Permit CITY OF TIGARD
PLUMBING PERMIT
- DEVELOPMENT SERVICES PERMIT #: PLM2001 -00169
°`�'` �� I ° 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/18/01
SITE ADDRESS: 15115 SW SEQUOIA PKWY 100 PARCEL: 2S112DA -00800
SUBDIVISION: PACIFIC CORP. CENTER 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: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Addition of 2 bathrooms and 1 kitchen to existing office building.
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT CTR 5/18/01 $282.20 27200100000
15350 SW SEQUOIA PKWY #300 -WMI 5PCT CTR 5/18/01 $22.58 27200100000
PORTLAND, OR 97224
Total $304.78
Phone 1:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
(hone 1: 236-4152 Water Line Insp _
.+ • :i1Sr !} "- 1 <:Y� . n
Reg #: LIC 172
PLM 26 -83PB
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.
You may , • . • lies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued : . 2 .,(; . 4 / 4, Permittee Signature: a5 i-
Call (503 .39 -4175 by 7:00 P.M. for an inspection needed the next business day
I 7251'5 -� bl _ 2,.. -ou/7,/
M ' • A Plumbing Permit Application
( � . � y of Dafereceived: 9 ' 5 0/ Permit no.: if e& / -O /e- �j
/ " IL : City of Sewer permit no.: Building permit no.:
Ci ty ojTgord Address: 13125 SW Hall Blvd, Tigard, OR 97223
Phone: (503) 639 -4171 Project/appl.no.: Expire date:
Fax: (503) 598 -1960 4_u P,I.00I —,orD// o'L Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
11 PE OF PERM T
0 1 & 2 family dwelling or accessory ..' Co , _ ercial/industrial 0 Multi - family 0 Tenant improvement
O New construction ' Additio ', teration/replacement 0 Food service 0 Other.
J011 SFIE INFORSIATION FF:1: S('II I DI LE (for special information use checklist)
Job address: 15 115 5 U) 5r—Q LI F' Of A- - dwellings Qt'. Fee (ea.) Total
Bldg. no.: I Suite' no.: J y New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map/tax lot/account no.: SFR (1) bath
Lot: Block: I Subdivision: SFR (2) bath
Project name: f 'Block:
P,AGk...4R b SFR (3) bath
City/county: 77 6--4.A. lap: 9as - i Each additional bath/kitchen
Description and location of work oil premises: APO Mar.) d F Site utilities:
a P..>rs7 5 A} evA / k a761. E..i Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLliiIRING CON I RA( Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: D0AM wA - Rkan/ pi436 Manholes
Address: 31 S e / Rain drain connector
City: 1 , ' , • • ,.. Stat.i 0 ZIP: , , _ Sanitary sewer (no. lin. ft.)
Phone: a34,— i{ is a Faxg3( E-mail: Storm sewer (no. lin. ft.)
CCB no.: Plumb. bus. reg. no: Water service (no. lin. ft )
City/metro lic. no.: i gel / Fixture or item:
Contractor's representative signature: / 4 „ Absorption valve
Back flow preventer
Print name: CL Nov „ w Date: ''ate p Backwater valve
CONTACT PERSON Basins/lavatory ✓
Name: C 0/11/1.1 Fe-t-1.-0 ,5 Clothes washer
Address: Dishwasher
City: I State: ZIP: Drinking fountain(s) - ,/ f
Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub /
Name (print): PA- GTP 1. 5 / Garbage disposal d •
Mailing address: / 5'1 S $ IA) STS [A pKW -- Hose bibb
City: 77 6 I SaJ ZW: 9 7M Ice maker ✓
Phonef, — , „• Fax: __,, .t - ?Z i. Interceptor /grease trap
Owner installatibn/residential maintenance only: The actual installation Primer(s) r / a
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) ./ JJ
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet ✓
Address: Water heater .i .
City: I State: I ZIP: Other.
Phone: I Fax: I E -mail: Total 17
$ ,?89, • ao
f Not all juri. ions accept medic cards, ph iori
please cell adiction for more information' Notice: This perm application
Minimum fee Plan review (at _ %) $
C-- 0 Visa 0 MasterCard ex ires if a t is not obtained
Credit card number: / / p Pew State surcharge (8%) .... $ --1A • SS
within 180 days after it has been TOTAL $ 30 y, 7 g
Expires Name of cardholder as own m credit card accepted as complete.
Mown
Cardholder signature Amount , 440-4616 (600000M)
PLUMBING PERMIT FEES:
• , „ . - • P RICE -- TOTAL New 1 and 2- family dwellings only: 3 •
FIXTURES (individ `� Q • (ea) AMOUNT (includes all plumbing fixtures in PRICE ,- TOTAL"
Sink ✓ / 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
16 for each utility connection)
Lavatory ✓ 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 / 3 16.60 SUBTOTAL
Urinal ,/ j 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal t /
16.60 TOTAL
Laundry Tray - 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" ✓ A- 16.60
3" 16.60 0 PLEASE COMPLETE:
4" 16.60
Quantity 131 Work Performed •
Gas piping pingt er ir s a separate mechanical �' Capped
permit Sink
MFG Home New Water Service 46.40
Lavatory kt '
MFG Home New SaN 46.40 Stonn Sewer Tub or Tub /Shower
Hose Bibs • '16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
r/ •� Urinal /.
Other Fixtures (Specify) 16.60 Dishwasher
FD nQ iS ,/ R , Garbage Disposal /
f Laundry Room Tray
C� 114 /:9 14_ ✓ Washing Machine
Floor Drain /Sink: 2" a
Sewer - 1st 100' 55.00 3"
Sewer - each additional 100' 46.40 4 "
Water Heater
Water Service - 1st 100' 55.00 Other Fixtures • •
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55 D QIN me
Storm & Rain Drain - each additional 100' 46.40 t.i.a721 ;yv
Commercial Back Flow Prevention Device 4640 / - e5 f :
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60 1
Inspection of Existing Plumbing or Specially 72.5
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.
i:\dsts\formskplm- fees.doc 10/10/00 •
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 _
BUP
Date Requested `� z / AM PM � BLD
Location /51 /5 $ S11 Suite /°'U MEC
Contact Person Ph 2.1/ 3 � Z — PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear nn
Framing i;) gq(le ,/ QPdw.d /11?$. .A), ► 3 /e( �n�'a&.s
Insulation JJ
Drywall Nailing O r -Cm( a ge r?, r, A J .
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
IN131d�
Under Slab 6 •••
Top Out
Water Service
Sanitary Sewer
Rain Drains
(EPA PART FAIL
L./
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers Alo l-e S i / Co 7 I _ �� F.' H (1 / 716 c07-1
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 = -2-2 _ 3/11 L Ext
e. Ex
Other Date Inspecto
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
POW ( 7- 0 7P '4111pr
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 171
BUP
Date Requested .S- 3 I AM PM BLD
Location /S7/ $ 5) S-r kt I P a- Suite P/ P MEC
Contact Person Ph v g / Z PLM ?mil --G U / (r CJ
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
rte ii
Post & Beam
Under Slab
aVV fer Service
•
Sanitary Sewer
Rain Drains
01 21 PART FAIL
Post & Bea �` fret/ M--e qk S 2 / , S�—e
Rough In /4) cr �' ` cc -4�— (p—se i N k
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service fi ti / tO C c `e
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ I 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 /�
Other Date
Approach/Sidewalk /-6 Inspector 2 � 4 , '"e- ` V ' - Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
3. SW
CITY OF TIGARD BUILDING INSPECTION DIVISION "
MST �"
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested ' Z y AM PM P_4 BLD
Location (,) l / S .S"--/ Se i i_c 4 Suite / � MEC
Contact Person Ph Z >‘• - � � , PLM 2 -/ 47 /
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 OS 0 ,p t Framin A/ a/c� /C'e G� , n d 1 4
Insulation
Drywall Nailing A7? Q e� 1 c{-Pr- /� w)a �"�- ,CQ Firewall Fire Sprinkler n i/ r ` Q /2 aP p u / � d Pc / S"ee l S u-+.' c a to fP r
Fire Alarm /� ",
Susp'd Ceiling t.t) 4 44,- 4 a2e?Ae
Roof P
C . v-�Od APO S dr
� � ia� /oe �' i^ce.'0
Misc: / , •
Final / /
PASS PART FAIL ,4 � ) / e,,., : ✓ e 4 /� Q / � j� -a . ( %� S sG 14 ( v - ' -
• •St & Beam
Under Slab
Top Out
Water Service() i t9'"g
Sanitary Sewer
Rain Drains
I:7 I : 7 1W 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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk ( ' // 6 42 .e t
- EX
Other Date Inspecto c
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.