Permit -v c;v 0z/ to/o_did,(/) /BB
CITY F TIGARD PLOMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00335
' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/16/2004
SITE ADDRESS: 15230 SW SEQUOIA PKWY 100 PARCEL: 2S112DA -00300
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: M FLOOR DRAINS; 22 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 5
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Remove and cap off plumbing fixtures. Other fixtures are: (4) primers and (1) grease trap, 1 rough in for
future. EDU credits to apply to future fixtures. 7 -26 -04 add rough -in only for future. EDU tally not required at
this time. Per Gary L.
FEES
Owner:
Description Date Amount
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 7/16/2004 $125.00
PORTLAND, OR 97224 [TAX] 8% State Surcharl 7/16/2004 $10.00
[PLUMB] Permit Fee 7/26/2004 $16.60
[TAX] 8% State Surcharl 7/26/2004 $1.33
Phone:
Total $152.93
Contractor:
ADDISON PLUMBING
17506 SE RIVER RD.
MILWAUKIE, OR 97267 REQUIRED INSPECTIONS
Phone : 503 - 785 1840 Insp existing /capped fixtures
Final Inspection
Reg #: LIC 151754
PLM 3 -449PB
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.
Issued By: I . o� Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Buili"ng Fixtures . .
Y�uinbing Permit Application FOR OFFICE USE ONLY
City of Tigard Date/By: 7 Iii eV Permit No.:'j k - • 565"
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
/i
Phone: 503.639.4171 Fax: 503.598.1960 /ft/1/4 $161P $161P Date/By: Pen
nit Other Peit No.:
� ``
24- Hour Inspection Line: 503.639.4175 „ • 14. 1 l °•I Date Ready/By: Juris' ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: let if , Supplemental Information
.,, ..._.,a s „ , .. m <�° - ` t� 6 .;.,,r '�,�_ tt.,:}.... _ . .
❑New construction For special information use c hecklist
IN Demolition
Description I Qty. I Ea. 1 Total
❑ Addition/alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
' a , `L ,, E " t g i SFR (1) bath 249.20
"' k ..r.,. be - ,. . ,, ,
❑ 1- and 2- family dwelling IN Commercial/industrial SFR (2) bath 350.00
El Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
„ Fire sprinkler (- sq. ft.) Page 2
Site utilities
Job site address: 1S Z30 Sw S ,.c e W.1i O. Catch basin or area drain 16.60
City/State /ZIP: Par -f ic, (3 ,0_ co 27J/-
Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I Project name: qvo ks(n r1/4,„, }wca- Gmtt
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
1 , Absorption valve 16.60
wb C 6 O a i' 's' ' $ q
A.ezn , d r . ; . , ')� ''.O� Backflow preventer Page 2
g-P_.w.,, ,.z cx,- .1- d cair Po. S: wk S, rk., .,�. S Backwater valve 16.60
II ■ s�.wa�..� t f� w,c-„r ‘4"-`1S1 �� 1 O"--J (:".°"4-(4L- l Clothes washer 16.60
Dishwasher f 16.60 4(,,,,
l , Drinking fountain 16.60
Ejectors /sump 16.60
Name: 1) ` Cv\... Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/ State/ZIP: Floor drain/floor sink/hub 2-L, 16.60 365:2
Phone: (J C6 � , ix, _ r • Fax: ( ) Garbage disposal 16.60
- , , _ X11 7 .. � 11:S n Hose bib 16.60
,. ,,: �_ " ` ., Ice maker 16.60
Business name:
Interceptor /grease trap 16.60 A, .. 6d
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 1 16.60 6 , 4.0
City/ State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 2_ 16.60 33.2-0
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
' ' Water closet 16.60
Business name: Adcsm., e \vv.>s,;,,,,, I.LC- Water heater 16.60
Address: % Vilto SC gZ;vGr et Other:
City/State/ZIP: 1M ; \ ura 0'. cy-1�1 Subtotal -
Minimum permit fee: $72.50 , AO
Phone: (Sn'3 )1r - - \Kelp Fax: (5 )74, --d`-41 Residential backflow minimum permit fee: $36.25
CCB Lic.: t S t 7 S1. Plumbing Lic. no.: 3 - 4441.7 QQ Plan review (25% of permit fee)
State surcharge (8% of permit fee) 18.40
Authorized signature: � ,zfenr_\ -A- TOTAL PERMIT FEE /26
Print name: J a , 1/44. v . r - 2 Date:1 1(, - 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.
i:\Building\Pemrits\Pt,M .PemitApp.doe 12/03 440- 4616T(IO /02/COM/WEB)
t
Plumbing Permit Application - City of Tigard
•
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Su a pression Systems:
�� t Fe .
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 S stems:
Water Service - each additional 100' 46.40 9 �
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
sr Y additional $100.00 or fraction thereof, to and
1„ ? _ .n ' e 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
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
_ rt 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" 'vL
-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 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 Plan review is required if fixture quantity total is >9.
Urinal
Other Fixtures: G . Teti P 1
Qr■w..x veal H
is\ Building \Pertnits\PLM- PemmitApp.doc 3/03
Accumulative $ewer Tally Parcel # ,
Fer c a tAf tg sit,6000 Y This SW R# f<i K W r
6.
ait 4.. P0;0y0 ... .. . , This PLM# ;2(00035,, . < i. ,.. , . .
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 ', 4 0 �, 0 0 0
Bath - Tub /Shower 4 s y 0 k
- Jacuzzi/Whirlpool _r 3 0 0
Car Wash - Each Stall 6 , 0
- Drive through 16 • A 0 r 0 ;.
" 0 0;,Ie 0 0 0
Cuspidor/Water Aspirator 1 ', r • 0 Wi 0 :44:'`,04-6;F'' i 3 0 0 0
Dishwasher - Commercial 4 r t 0 .'' 4 0 -1 -4
- Domestic 2 ,# :;> 0 0 0 0
Drinking ountain 1 0 : nom,
0 ,�� ��� rte.
9 0 r 0 0 0
Eye Wash 1 : ry x.Y�. 0 ., 0 'moo , 0 0 0
Floor Drain /Sink - 2 inch 2 0 `mg 44 .5 0 -22 -44
4 ; ;mw is
-3inch 5 111 0 � `x 6:140 0 0 0 0
-4inch 6 0 3' 0 s � �r 0 0 0
- Car Wash Drr 6 3 v „�eg, �` 0 .,`" h 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 F, 0 n .i ,� = 0 u 0 0 0
- Commercial (to 5 HP) 32 " 0 44 0 < �� = 0 0 0
- Industrial (over 5 HP) 48 : 0 ' ., 0 1:::: ` 0 0 0
Ice Machine /Refrigerator Drain 1 ` * , 0 x ,t 0 ;' 0 0 0
Oil Sep (Gas Station) 6 � 0 mss 0 5 a F , t 0 0 0
3e aug.t 'i ti ,
<= 0 0 0
Rec. Vehicle Dump station 16 ..::' 0 ;."5,- 0�
Shower - Gang (per head) 1 g k 4 0 � � . 0 t �. 0 0 0
Stall 2 y r v , ':.
` ' 0 z.r m z 0 . 0 0 0
Sink - Bar/Lavatory 2 � a -_ 0 �i�� ° 0 � 0 0 0
- Bradley 5 0 44 0 i t ' l l ' ' . ; : * . , : 0 0 0
- Commercial 3 0 °" 6 A ,� �. "` ` 0 -2 -6
- Service 3 0 Iz}� 0 0 0 0
Swimming Pool Filter 1 0 0`;, 0 0 0
Washer - Clothes 6 0 0 >x`a 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 -> 0 0 `t 0 0 0
f • Urinal 6 � t , , 0 • r 0 ,; 0 0 0
Previous EDU Count 0 0
Capped EDU Credit � g 0
TOTALS _ 0 0 25 54 0 0 -25 -54
Current Fixture Value -54 divided by 16 = -3.4 Current EDU 1 EDU = $ 2,500
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -54 divided by 16 = -3.4 over (under) $ (8,500.00)
Enter EDU Change Here , „ T., CAwa—
Notes: ** *CREDITS * ** its for fig u demo'd d - to change of use from restaurant to retail.
ignature: , / .;1 . 'S L_'../L} ,/„__; Date: /64
Buil• - g 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 11/19/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection tine: (503) 639 -4175
INSPECTION DIVISION Business" Line: (503) 639 -4171 MST
BUP
Received Date Requested ° i 21 y AM PM BUP
Location I S2 3 0 sPci u o is Pktv l 00 Suite MEC
Contact Person Ph ( --03 ) 3 2D r6 a t PLM 2o6` 003. 5
Contractor A Sots. Ph (S ) - 7 U 0 V I 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 C ' w �.. i ..� � Q ✓r- f Ca- 0 Ffc- 4— Ot--c- c�-�c�✓�
Insulation �� /
Drywall Nailing 10 1.. i ,- � nUg L . � �. C ( o ` L 0 FE 1,--
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
RT FAIL
LUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fi -
PART FAIL
M 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 Please call for reinspection RE: 111 Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date (`, l7'-i Inspector . Est
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL