Permit CITY OF TIGARD
4144 I ,
DEVELOPMENT SERVI F , ERMI 'LUMMBING PERM PLM98 —Oi43
IT
DATE ISSUED: 05 /22/98
PARCEL: 25112DA -00800
SITE ADDRESS...: 15115 SW SEQUOIA PKWY #200
SUBDIVISION ZONING: I —P
BLOCK LOT ° JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -COM WASHING MACH 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:B FLOOR DRAINS 0 TRAPS : 0
STORIES ° 0 WATER HEATERS - 0 CATCH BASINS ° 0
FIXTURES LAUNDRY TRAYS ° 0 SF RAIN DRAINS ° 0
SINKS . 1 URINALS ° 0 GREASE TRAPS ° 0
LAVATORIES 0 OTHER FIXTURES 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS ° 0 RAIN DRAIN (ft)...: 0
Remarks: Add a sink to a commercial tenant space.
Owner: FEES
NW EVALUATION type amount by date recpt
15115 SW SEQUOIA PARKWAY PRMT $ 25. B 05/22/98 98- 305989
SUITE 200 SPCT $ 1.25 B 05/22/98 98- 305989
TIGARD OR 97224 -
Phone #:
Contractor
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND OR 97202
Phone #: 236 -4152 $ 26.25 TOTAL
Reg #..: 000001
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Misc. Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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 ',∎', 1-0010 through OAR 952 - 0001 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
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Issued By: re L--/ Permittee Signature:
+++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + ++ + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY'OF TIGARD Plumbing Application Recd Sv 4 417 `
12,4'25 SW HALL BLVD. Commercial and Residential Date Recd J
P E.
TIGARD, OR 97223 CJ1e to
Date to DST
(503) 639 -4171 Permit *Pe -17. Print or Type � Related SWR a V /9'
Incomplete or illegible applications will not be accepted called 5 -R /- q.4j
Name of CevelopmenuProlect FIXTURES (Individual) QTY PRICE AMT I
Job Jvw Fv�t L.di.411 ors' Sink /_ 9.00
S:: eel Address Lavatory 9.00
Address Su ite
I Sj 11 5 S W Se.Q/, D v rub or ruo,Shower Comb.
9.00
31,1g . City/State Zip Shower Only 9.00
Nom - T/ 6:4Y n� Water Closet .. 9.00
Dishwasner
1� GT1. t,1. S l 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
Washing Machine 9.00
Ca/State Zip Phone Floor Drain 12- I 9.00
toay -(v3 3. 9.00
Name
S A 4. 9.00
Occupant Mailing Address Suite Water Heater I 9.00
Laundry Room Tray 9.00
City/State Zip Phone Unnal
I 9.00
Name Other Fixtures (Specify) ' 9.00
I BEAK wA ik, E iry ,PL a Cr 9.00
Contractor Mailing Address ' Suite I
� 9.00
3t11 S, / 3- 9.00
(Prior to issuance �tyrState Zip Phone
applicant must n 41 - � v^ or 9 7 4 436_& (SR, 9.00
•ice all Oregon Const. Co n Bard Lic.s Exp. Date 9.00
3C.OM a' to T3 / � Ciigl9g '' 9.00
license Plumbing Lic. ae Exp. Date Sewer - 1st 100' 30.00
information 0 t 7 a, 1 a1 4319 FI ✓
for COT COT Business Tax or Metro Exp. ate Sewer - each additional 100' 25.00
tla[ abase). 1 4 Q 1 1 a / 1 qo Water Service - 1st 100' 30.00
Name /0 Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 100' 30.0
or r Mailing Address Suite Storm & Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
Engineer City/State Zip I Phone Commercial Back Flow Prevention Device or Anti- . 25.00
Pollution Device
=esc• ^.be work New 0 Addition .7.; altera ion 0 Repair C Residential 3ackflow Rrevention Device' • I 15.00
:c ce acne: Residential 0 Non - residential I Any Trap or Waste Nct Connected to a Fixture
)cdit :onai aescnotion of wont
4.00
Catch Basin 9.00
/A/S779 OA/& /k/E S 7^//1 , insp. of Existing umbm9 I 40.00
Peihr
Existing use of Soedaily Requested Inspections l 40.00
:uilcing or property r! �/ x� ale e -L. SALE S 30. Rain Drain. single family dwelling I 30.00
'rocosed use of Grease Traps I I 9.00 I
owicing or property Sin -.. _.
QUANTITY TOTAL I I
Are you capping . moving or replacing any fixtures? Yes L Nog IsOrr:emC or user :iagrart •5 .�uiretl I Cuaruty "%tai is > B
(If yes see back of forth) / ` 'SUBTOTAL oS
' hereoy acknowledge that ; have read this application, that the information
given is correct. that I am the owner or authorized agent of the owner. and 5% SURCHARGE I
:hat clans submitted are :- compliance with Cregon State Laws.
Signature of Ow ri ent Date PLAN REVIEW 25% OF SUBTOTAL I r /
/ ?eoured oniv if ct % ure :Cacti is > 3
5 oZ I I c
8
I TOTAL `-���d'�
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Contact Person Name Ph ne B� r
6 ll 'Minimum permit fee is 325 - 514 surcnarge. except Residential Backflow
--- 4. F "-/p./ I Q31, -- ills Prevention Device. w^ica1 is 315 - 5% surcnarge
i :ldsts'.plmacp.doc 3/96
CDIUlAr ,per
'LEASE COMPLETE AS APPROPRIATE TO PROJECT:
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I Fixtures to be capped, moved or replaced I •
Sink / �/✓���
j Lavatory
I Tub or Tub /Shower Combination
Shower Only
Water Closet _ ,.
Dishwasher
Garbage Disposal ^�
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
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:OMMENTS REGARDING ABOVE:
1
,, II '' t/ II 11 Accumulative Sewer Tally •
;Tenant Name:MG cd AL U," 77 &Pt/ This SWR# ■ 14-) / 9 " eP //.
Address: 57/5 s 6) S'E Quo iA # o 6 This PLM#: POI/ q - O/ 4 /3
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 i
Bath - Tub/Shower 4
- JacuzzWVhiripool 4
Car Wash - Each Stall 6
- Drive Through 16 -
Cuspidor/Water Aspirator 1 - -
Dishwasher - Commercial 4
4 •
- Domestic 2
Drinkin • Fountain 1
Wash - 1
Floor Drain/sink - 2 inch 2 •
- 3 inch 5 ,______,
- 4 inch 6 •
- Car Wash Dm 6 .
Garbage Disposal 16
Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48
- -• -• Ice Machine/Refri • erator 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 ' - / 3 1 3
- Service 3 '
Swimming Pool Filter 1
Washer - Clothes ' 6 -
Water Extractor , , 6
Water Closet - Toilet 6
Urinal 6 '
TOTALS -3 D 3 G3
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Total fixture values: 3& 3 divided by 16 = c772 lr9 EDU R.3
HISTORY - Ajd sefed E D# s
PLM# 9 4 - o// 7 EDU# - ,- 3 • SWR #9 -- -oR y PLM# EDU# SWR#
PLM# 9 6 -o. // 6 EDU# as SWR# 96, -0gy/ PLM# EDU# SWR#
PLM #,�'- - 9� EDU# / SWR #,� ,q PLM# EDU# SWR#
PLM# EDU# SWR# • PLM# EDU# SWR#
i:ldstMswrtaly.doc
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Page No '1" - ' + - - + CASE ,HISTORY' FOR CASE NO. PLM98. -0143 - - ,
r _ NW EVALUATION Y. • J • - 15115 SW SEQUOIA .. Unit: 200
07-/24/98 ' - •
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Action 'Description Reg/ ' r Schd/ End /' Action Notes Disp By Update • -Upd. ,
,Code - Sent Dane - Done 'Date ._.. :•'": •
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,..'PIMC003''Application received / / / ,/ 05/22/98 • RECD`DLH 05/22/98 GEO
- ','BLMC005 Permit Created / / / / 05/22/98 DONE GEO 05/22/98 GEO
PLMC040 (F) Ready to issue / / / / .05/22/98 no change to EDU count, no addn sewer PASS GEO 05/22/98 'GEO
fees. ;' .
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''PLMCO50 (F) Issue permit / / / / 05/22/98 PASS B 05/22/98 DST.., '
- _,''PL,MC715 Rough, in Inep / ,/ . / / 05/29/98 • PASS TLP 05/29/98 J *H
''PU C799 Final Inspection - ,.,05/22/98. / / 0_6/22,/98 -'.. - PASS TLS' 06/23/98 J *H .
PLMC800 Case Finaled '-/ / �/. .% ,06/23/98 - _ • TLP 06/23/98 J
*H
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CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: (0 )'' S A.M. A P.M. MST:
Location: (5 ` 15 a,0
J k- BUP:
Tenant: S uite: c) Bldg: MEC:
lJ �cJ
Contractor: Q;A/I,e/12 eizit'`-- Phone: /zl(Q.4 ■ 5 I PLM: ci A
Owner: Phone: ELC:
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ELR:
(( tt,�, SIT:
BUILDING ''' I. i con't) PLUMBING MECHANICAL ELECTRICAL SITE
Site •ost/Beam Pos eam Post/Beam Cover /Service Sewer /Storm
- Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
. Foundation Insulation Sewer Hood/Duct Reconnect Vault
• Bsmt Damp • Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt
Approved L..pproved Approved Approved Approved
Appr /Sdwlk Not Approved lkig _ - Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL
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O Call for rein 0 Reinspection fee of $ required before next inspection 0 Unable to inspect
Inspector: Date: . ,� — /�� Page of
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