Permit •
CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2002 -00271
J ! 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/15/02
SITE ADDRESS: 06640 SW REDWOOD LN 2ND FL PARCEL: 2S112DA -01300
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 001 JURISDICTION: TIG
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: 22 URINALS: GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 4 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Adding sinks and toilets. 4 lays, 22 sinks, 4 water closets, 1 water heater. Other fixtures: 1 primer, 1 drinking
fountain, 1 floor drain.
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT CTR 7/15/02 $564.40 27200200000
15350 SW SEQUOIA PKWY #300 -WMI 5PCT CTR 7/15/02 $45.16 27200200000
PORTLAND, OR 97224 PLCK CTR 7/15/02 $141.10 27200200000
Phone 1: Total $750.66
Contractor:
DETEMPLE CO INC
1951 NW OVERTON ST
PORTLAND, OR 97209 REQUIRED INSPECTIONS
Phone 1: 503 - 227 -2641 Water Line Insp
#: L IC 2510 Rough -in Insp
Reg Misc. Inspection
PLM 26 -25PB 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 Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: g3Gj,a,t,CC � d Permittee Signature: / �,�J r -
Call (503) 639 -4175 by 7:00 P.M. for an inspection need ° • the next siness day
/,e %e TD v� 0 '°°61C/ Salle ol - CrO -D-�
7 /0 2 ' ,Plumbing P ermit Application
► g PP
Date received: 6 a-i -O rmit no. i gie n do ad . _0).1/
-. ��i. ; � � � g
i ,, • of Tigard
Sewer permit no.: Building permit no.:
X 11 ss: 13125 SW Hall Blvd, Tigard, OR 97223
r ' ' one: (503) 639 -4171 C� Project/appl. no.: Expire date:
Fax: (503) 598 -1960 v 9)— Date issued: By:ZR I Receiptno.:
1
,UN 2 L an d use approval:
�3 Case file no.: Payment type:
4 'I i PE OF PERMIT
p3't1 family dwelling or accessory ii�'• C� mercialindustrial ❑ Multi- family 0 Tenant improvement
❑ New construction ( ddition/alteration/replacement 0 Food service ❑ Other.
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: (p (p 1 40 ✓i - p • . 14' Description Qty. Fee(ea.) Total
Bldg. no.: I 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: I Block: Subdivision: SFR (2) bath .
Project name: WC. % '(e.... SFR (3) bath
City /county: , o1-- I ZIP: Each additional bath/kitchen
'on d 1 a
Descrip tron of work on premises. einflt S Site utilities:
Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
• Manufactured home utilities
Business name: we om li ,.9 c6 , Manholes
Address: — n/ L/ (((V dl/1 Rain drain connector
City: I State:aL. I ZIP: C.0-�01 Sanitary sewer (no. lin. ft.)
PhoneV2(aq( I Fax: 27t4744,1E-mail: Storm sewer (no. lin. ft.)
CCB no.: 2S10 I Plumb. bus. reg. no: 216 - �s Water service (no. lin. ft.)
City /metro lic. no.: et Vp (- t o _ p3 Fixture or item:
Contractor's representative signature: I �
/ Absorption valve
Back preventer
Print name: & h —i _ late: CD .2-14),--• Bacc floow w Backwater valve •
CONTACT PERSON Basins/lnatory • •
Name: •- o f f I D. M i Clothes washer
Address: v Dishwasher
Drinking fountain(s)
City: I State: I ZIP: Ejectors/sump
Phone: , 2. o . Fax:2 E -mail: Expansion tank
Fixture/sewer cap
Floor drains/floor sinks/hub V
Name (print): Garbage disposal
Mailing address: 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) ,, 1
will be made by me or the maintenance and repair made by my regular . Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), -bs ltt-tt s(s) 30
Owner's signature: Date: Sump
ENGINEER Tubs/sbower /spgwer -pan _
Urinal .
Name: Water closet _
Address: Water heater X
City: I State: I ZIP: Other.
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call Jurisdiction for more information. Minimum fee $ f/
Notice: This permit application Plan review (at _ %) $ S•
U Visa 0 MasterCard expires if a permit is not obtained / e
Credit card number / / within 180 days after it has been State surcharge (8 %) $
Expires TOTAL $ 7S n 6
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616 (6I00/COM)
p r _, 3,;,-,-,„--f . (Ircii;
PLUMBING PERMIT FEES: t
PRICE TOTAL New 1 and 2- family dwellings only: •
FIXTURES (individual) QTY (ea) AMOUNT (Includes all plumbing fixtures in PRICE TOTAL
Sink . 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory if 16.60 for each utility connection)
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 ,7 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 PLEASE COMPLETE:
16.60 LETE:
4" 16.60
Water Heater Aonversion 0 like kind / Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: ,7 . Ney4" • Mbve • R�epiaced Removed/
permit. _ - • • •, Capped
MFG Home New Water Service 46.40 , . Sink' - ' t. , 9 i _ ` r
MFG Home New San/Storm Sewer 46.40 . La\ra1ory • N Alt 4/
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain r 16.60 Water Closet il
16.60 Urinal • ` • r - • _
Other Fixtures (Specify) Dishwasher
1 vvw gr.- I /6 14 _ •• • Garbage Disposal ' • •
+Laundry Room Tray _
Washing Machine - ••t �-
' , - • - Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 . '• ' 3" 1, •' .
Sewer - each additional 100' 46.40 4" , ,
Water Service - 1st 100' 55.00 Water lieate• • . ' •
Water Service - each additional 200' .40 • ' Qther Fixtures ♦. T f >q . • - .' ,
U r
(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 q •
" Isometric or riser diagram is required If / 4, 0
Quantity Total Is > 9 �f0 V
*SUBTOTAL
8% STATE SURCHARGE
4716 /'
lcJ
**PLAN REVIEW 25% OF SUBTOTAL -
Required only if fixture qty. total is > 9 / • /0
TOTAL
$ 7�1 a
-
* 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.
I: dsts\forms\plm- fees.doc 10/10/00
CITY OF TIGARD 24 -Hour -
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: - (503) 639 -4171 MST
�
J BUP
Received �� "" Date Requested /� � AM PM BUP
Location �Q c��) ` � � ( Suite MEC
Contact Person Ph ( ) Z� 7 " -(' (4l PLM — 4) a.7(
)
Contractor Ph ( SWR
BUILDING Tenant/Owner _ 1� -c�c.c -cam 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
Other:
• - 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 El Please call for reinspection RE: [] Unable to inspect — no access
Fire Supply Line
ADA 7,73 �( Approach/Sidewalk Date u Inspector C� Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
•