Permit r CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2001 -00295
,y ;�ji� DEVELOPMENT SERVICES DATE ISSUED: 7/12/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12220 SW SCHOLLS FERRY RD PARCEL: 1S134BC-00300
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Commerical TI: Remove and cap (1) sink, install (1) primer and relocate (1) water heater. _
FEES
Owner:
Type By Date Amount Receipt
BPP RETAIL LLC PRMT CTR 7/12/01 $72.50 27200100000
BY BURNHAM PACIFIC PROPERTIES 5PCT CTR 7112101 $5.80 27200100000
ATTN: JOHN WATERS
SAN DIEGO, CA 92101 Total $78.30
Phone 1:
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 503 - 692 -4139 Rough -in Insp
ti
Reg #: LIC 87852 Final Inspection
PLM 34 -166PB
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 throu• h OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calli g (503)246 -1987.
Issued By: -. ` i �, Permittee Signature: AA G
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed he next bus s day
•
III Jul -12 -01 10:29A Rayborn's Plumbing, Inc. 15036912328 P.01
IQ /13/00 FRI 10:48 FAX 503 598 1880 // CITY OF TICARU I�002 ,
A Plumbing Permit Application
Date received: Permit no. LA 200/ . �� 5
. �r 1 : - •I y of Tigard Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Pro)ecl/appl.no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: - Case file no.: Payment type:
U 1 & 2 family dwelling or accessory mmercial/industrial U Multi- family O Tenant improvement
U New construction Addition /alteration/replacement l] Food service U Other:
.Ifllt..5111. \1 Olt 11_\1ION 11.1..St III :1)111 (Irtrs1 ( rialh,lurit allot' ow•cliccMist)
Job address: /, -4L 0 - 1.•5 .S c-4.4 tilt rtiv, L.. Descripaoe Qty. Fee(ea.) Total
Bldg. no.: Suite tto : New it- and � dw (andly only:
Tax no.: map/tax lot/account no.: (Includes 100ft .foreachtrlWtyconnection)
SFR (1) bath
Lot: 'Block: 'Subdivision: SFR (2) bath '
Project name: L qv> d J 71 !email') SFR (3) bath
City /county: TL pair_ p0 I ZIP: - Each additional bath/kitchcn
Description and location of work on premises: _ t Site utilities:
S Mt. --t• - r. Mt r : S Catch baslNarea drain
Est. date of coo etiodinspecdon: _Dry wells/leach line/trench drain
rooting drain (no. lin. ft.)
Manufactured home utilities
Business name: .�4Y�eALS' LQnt&r A fi here. Mtut ales
Address: RD, g pY ( _ stn t ram connector
City: • C... State:0 ` ZIP: - 0 L Z Santa sewer (no. lin. ft.) -- —
Phone: £7& q 1 34 Fax: 6 143 E -mail: Storm sewer (no. lin. IL)
CCB no.: 4 7 15 Plumb. bus. mg. no: 3 q -t•,ft5 "ater service (no. tin. t.)
City /metro lie. no.: / 80 Fhcture or Item:
Contractor's re entative si _r ature: i - . , / Back Bow preventer
Print name: • M •. .y Date: ' I Backwater valve — .
(O\ I kl I I'l Ittit1\ : asins/ avatory
Name: ..4 -�,.. ,(-{., . , 4J Clothes washer
Address: P p / 09 Dishwasher
Drinking fountain(s)
City: - �,r/�t. �• -r3 I State: o j ZIP: ci 7 0 6 u ' L•jcctors/sum
Phone: (, 1LP Fax: E-mail: - Ex suasion tank ,
ixlur sewer ca
Name (print): L 4r s 77-60 t,e ft.)n -) Hour drains/ sal sin
Garbage disposal
Mailing address: Hose bibb
City: Sfa'r' I State: I ZIP: ; Ice maker - --
Phone: Fax: 1F.-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 Ruof drain (commercial)
employee on the property 1 own as per ORS Chapter 447. Sink(s), basin(s), lays(s) pe is P '1 ,
Owner's ' ture: Date: Sum
'I'u shower /shower pan _
rim _
Name: Water closet
Address: Water heater "?g'(-QCA--rg j
City: State: LiP: Other: I
Phone: I Fax: 1E-mail: Total
Not an prtivactiona accept credit cords. please can jmivaction for Tome information. Notice: This it application Minimum fee $ /a2 SD
0 Visa U MasterCard
Plan rev (at _ %) $
expires if a permit is not obtained
Credit card number: within Igo days after it has been State surcharge (8%) .... $ S, �d
�' TOTAL $ 7,,, g d
Name of cardholder as damn on credit card
accepted as complete. S
,•..,4 4.'., sl.,r.n.,e —.... Amount 440 4116 Wall/ OM
F
r .PLUMBING PERMIT FEES:
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
Lavato 16.60 for each utility connection)
rY 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" 166.660 0 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind _ 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical / Fixture Type: New Moved Replaced Cap ed /
permit.
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
•
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
16.60 Urinal
Other Fixtures (Specify) 7 / Dishwasher
Garbage Disposal
Laundry Room Tray _
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 3"
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater 1
Water Service - each additional 200' 46.40 Other Fixtures
(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
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL
•
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL
Required only if fixture qty. total is > 9
TOTAL $
* 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.
is \dsts \forms\plm - fees.doc 10/10/00
Accumulative Sewer Tally t
Tenant Name: .'r This SWR# T41Q►
Address: I O S t.0 . ` S1.A i This PLM #: PI- 2o0' -OO i5
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
. , # Value Capped off value added # added #s total
Count off #s • count value values
Baptistry/Font 4
Bath - Tub /Shower 4
• - Jacuzzi/Whirlpool 4 .
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1 ,
Eye Wash 1
Floor Drain /sink - 2 inch 2
- 3 inch 5 _
- 4 inch 6
- Car Wash Drn 6
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2 •
- Bradley 5
- Commercial • 3 I &J •
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6
Urinal 6 1(�
TOTALS l O i . e /11
Total fixture values: 4 45/ divided by 16 = 1 1 • 3a- EDU = / 1, 3 1 o't -a-- 1, 1)'i -L• °G •Z epill
HISTORY - ? -13 -o)
PLM# G 7 - - oa - i 3 EDU# /1. S SWR# 9 7- 0.1/ 1 PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# • , EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
i:\dsts\swrtaly.doc
�GV
- ' CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
/ BUP
Date Requested 1" Z AM PM BLD
Location / Z - - ' 54/ (: ? 7 Suite MEC
Contact Person / Ph - 1 7- 7 Z- 3) PLM 2 .6V/ 00 Z9,5
Contractor Ph SWR
BUILDING Tenant/ ner u w I LC
Retaining Wall ELR
Footing
Foundation Access: S y 17Q c% FPS
Ftg Drain Z ��� �6 ��J . ff�'� C Vi
Crawl Drain Inspection Notes:
SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear •
Framing
Insulation
Drywall Nailing
Firewall
v
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
B
Post & Beam
Under Slab 1.74
Top Out
MEM
Water Service
Sanitary Sewer
rn Drains
��'` PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk _
D 7 "_ 49 / Inspector f ✓ Ext
Other —
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.