Permit ' CITY OF TIGARD PLUMBING PERMIT
A- . DEVELOPMENT SERVICES PERMIT #: PLM2000 -00209
" DATE ISSUED: 6/13/00
13125 SW Hall Blvd., T igard, OR 972 -- •503) 639 -4171
SITE ADDRESS: 14945 SW SEQUOIA PK 1 PARCEL: 2S112AD -01000
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 • CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Tenant improvement: Install two (2) sinks, one (1) shower stall, 2" floor drain, water heater, and hose bib.
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY PRMT DEB 6/13/00 $69.00 0002934
13500 SW SEQUOIA PKWY SPOT DEB 6/13/00 $5.52 0002934
SUITE 300
TIGARD, OR 97223 Total $74.52
Phone 1:
- 'Contractor:
POWER PLUMBING CO
P O BOX 23144
TIGARD, OR 97281 REQUIRED INSPECTIONS
Phone 1: 244 -1900 Rough -in Insp
Reg Underfloor /Underslab
eg #: LIC 00052378
PLM 34 -150PB Final Inspection
0
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 -0080.
Yo ay obtain , •ies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Iss d By: 111,1,4_, / r Permittee Signature: .._,
Call (503) 639 -4175 by 7:00 P.M. for an inspection neede the next busi s day
CITY OF TIGARD Plumbing Permit Application Plan eck#
W, I":
13125 SW, BLVD. Commercial and Residential Rec'
OR 97223 Date Rec'd !o 5
(503) 639 -4171 Date to P.E.
Print or Ty Date to DST
Incomplete or illegible applications will not be accepted Permit # - Da7oq
Related SWR #
Called
Name of pkvelopm Project FIXTURES (individual) QTY PRICE AMT
Sink 11.50 eu
Job 4.0._% •tom (2.9.4e..- Gu rZ. .3. s
Address Street Address p l Suite Lavatory 11.50
14 9 4 S $W Se,oua ` �'( 11 O Tub or Tub /Shower Comb. 11.50
Bldg # C Zip C� Shower Only I 11.50 �) S)
.A. \A ,t, OR 112/9 Water Closet 11.50
Nam
9.4_77rySt. Urinal , 11.50
Owner Mailing Address Suite Dishwasher 11.50
Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50
Namesn Washing Machine /Laundry Tray 11.50
lle0 eS1 tJ Floor Drain/Floor Sink 2" I 11.50 /),S'O
Occupant Mailing Address Suite 3" 11.50
I L VI L IC SW Seij ,upta. Ylit 110 4" 11.50
City / tate Li Phone •
YO % ®Q„ 91 2.2-9 Water Heater 0 conversion A like kind 11.50 ) 1
- Gas piping requires a separate mechanical permit.
l \ MFG Home New Water Service 32.00
a ov9 tr. w wJ0 I tv ct
Contractor 41ailing Address Suite MFG Home New San/Storm Sewer 32.00
Y0 vgyi$6 Hose Bibs / 11.50 J /,Sy.
Prior to permit City/Late Zip Phone Roof Drains 11.50
issuance, a copy Vc i,,,0 ®i2- 9 - 12.50 .44 -\goo Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if 5: 1 &) /)2 -O ( Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Ex . Date
database 34-(SO �Z 6- -30 -O(
Name
Architect _ Sewer -1st 100' 38.00
Or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City /State Zip Phone
Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commerci4
I descri ion of work:/ Commercial Back Flow Prevention Device 32.00
T Z ' 017 r � / � �/ Residential Backflow Prevention Device' 19.00
ae /o-sti liyE Catch Basin 11.50
Are you capping, moving or replacing a y fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Ye No 0 Inspections per/hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL / fcl
I
hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9 ( 1
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL pm
that plans submitted are in compliance with Oregon State Laws. /_q
(gnat o f er /Age w �\ Date ��0 8% SURCHARGE ``��
S.
Co c Persona ) Phone
�� �b e1 , c\ a44_ (cf00 '*PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 • Required only if facture qty. total is > 9
2 BATH HOUSE $250.00 TOTAL /�t7 J71/752- 3 BATH HOUSE $285.00
(This fee Includes all plumbing fixtures In the dwelling and the first *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
100 feet of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I:tdstsVormstplumapp.doc 11/18/99
•
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced RemovedlCapped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
Rose- \:),`o`o
•
COMMENTS REGARDING ABOVE:
•
I:ldstsVormslplumapp.doc 11/18/99
G Accumulative Sewer Tally
Tenant Name :` C O e S/ V) This SWR#
Address: j Lf c 5cJ �C��n; i kt.JvJ I.,; k This PLM #: .
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 r cZ
-3inch 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 1 . a
Sink - Bar /Lavatory 2
- Bradley 5
- Commercial • 3 / ( erVE) 3 '/. 3
- Service 3 •
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6
Urinal 6
TOTALS 7 13�
/ ' 1d V7 Ce.
Total fixture values: / 3 divided by 16 = � I y EDU N
p
HISTORY fee j -od
PLM# EDU# 7( SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
i:\dstslswrtaly.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 7- 2g? AM PM BLD
Location /c011 r 5 W .So3 wG! -A- Suite . /.0 ( 1 MEC
Contact Person Ph PLM 2 ^ 0 6?
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation c l //a e /0 L FPS
Ftg Drain f ( SGN
Crawl Drain Inspection Notes:
Slab SIT Ar, -
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
1SS PART FAIL
(PLUM
Post & Beam
Under Slab
o• •
e iWirlegri- 1
anitary Sewer
Rain Drains
401 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
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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA /
Approach /Sidewalk D Inspector /� Ext
V
Other i � fi'
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
_ BUP
Date Requested AM PM BLD
Location / Y cep 54.0 Sq .Q Suite / 70 MEC
Contact Person .11 J A Ph 2V (9& PLM 2 0-vd 06 -
Contractor Ph 7376 30 / SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing i
Fire wall O � AA _ AIM
Fire Sprinkler � —L _ �� � -� � �j� ��
Fire Alarm /
Susp'd Ceiling %jam %4P� ��
Roof
Misc: 4111�/./� ,I Ar_dilla
Final /
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains ,
SS PART /A
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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date 7/S/Z Inspector l ? ' / Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ `/ BUP
Date Requested �/ / `'( 00 AM 1C PM BLD
Location L /C lJ ^ -- Suite )7 0 MEC
Contact Person Janie Ph 2 y H 960 PLM /600 - ODZOc7
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
MBI G�
P
ost & Beam
Under Slab
op Ou
a er Service
Sanitary Sewer
Rain Drains
Final
'92? PART FAIL
- 1ANICAL
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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date t" Inspector /l�
Final EXt `'�
t
Other fir( � � 1.
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.