Permit lw
CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: P 10/31/2005
-00609
,.��I 13125 SW Hall Blvd.; Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/31/20
PARCEL: 2S112DD -01600
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: JURISDICTION: TIG
Project Description: Medical gas, project value: $3,800
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
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [PLUMB] Permit Fee 10/31/200: $72.50
[PLMPLN] Plan Review 10/31/200: $18.13
Phone : 503 - 624 - 6300 [TAX] 8% State Surcharl 10/31/200: $5.80
Total $96.43
Contractor:
D P PLUMBING /DARREN T PLACEK
15825 NE SPRINGBROOK RD REQUIRED ITEMS AND REPORTS
NEWBERG, OR 97132
Phone : 537 -9492
Reg #: LIC 110612
PLM 36 -70PB
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
952-01 ; -00 1 q rough OAR 952 - 0001 -0100. You may obtain copies of these nile, or direct questions to OUNC by
calli - g 503-246-66 • : 01;332-2344.
Iss ed By: / /ae 4Z Permittee Signature: ,VIM 11,,7c,
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
154 cis (...) Sec (40 i 4 Sf-e, /2o
Bur ling Fixtures
Ylumbin� Permit °_� c �ED FOIl Orl l( I: 1 'l. ()NI .1
City of Tigard 8 C Receiv y. 7,5 0� P vi, Permit No.: • 5 ��
13125 SW Hall Blvd., Tigard, OR 97223 ') O 2005 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 . Date/By. t 0 / 31/ 0 5 .J Other Permit No.:
24- Hour Inspection Line: 503 TIGARD '. Date Ready/By J H See Page 2 for
Internet www.ci.tigard.or.us C1TY OF • °"
�� p�1StON NdiB ethod10 /ai, Supplemental Information
F WORK 4 %�lt L. I .4 , a FEE* SCHEDULE
❑ New construction ❑ Demolitio A For s, ecial in ormation use checklist
Des r tion Qty. Ea. Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY' OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2 -family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
s: is- S `� sa."-Q a0 / A 4 j / 247 Catch basin or area drain 16.60
/ C !9 A-b 0 it. q 2� Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I
( oting drain (no. linear ft.: Page 2
kn.,. �JLa 1p 1
Y anufactured home utilities 110.00
Cross street /d 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
Tax map /parcel no.: Fixture or item
Absorption valve I 16.60
Back flow preventer Page 2
/ X,5 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
4
I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: pke.., 1 L is r Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
�` Hose bib 16.60
4 ❑ APPLicio T ❑ CONTACT PERSON
Ice maker 16.60
Q Business name:
• _ Interceptor /grease trap ,_
Contact name: - _ . - Y r
SO Address: Primer 16.60
J p City /State/ZIP: Roof drain (commercial) 16.60
• Phone: ( ) Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
Water closet 16.60
szCillirget t) -I) .1) / 1340 ! ini Water heater 16.60
/
4 Ill iress: ! ` 5 ' g T � p C3� g� Other:
tt /state/ziP:
7 &t La D te__ 9 / 3.7._ Subtotal
...05)
/ Minimum permit fee: $72.50 7a,
637-9' . r'J �- Fax: ( ) Residential backflow minimum permit fee: $36.25
O Plan review (25% of permit fee) RIM
State surcharge (8% of permit fee) .
IIIIIIMPIPigna TOTAL PERMIT FEE -96 r
,/L/t L c/ 3
i iq - hAl › Date t/° 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 \Penni.s\PLMF- PennitApp.doc 06/05 440.4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard •
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qtr Fee (ea) Total Square Footage: Permit Fee:
Footing drain - 1 "' 100' 55.00 0 to 2,000 $115.00
Foo ' g drain - each additional 100' 46.40 2,001 to 3,600 $160.00
Sewer 1st 100' 55.00 3,601 to 7,200 $220.00
7,201 and greater $309.00
Sewer - . h additional 100' 46.40
Water Servi - 1st 100' 55.00 Medical Gas Systems:
Water Service - ch additional 100' 46.40
Storm & Rain D 1st 100' 55.00 Valuation: Permit Fee:
$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 ' ,000.00 and $1.52 for each
Fixture or Ite i Qty. Fee (ea) Total additional $100.' i or fraction thereof to and
including $1 I 00.00.
Commercial Back Flow Pr. vention Device 46.40 $10,001.00 to $25,000.00 $148.50 fl e first $10,000.00 and $1.54 for
Residential Backflow Preven on Device each ad. . onal $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 and i luding $25,000.00.
Rain Drain, single family dwellin a 65.25 $25,001.00 to $50,000.00 $3 ' .50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or - ch additional $100.00 or fraction thereof to
specially requested inspections - per h. r 72.50 and including $S 00.
Subto • I: $50,001.00 and up $742.00 for the first $5000.00.
$5 $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? f "yes", • "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failu to system that meets any of the following criteria.
accurately report fixtures could result in increased er fees *. Please check all that apply.
Quantity by (Fixture) Work Perfo ❑ Any new commercial building.
Fixture Type: ❑ Any new exterior plumbing site utilities.
Previous Capped Added ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall • Plumbing installations, alterations or additions to food service
- Drive Thru facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator e being installed for the food service area.
Dishwasher - Commercial ❑ An ew residential building containing three (3) or more
- Domestic P dwell , units.
Drinking Fountain , ❑ Any NF ' : 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink 2" Submit is of plans with any of the above.
- 3"
4 „
Car Wash Drain Isometri r Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagra 's required for new buildings
Disposal - Commercial three. (3) or more stories in • ' t. •
- Industrial
Ice Mach./Refri:. Drains
Oil Separator (Gas Stati.,j Comments regarding fixture work.
Rec. Vehicle Dump . on
Shower -Ga
.11
Sink , - Bar/Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Uripal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
is \ Building \Pe.mits\PLM- PennitApp.doc 07/06/05
•
Fax Transmittal Cover Sheet
11 Building Division
City of Tigard
Date l pm i 0.-
Number of pages including cover sheet /
To: 0arrs✓ U P plk�b +�, From: Y0 1„�w>�'II,�ra. -.�
Co: Co: City of Tigard, Building Division
Fax #: CO3 - 573 $ - 93 0 ( Fax #: 503 - 598 -1960
Ph #: S3 - S3 7 - °P 4 Ph #: 503 - 639 -4171, Ext. 2439 5 7/82&3 /
SUBJECT: p�w..b;;��� Q1;✓ t k4-.L I Pro re - A- 6f ' I 5-119s-Ct✓ l" eaACwa
MESSAGE:
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i:\ dsts \forms\FaxTransmittalToCopy.dot 06/13/02
•
TRANSMISSION VERIFICATION REPORT
TIME : 10/11/2005 11:44
NAME : TIGARD BUILDING DEPT
FAX : 5036243681
TEL .
SER.# : BROD4J479592
DATE, TIME 10/11 11:43
FAX NO. /NAME 5035384306
DURATION 00:00:17
PAGES) 01
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00609
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/31/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 _ ' 5'I �. 1
INSPECTION WORKSHEET FOR DATE: 12/16/2005 TIME: 7:06AM PAGE: 7
! SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: DENTAL PROFESSIONALS
DESCRIPTION: UMEIrn project value: $3,800
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503- 624 -6300
CONTRACTOR: U P PLUMBING /DARREN T PLACEK PHONE #: 637-9492
Inspection Request Scheduled For: Date: 12/1612005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 023620.06 503 -888 -0214 N
Corrections /Comments /Instructions:
s___, -1/f7
■..ice // _ /_ge /_..
7 i■ - /
' ' i e fr/
'fi 7'
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
,t
Inspector: Date: /, Phone #: (503) 718 -
g-b)
z
CITY OF TIGARD ■
BUILDING DIVISION PERMIT #: PLM2005.00609
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 10/31/2005
Phone: (503) 639 -4171 "� i le
Inspection Requests (24 Hrs.): (503) 639 -4175 F'I L .
INSPECTION WORKSHEET FOR DATE: 11/8/2005 TIME: 7:00AM PAGE: 45
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: DENTAL PROFESSIONALS
DESCRIPTION: Medical gas, project value: $3,800
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503-624 -6300
CONTRACTOR: D P PLUMBING /DARREN T PLACEK PHONE #: 537 -9492
Inspection Request Scheduled For: Date: 11/812005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 020606 -02 503-868.0214 N
Corrections /Comments/ Instructions:
I
14ZASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
dr
Inspector: Date: / / Phone #: (503) 718 -
CITY OF TIGARD • --
BUILDING DIVISION PERMIT #: PLM2005 -00609
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10131/2005
Phone: (503) 639 -4171 �ij
Inspection Requests (24 Hrs.): (503) 639 -4175 `_ ..
INSPECTION WORKSHEET FOR DATE: 11/1/2005 TIME: 7:06AM PAGE: 84
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: DENTAL PROFESSIONALS
DESCRIPTION: Medical gas, project value: $3,800
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503- 624 -6300
CONTRACTOR: D P PLUMBING /DARREN T PLACEK PHONE #: 537 -9492
Inspection Request Scheduled For: Date: 11/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 019963 -01 503 - 8880214 N
Corrections /Comments /Instructions:
MA ■ C.--- ' Al i
0
4
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: tri2-) Date: i Phone #: (503) 718-