Permit CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM2005 -00320
DEVELOPMENT SERVICES DATE ISSUED: 7/18/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112DD - 01600
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 ZONING: I -
SUBDIVISION: PACIFIC CORP. CENTER LOT: JURISDICTION: TIG
Project Description: Installation of mop sink and water heater.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 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 7/18/2005 $72.50
[TAX] 8% State Surcha 7/18/2005 $5.80
Phone : Total $78.30
Contractor:
CASCADE PLUMBING CO.
2630 N HAYDEN ISLAND DR SP #3
PORTLAND, OR 97217 REQUIRED ITEMS AND REPORTS
Phone : 503 -544 -7464
Reg #: LIC 120893
PLM 34 -412PB
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 or 1- 800 - 332 -2344.
Issued By: �'i �> Permittee Signature: `' Qj�p P
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.
P iIdingFiures mbin2 Permit Application I Olt c)hl lcl USE oL\
y of Tigard By / � > d� 1 PemtitNo )\h,2Gtl�'�xl.�Ct'9 SW Hall Blvd., Tigard, OR 97223 plan Review
e: 503.639.4171 Fax: 503.598.1960 „f. Date/By Other Pemlit our Ins ection Line: 503.639.4175 p Date Ready/By: ® See Pege 2 for •
net: www. Ci.ti gard.or.us Notified/Method Supplemeotallnformation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
ddition /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
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: L 9_5 �+��_,,,, cc", e l- > n Catch basin or area drain 16.60
City /State/ZIP: ',. t . - a �' Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: cYy-i� ��� Footing drain (no. linear ft.: ) Page 2
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.: Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Page 2
•
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
• Drinking fountain 16.60
❑ PROPERTY OWNER 1 ❑ TENANT
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) I Fax: ( Garbage disposal 16.60
❑ APPLICANT I CONTACT PERSON Hose bib 16.60
Ice maker 16.60
•
Business name: '� s - e -- .9:',4 - J A-5 Interceptor /grease trap 16.60
Contact name: f Y��2 w / Medical gas (value: $ ) Page 2
Address:��,D J / „ / y n X ), 4.. ) Primer 16.60
City /State/ZIP: ,��trft -faL •/e 9�� 7 J Roof drain (commercial) 16.60
. Phone: 46.2 I Fax : /;, t7' 44 �/ Sink/basin/lavatory 16.60
�� �� // �/ Tub /shower/shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: a 1 ui , -i 4 J ity Water heater 16.60
Address: s.�i7r1 Other:
City /State/ZIP: Subtotal
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCBLie.: j 7673'3 Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signature: State surcharge (8% of permit fee)
TOTAL PERMIT FEE
Print name ,9 , Z, , ., , I Date /. 61 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.
is\ Building \Pennits\PLMY.PennitApp.doc 06/05 440.4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard or .-
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems: I
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l 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 Systems:
\
Water Service - each additional 100' 46.40
Valuation: Permit Fee:
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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof to and
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 $5,000.00 and $1.45 for
Inspection of existing plumbing or
each additional $100.00 or fraction thereof; to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $5Q,001 and up $742.00 for the first $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? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ 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 are being installed for the food service area.
Dishwasher - Commercial ❑ My new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 -D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink -2" Submit 2 sets of plans with any of the above.
1 • _ ,
-4„ 1
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ isometric or. riser diagram is required for new buildings
Disposal - Commercial three (3) or more stories in height.. •
- Industrial
Ice Mach./Refrig. Drains -
Oil Separator (Gas Station) Comments regarding fixture work: -
Rec. Vehicle Dump Station
Shower -Gang
-Stall
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 w ill be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued. ,
iMuilding \Permits\Ptdd- PennitApp.doc 07/06/05
CITY OF TIGARD BUILDING DIVISION PERMIT #:QJ,.)M2 &• MU) 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 / A‘,..
o *
Inspection Requests ( , Hrs.): (503) 639 -4175 .�' "'I I
� ..
INSPECTION WORKSHEET OR DATE: 1 1 goy TIME: PAGE:
SITE ADDRESS: 64C5' 6 $t;rEX 3O 4' 2s0 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: IN/gut. p : 5i
DESCRIPTION: ca..
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: S ate: Pour Time:
Code # Inspection Description Co irm # Contact # Message
391 P1- %L- % ■ P14t•Air
Corrections /Comments /Instructions:
•
Pti PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v t 1 Wp Date: Ili I b( O Phone #: (503) 718- 2 44 •
1
CITY OF TIGARD
BUILDING PERMIT #: PLM2005-00320
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/16/2005
Phone: (503) 639 -4171 / i��nNp.� �;�,�.;r l I
Inspection Requests (24 Hrs.): (503) 639 -4175 �- L'i ..
INSPECTION WORKSHEET FOR DATE: 7/19/2005 TIME: 7 PAGE: 79
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORP. CENTER LOT #: TYPE OF USE:
PROJECT NAME: SPEC SPACE
DESCRIPTION: Installation of mop sink and water heater.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: - PHONE #:
CASCADC PLUMBING CO. G0 P E 503544 -7464
Inspection Request Scheduled For: Date: 7/19/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 011677 -01 503 -740 -0857 Y
Corrections /Comments /Instructions: r A l ‘e \, t,kpo
5/
P ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4 Date: _ /f1 Phone #: (503) 718 -