
8% STATE SURCHARGE: •
2‘ 'As
"PLAN REVIEW 25% OF •
SUBTOTAL: $0 2)
Required only If ordure qty. total Is> 9
TOTAL PERMIT FEE: $1111. Dt,
'Minimum permit fee Is $72.50 + 8% state surcharge, except Residential Bacldiow
Prevention Device, which Is $3825 + 8% state surcharge.
"All New Commercial Buildings require 2 sets of plans with isometric or riser
diagram for plan review.
■
i:ldststformslplm- fees.doc 02/05/02
•
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
// BUP
Received i r 2S D ate R e ested 7 —� 3—� PM BUP
Location / SS P�C.O Suite MEC
Contact Person Ph (�) (l q— 0 ?F! PLM 0005"(/
Contractor Ph ( ) SWR
BUILDING Tenant/Owner a 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
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
7 P• - PART FAIL
CHANICAL
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 r / /
ADA 3 a
Approach/Sidewalk Date , Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL