Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: P 24/200 -00229
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/24/2004
SITE ADDRESS: 06650 SW REDWOOD LN 290 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: TRAPS:
STORIES: WATER HEATERS: 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
Remarks: Install (1) new breakroom sink. EDU credits from PLM2004 -00096 allplied to this permit.
FEES
Owner:
Description Date Amount
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 5/24/2004 $72.50
PORTLAND, OR 97224 [TAX] 8% State Surchan 5/24/2004 $5.80
Total $78.30
Phone:
Contractor:
DEAN WARREN PLUMBING & REMODEL
PO BOX 14701
PORTLAND, OR 97293 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Top -out Insp
Reg #: LIC 154919 Final Inspection
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
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 -000 -1100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
24 • .699.
Is ued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed th ext business day
Building Fixtures
FOR OFFICE USE ONLY
Plumbing Permit Application Received J Plumbing
Date/BY: l G 7 Permit No.: P � jq - CO
Planning Approval Sewer
City of Tigard Date/By Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
Date/By: Case No.: ii Internet: www.ci.tigard.or.us c ! I I I Contact Ju ® See Page 2 for
24 - hour Inspection Request: 503 639 - 4175 W Name/Method: 'JO, Supplemental Information.
• New construction ❑ Demolition Descri I tion Qty. Fee(ea) Total
74 Addition/alteration/r •lacement • Other: `s ,� - `III i ' ' 4
• 1 & 2-Family dwelling • Commercial/Industrial SFR bath 350.00
y g 2 SFR 2 bath 350.00
■Accessory Building ❑ Multi - Family SFR 3 bath 399.00
❑ Master Builder El Other: Each additional bath/kitchen 45.00
',-,, i t; ` t \ORMIDZIIP a e -k, 1 111211MEMINI Pa:e 2
Job site address: 4‘ fa 5 4., i .4.J tom, vi ( Lam -
Suite #: -9Q.) I Bldg. /Apt. #: Catch basin/area drain 16.60
I ell/leach line/trench drain 16.60
Project Name: f*Lau.14 y Himtr4•4 ti Footin: drain no. linear ft. Pa:e 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sani sewer no. linear ft. Pa:e 2
Subdivision: I Lot #: Storm sewer no. linear ft. Pa:e 2
arcel #: Water service no linear ft. Pa e 2
Tax Ina •/
, " y ' Abso • t ion valve 16.60 -
4 , zor d A J AF /bert CA.* Backflow • eventer Pa:e 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinkin: fountain 16.60
€ iTig:Tirc ,,- ° f: , :1j' s : E ectores ,, 16.60
Name: ,.ems 4 ' Ex tank 16.60
Address: 1,S35V sc./ s'e,co zi ■0 .4y Fixture/sewer c • 16.60
City /State /Zip: Portia „ q 7)44/ Floor drain/floor sink/hub 16.60
Garb. le •' • 16.60 -_
Phone: 6 24- 3 00 Fax 16.60
a i,k Hose bib . ,,. tf Alf; ; '�. # : 16.60
Ice maker �_
. �i
Name: Interc ,tor / y ease , . • 16.60
Address:
Medical : as - value: $ Pa:e 2
Primer 16.60
City/State/Zip: Roof drain commercial 16.60
Phone: I Fax: Sink/basin/lavato f' 16.60 t 6- a
E -mail Tub /shower /shower ,an 16.60
r s ,$*. -; Urinal 16.60
Water closet 16.60
Business Name: j, 4.43, "J /., - 47e4r, Water heater �
Address: P.0. ,d / fr7or Other:
City /State /Zip: //0-ft J 02- 9 725 3 Other: �
Phone: 3a1- y Si- 4S/y Fax: y 9( -zil $ .x � E �� , , .
CCB Lic. #: y 9 9 Plumb. Lic. #: z6 -
Subtotal
$ al $
� Min imum Permit Fee $72.5 /� , 5-0 Authorized 1 '06- Residential Backflow Minimum Fee $36.25
Signature: Date: ,r - Y - ) e/ Plan Review 25% of Permit Fee $
State Surchar:e 8% of Permit Fee $ , : D
/
(Please print name) TOTAL PERMIT FEE INEISTAIMII
Notice: This permit application expires if a permit is not obtained within All new commerclat 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:
F 1tt treType Replac ` .
,' +.... � r, f ,. ; Moved Eidst1ng ,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"
- 3"
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
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
is \Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
Accumulative Sewer Tally Parcel # �'[ ,
Tenant t ner Mgrtgage This S W R#r s
Siff Addf , ER o Lane #290 . This PLM # -0.6•
,
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
x ;
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 ii ::::::1,. 0 0 0 0
Eye Wash 1 r 0 0 „..,,,„,,,, .....L 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 _it , 0 , ,,,° 0 0 0
- 4 inch 6 z.4.; 0 0 0 0 0
- Car Wash Drn 6 ;;„,; 0 �k ,.: 0 t 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 Igliit 0 , ; ` 0 s 4:44 0 0 0
x --
- Commercial (to 5 HP) 32 �� ,, 0 0 0 0 0
- Industrial (over 5 HP) 48 0 V���- 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 >s 0 °' z , 4,„ J i, 0 0 0
_
Oil Sep (Gas Station) 6x t . 0 0 , 0 0 0 •
Rec. Vehicle Dump station 16 0 0 u x 0 0 0
Shower - Gang (per head) 1 nWROi 0 0 "„ 0 0 0
- Stall 2 0 a>� 0 $ 0 0 0
i if
Sink - Bar /Lavatory 2 ,.<..�. 0 1•;:;i'4.•;,;4.4.:. 0 ). 0 0 0
- Bradley 5 #52E11.4". 0 >:.':, 0
0 0 0
- Commercial 3 : 0 s 0 0 0 0
- Service 3 -, 0 0 3 1 3
k� s
Swimming Pool Filter 1
0 0 k� �� z � 0 0 0
x .
Washer - Clothes 6 `. 0 „: ; .;, 0 w i,, 0 0 0
Water Extractor 6 i „err 0 0 r 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 5 " 8
TOTALS 0 0 0 0 1 3 1 - 5
Current Fixture Value -5 divided by 16 = -0.3 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -5 divided by 16 = -0.3 over (under) $ (720.00)
Enter EDU Change Here -0.3
Notes: Credits from PLM2i ! - - i i i ' ' applied to this sermit.
Si•nature: 4 _ ; V _ , / _, , Date:.. „ ,
Bui :ing Division
Note: The property owner shall retain 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 development charges.
i:\Building\Sewer Tally \SewerTallySheet.xis 11/19/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Ling: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested 7• /' AM PM BUP
Location (o la Sv (1 c , /� Suite t=2 96 MEC
Contact Person Ph ( ) a.,3 - f PLM 200 V-4 Daa
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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
K t) ri/
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
i/�%'rJ►
• 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 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 l G (
Approach /Sidewalk Date � Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL