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Permit r CITY OF TIGARD PLUMBING PERMIT PERMIT #: PLM2000 -00471 s;��l� - 13125 DEVELOPMENT H BMEN9 Tigard, ) 639 -4171 DATE ISSUED: 1/9/01 SITE ADDRESS: 15350 SW SEQUOIA PKWY 100 PARCEL: 2S112DA -01400 SUBDIVISION: PP1996 -048 ZONING: I -P BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; 2 TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: 3 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: 1 RAIN DRAIN: ft Remarks: Tenant Improvement - New Fixtures: 2 sinks, 2 lay's, 1 dishwasher, (2) 2" drains, 1 water heater, one ice maker and 2 primers. FEES Owner: Type By Date Amount Receipt ' PACIFIC REALTY ASSOCIATES PRMT CTR 1/9/01 $182.60 27200100000 15350 SW SEQUOIA PKWY #300 -WMI PLCK CTR 1/9/01 $45.65 27200100000 PORTLAND, OR 97224 5PCT CTR 1/9/01 $14.61 27200100000 Phone 1: Total $242.86 Contractor: MODERN PLUMBING 11120 SW INDUSTRIAL WAY TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone 1: 691 -6166 Rough -in Insp Top -out Insp Reg #: LIC 87906 PLM 34 -250PB Finallnspection 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. o` You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. c; Issued By: A-0 Permittee Signature: \ .ark _2 Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Plumbing Permit Application • 1 _ I f 1. , ! . , 4, . 1 , D ate received: / a_ a ,, Permit no.: ,'(i ,,, ii. T . ' Ci of Tigard Al -. `� Sewer permit no.: 4 , /039 Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 CityofTigard Phone: (503) 639 - 4171 Project/appl.no.: Expire date: Fax: (503) 598 - 1960 Date issued: By: Receipt no.: • Land use approval: Case file no.: Payment type: TYPE OF PERMIT ;I { I` 1 ;: ' T 01 I,_ ❑ 1 & 2 family dwelling or accessory lir Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION 1 , M. FEE SCHEDULE (for special Information use checklls t)'J1 :1 Job address: / Description Qty. Fee(ea.) Total • 5- • -,.� Bldg. no.: 4 1 Suite no.: New 1- and 2- family dwellings only: Tax map /tax lot/account no.: (includes 100 ft. for each utility connection) SFR (I) bath Lot: I Block: I Subdivision: SFR (2) bath Project name: 5f,4-r 47oC 5 SFR (3) bath City /county: 77 gA I ZIP: q 7 . Each additional bath/kitehen Description And lkation of work on premises: / Vil W) d' Siteutilities: Set v . i - ti Q Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain PLUMBING CONTRACTOR, Footing drain (no. lin. ft.) • Manufactured home utilities Business name: J 0,06e /0 1.7 b/✓7 Manholes Address:hi /Z(J SLV T./I�U, i4a-L LUn- Rain drain connector City:TjAit) State:Lf, .ZIP: ( 7 Sanitary sewer (no. lin. ft.) Phone:,'/-/(, I Fa , / --&77 E -mail: _ Storm sewer (no. lin. ft.) CCB no.: • • AP, • Plumb. bus. reg. no: : r •�,- Water service (no. lin. ft.) City /metro lie. no.: a[i Fixture or item: !p . Contractors representative si:nature: `, Absorption valve Back flow preventer Print name: • t , - ._ , Date: tZ '9 -00 Backwater valve CONTACT PERSON • ; ' Basins/lavatory / 2 ■' .2 Name: Clothes washer Dishwasher 1 J 4,40 -- Address: Drinking fountain(s) . City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture/sewer cap Floor drains/floor sinks/hub ✓ 2. , .2./ Name (print): Garbage disposal Mailing address: Hose bibb • _City: • I State: I ZIP: • Ice maker ✓ / .71‘ Phone: I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) 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) t ,7 , 960 Owner's signature: Date: Sump I� t Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater / (o, ( City: I State: I ZIP: Other: Phone: I Fax: I E -mail: Total // f .': ' Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ !�i�� k' / �� if5 %) YS' ❑ Visa ❑ MasterCard Plan review (at G/ p?S /o) $ expires if a permit is not obtained r _ Credit card number: / / State surcharge (8 %) $ / Expires within 180 days after it has been _ , Name of cardholder as shown on credit card p accepted as complete. TOTAL $ _ !!!��!"� , ' Na. w Cardholder signature \. Amount 440 -0616 (6/00 /COM) 4- PLEASE COMPLETE: :FIXTURES • (individual) c Qty. 'Fti Total Sink 16.60 . .. Fixture Type Quantity by Work Performed �, New Moved Replaced RemovedlCapped Lavatory 16.60 Sink al Z 3 • it Lavatory Tub or Tub /Shower Comb. 16.60 Tub or Tub /Shower Combination Shower Only . 16.60 Shower Only Water Closet . 16.60 Water Closet Urinal Urinal 16.60 Dishwasher / -_ Dishwasher 16.60 Garbage Disposal W. �' Laundry Room Tray Garbage Disposal 16.60 Washing Machine Laundry Tray 16.60 Floor Drain /Floor Sink 2" _2 3" Washing Machine 16.60 4" - Floor Drain/Floor Sink 2" v . 2 16.60 e.'20 Water Heater / Other Fixtures (Specify) 3" 16.60 ..2-c4 rno jr _L._ 4" 16.60 _ Water Heater 0 conversion • like kind / 16.60 - - -- - -- - -_ --- - - - -- - -- Gas piping requires a separate mechanical permit. ✓ / (p. ^ • - MFG Home New Water Service 46.40 MFG Home New San/Storm Sewer 46.40 COMMENTS REGARDING ABOVE: Hose Bibs 16.60 Roof Drains 16.60 • Drinking Fountain 16.600 G10 Other Fixtures (Specify) a iii L � 1•e5 .__��j • a lt Hi 26 9- io Sewer - 1st 100' 55.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Water Service - each additional 200' 46.40 Storm & Rain Drain - 1st 100' 55.00 Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device' 27.55 Catch Basin 16.60 Insp. of Existing Plumbing or Specially Requested 72.50 • Inspections per/hr Rain Drain, single family dwelling 65.25 Grease Traps 16.60 /p v) 6 /o 0 QUANTITY TOTAL �,W (OoC ( . Isometric or riser diagram is required if Quantity Total is > 9 /3 s ; : •, ±J + , . -' J 'SUBTOTAL ''':`,,,,,..,,;;.:r3 F . ,,,N, %: J � r J� I ]y( ` t, - :r 1- i 7 8% SURCHARGE r. ,;; u �:� *;��= `r�_�y � a ry,- •. • ._� " ' � W - s i r "PLAN REVIEW 25% OF SUBTOTAL 'At T-<'.:, t; - .0: : �� . /� Required only if fixture qty. total is > 9 + c �"i�'" , ', . * dP C TOTAL, f , .� P, • ,, / / r; ✓ ., . '.`. �. j `:�;7 'e1 .' i V i t % /' 'Minimum permit fee is $72.50 + 8% surcharge, except Residential Backflow Prevention r) 9 . I Device, which Is $36.25 + 8% surcharge. • �` All New Commercial Buildings require plans with isometric or riser diagram and plan review. • CITY F TIGARD BUILDING INSPECTION DIVISION A N MST , . r 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested /, / AM PM BLD( - • Location /S 3 To of 'Ai' I Suite MEC ~~ Contact Person Ph ��� �� / PLM 2ev1) —o d C/7( Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall ELR Footing Access: Foundation FPS Ftg Drain % v 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 �L�1MBI Under • • • • ut Water Service Sanitary Sewer Rain Drains Fi• ij PART FAIL ANICAL 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 Otheoach /Sidewalk Date t ` / Z- / Inspect ( 12 E Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. I 'CITY'9F TIGARD BUILDING INSPECTION DIVISION Mss 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 �J BUP Date Requested /' Z ( AM PM BLD tie ' Location / ?5 Sw Sit " - l v w Suite MEC Contact Person "174•; "174•; Ph lvfl "W G PLM Zoe 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 Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL LOMB Post & Beam U..- • Service Sanitary Sewer Ra' ' ns nal P ASS PART FAIL ANICAL 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 ate 2 "I D Inspector � ( � Other l Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Insp Line: 639 -4175 Business Line: 639-4171 M ST BUP Date Requested U AM PM BLD Location /5 Se./ (SI c, G J 4, Suite MEC Contact Person 5,40, pi„ (4 ph 4 9/ 4" PLM p - if i( 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 C CC 41‘.? L Roof Misc: Final PASS PART FAIL �tG1tlIBIA�G Post & Beam Under Slab Top Out Water Service Sanitary Sewer Drains PA PART FAIL M CHANICAL 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 [ 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 Appr D a t e VV oach /Sidewalk 2 / / � I Inspector � 1 Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.