Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2005 -00108
`�I�� DEVELOPMENT H BMENg r SERVICES O -639 -4171 DATE ISSUED: 3/17/2005
PARCEL: 2S112DA-01400
SITE ADDRESS: 06650 SW REDWOOD LN 250 ZONING: I -P
SUBDIVISION: PP1996 -048 LOT: 002 JURISDICTION: TIG
Project Description: Plumbing TI.
CLASS OF WORK: OTR 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: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [PLUMB] Permit Fee 3/17/2005 $72.50
[TAX] 8% State Surcharp 3/17/2005 $5.80
Phone : 503 624 - 6300 Total $78.30
Contractor:
ADDISON PLUMBING
17506 SE RIVER RD. REQUIRED ITEMS AND REPORTS
MILWAUKIE, OR 97267
Phone : 503 785 - 1840
Reg #: LIC 151754
PLM 3 -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 -000 -1010 t gh OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calli • 503 - 246 -6699 0 •32 -2344.
Iss - d By: / /ir Permittee Signature: ,`/ M o�nu2
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.
Building Fixtures
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received % � � permit No.
Plan Re view i r /
13125 SW Hall Blvd., Tigard, OR 97223 a / i �� 0 . • �
P Re
Phone: 503.639.4171 Fax: 503.598.1960 //�.l.� �. t Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 67 I Date Ready/By: - • Ed See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: i t .. Supplemental Information
TYPE OF WORK _ FEE* SCHEDTJLE' '_
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
4 Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION ' ',`. SFR (1) bath 249.20
❑ 1- and 2- family dwelling • IN Commercial/industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath/ldtchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND' LOCATION Site utilities
Job site address: L,�� s1/4 fat Qea,.N„.A. L . Catch basin or area drain 16.60
City/State/ZIP: Po,,_,‘‘o.►r.d- I or_ cf"72.Z4. Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: zso I Project name: Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
• Rain drain connector 16.60
Sanitary sewer (no. linear.ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
- DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER' ' I .. ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: T.,., -N5A Expansion tank 16.60
Address: 1535 5W 5 eZuo, ,, -- Pkwy ' .0c, Fixture /sewer cap 16.60
City/ State/ZIP: (),0„r.1/4‘,,„,.,4 p12, q q Floor drain/floor sin 1.(3 I 16.60 16 • LO
Phone: (61)3 ) CZy-63cb Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
(671).1 asin/lavatory I 16.60 tto,bd
Phone: ( ) Fax: : ( )
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR • ' ' ' - Water closet 16.60
Business name: / 91.,.......\,.; � a L L L Water heater 16.60 ( b -`�
Address: 115a(. SE Kzv 12_t• Other:
I
City/State/ZIP: Subtotal 4140
Ci
ty (M��vs° .t`k� g �� g12tn� Minimum permit fee: $72.50
Phone: (set ) Z ?Y KIS `!O Fax: ( ) p G
Residential backflow minimum permit fee: $36.25 7�-
CCB Lic.: is-17 s--r4 Plumbing Lic. no.: 3-441 Pis Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5. '
Authorized signature: TOTAL PERMIT FEE 7s. 3 a
- Print name: j q tea., -� Date: ; -o. This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
i:\ Building \Pemtits\PLMF- PermitApp.doe 12/03 440- 4616T(10 /02/C0M/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site.U.tilities .Qty. Fee (ea) . Total • Square Foota_ ge:! ' Permit Fee:.;, ,:;;:,..
Footing drain - 1" 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00
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
Valuation: Permit Fee:E`' "'
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or-Item . ' Qty. Fee (ea) . -Total additional $100.00 or fraction thereof, to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $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
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
•
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 * .
Quantity by (Fixture) Work Performed .
Fixture Type: Replace
New .Moved Existing Capped, Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
Eye Wash
Floor Drain/sink ( ) 1
-3"
-4 "
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial increase of sewer EDUs, a sewer permit will be issued and
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar/Lavatory
Quantity Total
- Bra.
ommerciai 1 Isometric or riser diagram is required if fixture quantity
- Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet Plan review is required if. fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ Building \Pennits\PLM- PertnitApp.doe 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00108
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/17/2005
Phone: (503) 639 -4171 i� ,�,c'I �i,���r 1
Inspection Requests (24 Hrs.): (503) 639 -4175 5. °`'� L
INSPECTION WORKSHEET FOR DATE: 4121/2005 TIME: 7:08AM PAGE: 37
SITE ADDRESS: 06650 SW REDWOOD LN 250 CLASS OF WORK:
SUBDIVISION: PP1996 -048 LOT #: 002 TYPE OF USE:
PROJECT NAME: HOUSEHOLD FINANCE
DESCRIPTION: Plumbing Ti.
OWNER: PACIFIC REALTY ASSOCIATES. PHONE #: 503. 624 -6300
CONTRACTOR: ADDISON PLUMBING PHONE #: 503 - 785-1840
Inspection Request Scheduled For: Date: 4/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 005057 -01 503. 740.8116 N
Corrections/Comments/Instructions:
•
Car 'i' ✓., I J 1 (2-11-0,(p
4 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (Z li..A. -A- tt-~-, Date: Lit 2.I I 05 Phone #: (503) 718-
Accumulative Sewer Tally Parcel # 2S112DA- 001400
Tenant.Name: Epicor Software This SWR# NA
Site Address: 6650 SW Redwood Ln #200 This PLM# 2004 - 00096 -- see- 0 °
��
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 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 1 2 0 -1 -2
- 3 inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 2 4 0 -2 -4
Sink - Bar /Lavatory 2 0 1 2 0 -1 -2
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 4 8 0 0 -4 _ -8
Current Fixture Value -8 divided by 16 = -0.5 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -8 divided by 16 = -0.5 over (under) $ (1,200.00)
Enter EDU Change -0
Notes: Credits for capped fixtures.
Sign ture: ��� Date:
v p
Building Division
Note: The property owner sfl iLretain 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 deveent charges. ,2, Q (..),..) i:\ Building \Sewer Tally \SewerTallySheet.xls 11/19/03 • Ft ?COE 00/ 08