Permit CITY TIGARD PLUMBING PERMIT
411, �, DEVELOPMENT SERVICES PERMIT #: PLM2004 -00436
SII 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/29/2004
SITE ADDRESS: 12288 SW SCHOLLS FERRY RD PARCEL: 1S134BC -00300
SUBDIVISION: GREENWAY TOWN CENTER 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; 5 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 4 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 0
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing rough in & finish. VERIFY ALL CAPPED FIXTURES AT INSPECTION: (1) drinking fountian, (6) 2"
drains, (4) sinks, (1) lay & (2) water closets.
FEES
Owner:
Description Date Amount
BPP RETAIL LLC
BY BURNHAM PACIFIC PROPERTIES [PLUMB] Permit Fee 9/29/2004 $199.20
ATTN: JOHN WATERS [PLMPLN] Plan Review 9/29/2004 $49.80
SAN DIEGO, CA 92101 [TAX] 8% State Surchari 9/29/2004 $15.94
Phone : Total $264.94
Contractor:
CASCADE PLUMBING CO.
2630 N HAYDEN ISLAND DR SP #3
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone : 503 Underfloor /Underslab
Top -out Insp
Reg #: LIC 120893 Final Inspection
PLM 34 -412PB
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 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issue By: ��►►` ./Kee' Permittee Signature
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures EIVED -� °2 " OG // 06 �� O
,. QQ
'
Plumbing Permit App'1�c11 FOR OFFICE USE ONLY
City Of Tigard 2� Received 9 Permit
SW Hall Blvd., Tigard, OR 97223 SEP 2 Q I DateDate/By: y: J , ZQ t 19 C.1/ P it N. (, \V�' 00 / J (
g Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIG 112410 <J� Other Permit No.:
� i - %� „ �. : j Date/By: Date/B
24 Hour Inspection Line: 503.639.4175 r il • I I I Juris:
.,„ . W D ate ed /Met Ready/By:
!3 See Page 2 for
Internet: www.ci.tlgaz BUILDING L DING DI ,,, Notified/Method: )1V Supplemental Information
._ il . u.,:a : , .7 i' .� .� ,' ,,nom 7.1.Z.an.;lk :a, ...'# , _ , .-, � W ,, ,,,.
❑ New construction ❑ Demolition For special information use checklist
Description Qty. Ea. Total
• Addition/alteration /replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
• �ls' - -: ' a t^ , -- {.' * 1 ' 3 1 5 re `'' ,, Din SFR(1)bath 249.20
❑ 1- and 2 - family dwelling / i Commercial/industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler (- sq. ft.) Page 2
. 'j1:1;.-;•-_2j:. ' _® 1th . . 2 „e`l * , , '4't a. Site utilities
Job site address: 1 Z 2 as S St -,kol Is 1 ( 6. j R Catch basin or area drain 16.60
City/State /ZIP: 7 1 5d r 0 g-Q „ \ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Cold S -f -t,Ae CWedvh€i1' Footing drain (no. linear ft: ) Page 2
I 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
�. ? ya _ ,- 7i, ,KK , ,. yam . ' � �.. -.;w * .s 1 Backflow preventer Page 2
lC1 • - ^5 Kd i N. Ci r Fz ix - Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
r Drinking fountain 16.60
,, , ". -. ..' , '...'!":1..7".:. m'. 8 ,. a f ,, ,, ,, '. Ejectors /sump 16.60
Name: \I-\\c, Est- j t SS Q) Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub ,I, u 5 16.60 73
Phone: (TOY) Fax: ( ) Garbage disposal 16.60
Hose bib 16.60
16.60
Business name: C 1k5.. d• - 0 (um. .. • I n 5
Interceptor /grease trap 16.60
Contact name: &d f t.y �,\ (■ Medical gas (value: $ ) Page 2
Address: !. 3 Q N c1 1.3 ap \ i s', of 3k e I ► az 3 Primer 16.60
City/ State/ZIP: port ,Q 4u U cl 7 2 1 7 Roof drain (commercial) 16.60
Sink/basin/lavatory fl 1- 5 16.60 3 0
c s 3 ) s 7 (51 3) Z� -66 l
Phone: 6 Fax: -
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
srt 7 j *
.� 2 I, ,,. : 4 . ' . � 4 a Water closet 16.60 b U
� .. t : iz�?. 1 e ` asp .� , ,
Business name: C d, cd lte f (v11 ;Ay y Water heater I 16.60 ) -6 , ( D
Address: z6 30 A) flay Se" S5 • Q( ive SPerc 3 Other:
Subtotal
City/State /ZIP: pp(t14 N 0 4. 7 2 I7
Minimum permit fee: $72.50 ,., �l 5
Phone: (503 ) 54-4 - 7 4-6 q- Fax: (,03 ) L C 4' 9 - 6 6 7 q Residential backflow minimum permit fee: $36.25 / / 9 • L
CCB Lic.: I 1 3 Plumbing Lic. no.: 34- t}{ Z p6 Plan review (25% of permit fee) y g,
State surcharge (8% of permit fee) ! "91'f
Authorized signature: 4,/a N' ` TOTAL PERMIT FEE O (/, 9 t /
Print name: 1 41 A gv_ 0 05 prCw Date: 9 -00 - 69- 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.
is\ Building \Pemtts\PLMF- PertnitApp.doc 12/03 440- 4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard �•
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
` f ...._
$x� tiTaCfi �., � z . , ~ age yermit.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 •
Storm & Rain Drain - 1st 100' 55.00 " � 1'�'- Per
$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
g d ,
t , additional $100.00 or fraction thereof, to and
at ta'� �`'
�� m� 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 * .
.r.
°� � 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 2" C 6
- 3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach. /Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
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 5 5 Quantity Total
- Bradley Isometric or riser diagram is required if fixture quantity
- Commercial
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet I 02 Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 3/03
®ems ! s r �a�
�? Accumulative Sewer Tally Parcel # _�, �x
ti
„ ' ;?: � � � ;� . kt-Ot - �g This SWR# ' :� �� ! �'
r � ,
` "f.: r f 0y s' F ;, ` .,.. `,- This PLM #: � t 6 , 3 . F
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 g . ' r
� �^� i
rte' 0 x �c 4 0 � ��w: 0 0 0
Bath Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 01 ;','''''''W::;'::'.,''',-'`..: '. 0 0 0
Car Wash - Each Stall 6 i , ,, 0 h 0 i,-
g :r 0 0 4 '' 0 0 0
Drive through 16 �F? u' '�
Cuspidor /Water Aspirator 1 Vu :: 0 w, 0 Stems 0 0 0
Dishwasher - Commercial 4
J i `
- Domestic 2 7,1714N WP 0 0 `.
Drinking Fountain 1 F 0 to 1
Eye Wash 1 0 'OF ' 0 , -* 0 0 0
Floor Drain /Sink - 2 inch 2 f G4fi 0 t 12 n;�s 10 -1 -2
3 inch 5
4 inch 6 ''�` 0 r , Y , , „� r 0 � � 0 0 0
- Car Wash Dm 6 4 ='' 0 , � 0 ',� 0 0 0
Garbage Disposal
Domestic (to 3/4 HP) 16 ,4 0 0 0 0 0
- Commercial (to 5 HP) 32 3� 0 k ,t` 0 1 0 0 0
- Industrial (over 5 HP) 42 bV 0 `, 0 f .: 0 0 0
Ice Machine /Refrigerator Drain 1 j' 0 r 0 � 0 0 0
Oil Sep (Gas Station) 6 1 a 3 - �”
0 ,.'' 0 0 0 0
Rec. Vehicle Dump station 16 :' 0 0 '6 0 0 0
• Shower - Gang (per head) 1 0 r� 0 f� :' s 0 0 0
- Stall 2 '� 0 " 0 R 0 0
0
Sink - Bar /Lavatory 2 0 <� 5t a 2 ' : 2 0 0
- Bradley 5 .i : 0. q � 0 V 0 0 0
- Commercial 3 , „ , Y 0 r� 9 .
9 0 0
- Service 3 3 0 3 3 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 . A f 0 ; 5 0 s ' 0 0 0
Water Extractor 6 � � 0 � � ' ": 0 0 0 0
Water Closet Toilet 6 s 0 �� 't•
�� , 12 S 6 -1 -6
a
Urinal 6 ;do. . . : 0 f 0 ' Sh 0 0 0
r /z 4 ',o;
Previous EDU Count 0 0
Capped EDU Credit Credit :"7 0
TOTALS 0 0 14 39 11 30 -3 -9
Current Fixture Value -9 divided by 16 = -0.6 Current EDU 1 EDU = $ 2,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -9 divided by 16 = -0.6 over (under) $ (1,500.00)
. Enter EDU Change Here 14y0•.6
Notes: CREDITS!!!
. III H
• ignature: I IIIINIRMIIIIIIII/FACTAL ► ' Date: 1 1
Buil'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.xls 7/1/04
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION 4 Business Line: (503) 639 -4171 MST
BUP
Received // Requested lr' 3 AM PM BUP
Location r g b Fe Suite _ MEC / /
Contact Person Ph ( ) ���Y PLM �'1 �% �
Contractor Ph ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation 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 j
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 /P i
Storm Drain —
Shower Pan = p
Other:
tplIP
S PART FAIL
HANICAL
Post & Beam
Rough -ln
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 ti 6 Inspector �' , P'' y, h Ext
Other:
///
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL
•