Permit C ITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00096
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/5/04
SITE ADDRESS: 06650 SW REDWOOD LN 200 PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 ZONING: I -P
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 0 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 2 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocating (1) water heater & capping (1) 2" floor drain, (1) lay & (1) shower stall.
FEES
Owner:
Description Date Amount
PACIFIC REALTY ASSOCIATES [
15350 SW SEQUOIA PKWY #300 -WM I [PLUMB] Permit Fee 3/5/04 $83.00
PORTLAND, OR 97224 [TAX] 8% State Surchari 3/5/04 $6.64
Total $89.64
Phone :
Contractor:
DEAN WARREN PLUMBING & REMODEL
PO BOX 14701
PORTLAND, OR 97293 REQUIRED INSPECTIONS
Phone : 503 - 492 - 9514 Insp existing /capped fixtures
Final Inspection
Reg #: LIC 154919
PLM 26 -736PB
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
Iss ed By: Milk ft, , / .l Permittee Signature:/f"
Call (503) 6 ° -4175 by 7:00 P.M. for an inspection needed the t business day
Building Fixtures
•.
Plumbin Permit Application Received FOR OFFICE USE ONLY Plumbing '/ [ �
Date/By: , QC/ Permit No.: 1 -004 / 0
Planning App . val Sewer
City of Tigard Date/By: Permit No.:
li 1 32 H Blv Plan Review Other �L�,
Tigard , O regon all 97223 d. Date/By:
Permit No.: UD
Phone: 503 639 - 4171 Fax: 503 - 598 - 1960 Post - Review Land Use
GHnsi�di��� Date/By: Case No.:
Internet: www.ci.tigard.or.us �j,1 ' 1 1 Contact 1 i.s ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: / /(,• Supplemental Information.
TYPE OF WORK_ . FEE* SCHEDULE (for special information use checklist)
New construction 7 , - . Demolition Description I Qty. I Fee(ea.) I Total
Addition /alteration/replacement ❑ Other: New 1- & 2- family dwellings
s (includes 100 ft. for ea utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1 & 2- Family dwelling Cif Commercial/Industrial SFR (2) bath 350.00
['Accessory Building ❑ Multi - Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: C,C Sr.) 5 4 Red.J ocd /....174 e-- Site Utilities
Suite #: ).OQ I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: /� P/' Drywell/leach line/trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: a- /A /g7719 -d /44) Water service (no. linear ft.) Page 2
Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
C Zp 2.. ` Shawa,/ ) - ka.il Backflow preventer Page 2
RPioa3 ' W.d-# -.. ) Backwater valve 16.60
Re-b ed t 5 + t Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER I 0 TENANT Ejectors/sump 16.60
Name: P,D, /- Expansion tank 16.60
Address: ! 53 572 S r e wi' d P 644 Fixture/sewer cap '3 16.60
City /State /Zip: t efit, e,• . VIA, Floor drain/floor sink/hub 16.60
Garbage disposal 16.60
Phone: 6 7-4 -6 3'' Fax: Hose bib 16.60
❑ APPLICANT 0 CONTACT PERSON Ice maker 16.60
Name: 0e,a„ Gwen.., 'm R 0,0441 Interceptor /grease trap 16.60
Address: ,o. o /3ox_ i1G•-yo't Medical gas - value: $ Page 2
City/State/Zip: c /1,. q > S') Primer 16.60
Y p Roof drain (commercial) 16.60
Phone: 1{G _ ggiLf I Fax: )-94 >xis Sink/basin/lavatory 1 16.60
E -mail: Tub /shower /shower, pan 16.60
CONTRACTOR Urinal 16.60
Business Name: Water closet 16.60
Water heater 1 16.60
Address: Other:
City /State /Zip: Other:
Phone: Fax: Plumbing Permit Fees* g3
-
CCB Lic. #: ! FY 5/ ti Plumb. Lic. #: 6 -7 k 1
Subtotal $
Authorized C,U Residential Backflow Minimum Minimum Permit Fee Fee $72.50 $36.25 $
po
Signature: Date: / plan Rcview (25% of Permit Fee) $
State Surcharge (8% of Permit Fee) $ € . 4 4
(Please print name) TOTAL PERMIT FEE $ R 7, (
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.
i:'Dsts\Permit Forms\PlmPermitApp.doc 01/03
•
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: 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:
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
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total 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
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.
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 Comments regarding fixture work:
Fixture Type: Replace
New Moved Existing Capped
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 - 2" I
- 3"
-4 "
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal - Commercial 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)
Rec. Vehicle Dump Station
Shower -Gang
-Stall z
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
Accumulative Sewer Tally Parcel # 2S112DA- 001400
Tenant Name. Epicor Software This SWRt NA
Site Address: 6650 SW Redwood Ln #200 This PLM# 2004 -00096
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 Dm 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 Here -0.5
Notes: Credits for caPp xtureg:\
ignature: �i( Date: /)/
Building Division
(■ote: The property o - all retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
hich must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
i:\ Building \Sewer Tally \SewerTallySheet.xls 11/19/03
CITY OF TIGARD 24 -Hour
BUILDING • Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 4-23 AM PM BUP
Location 6 so f a4'/) lz' Suite z MEC
Contact Person Ph ( ) PLM 47/— D
Contractor Ph ( ) 7 �4- `��� 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
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 6
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 Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspectio record from the Job site.
PASS PART FAIL