Permit '.. CITY OF TIGARD PLUMBING PERMIT
'uooailla DEVELOPMENT SERVICES PERMIT #: PLM2000 -00171
'` ,. 13125 SW Hall Blv Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06/01/2000
SITE ADDRESS: 15230 SW SEQUOIA PKWY 120 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: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft -
Remarks: Install one (1) lay, one (1) water closet, and a water heater for tenant improvements.
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT GEO 06/01/200C $50.00 0002611
15350 SW SEQUOIA PKWY #300 -WMI 5PCT GEO 06/01/200C $4.00 0002611
PORTLAND, OR 97224
Total $54.00
Phone 1:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 236 -4152 Rough -in Insp
Reg Underfloor /Underslab
eg #: LIC 00000172
PLM 26 -83PB Final Inspection
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. "9, a -4
Issued By ♦ Permittee Signature.; ii 0 . —
Call (- • 3) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
:il OF TIGARD Plumbing Permit Application Plan Check# 5
r 312. S'' HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd -, -00
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit #Pc o►V000 - oal"7l
Related SWR #P4O' 001/
Called J� 36'
.>o */ ? •/d 1
Name of Development/Pro' t FIXTURES (individual) I QTY - PRICE AMT
• )• SPEC, S lT G e Sink .. 11.50
-
Address Street Address p$tu Suite Lavatory ) 11.50
15a 30 s w h
Sun IA- 1a0 Tub or Tub /Shower Comb. 11.50
Bldg # C' /State Zip Shower Only 11.50
Nam `7a+ � Water Closet Urinal (Specify) / 11.50
V A - 6 (.L.97" Dishwasher 11.50
Owner Mailing Address eCW y Suit Urinal 11.50
C ? 3 t 59 .5w Zip ' � Phone Garbage Disposal 11.50
} rte
97 62,J`1 ?„_ 7tXJ Laundry Tray 11.50
Name [ � -7 (v Washing Machine /Laundry Tray (Specify) 11.50
Floor Drain/Floor Sink 2° 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City /State Zip Phone -
Water Heater 0 conversion 0 like kind / 11.50
Gas piping requires a separate mechanical permit.
Nagze E. n/ WA-AkEta f i-Z6- MEG Home New Water Service 28.00
Contractor M Address MFG Home New San/Storm Sewer 28.00
31 l l Sg / Hose Bibs 11.50
Prior to permit /State p Phone Roof Drains 11.50
issuance, a copy Q /� � R3& Drinking Fountain 11.50
tll licenses are Oregon Connt. Board Lic.# Exp. D. to
required if 0 ) s ) a a3 Other Fixtures (Specify) 15.00
expired in COT Plumbin Lic Exp. • ate
database r. (� �� "�' 6/30
Name
Architect Sewer - 1st 100' 38.00
Or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City/State Zip Phone Water Service - each additional 200' • 32.00
Desc work to be done: Storm & Rain Drain - 1st 100' 38.00
New Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residen 0 Commercial 0
Additional description of work: �j ��}, j�L ) - 141 1 j Commercial Back Flow Prevention Device 32.00
1 LA v, I W Residential Backflow Prevention Device' 19.00
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No _Inspections per/hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES.
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total Is > 9
that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL 50°
Sig a Own ant n � Date
Y 8% SURCHARGE
Conte arson Name Phone
g- .....1.11.5,..A
a �L•' �A - PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if fixture qty. total Is > 9
^ BATH HOUSE $250.00 • • TOTAL 571°
LATH HOUSE $285.00
his fee Includes all plumbing•flxtures In the dwelling and the first *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
100 feet of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge
All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I:\dstsVormstplumapp.doc 10/1/99 - -
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
Sink `
Lavatory J
•
Tub or Tub /Shower Combination
Shower Only
Water Closet f
Dishwasher
Urinal
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
•
I:\dstsVorms\plumapp.doc 10/1/99 - - -
CITY OF TIGARD BUILDING INSPECTION DIVISION •
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
• Date Requested (01010D AM PM BLD
Location IS 2• 30 .e q u.ot Suite /2. 0 MEC
Contact Person OP AA Ph 7,3/0- y/S 2- PLM `1 C2) / 7
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
Roof
Misc:
Final
PAS T FAIL
eCUMBIN
Post & Beam
Underb
op Ou
Vater Service
Sanitary Sewer
Rain Drains
Fi
AS PART FAIL
HANICAL
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
Other Date / I Inspector l. 74 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/� / //� BUP
73 ` / 44-r Date Requested 7-- AM PM BLD
Location �5� 3 U w 5 rr,ova Suite /Z 0 MEC
Contact Person )) �� �� Ph PLM A621' 'L')1 7/
Contractor 2-C' —i i'f111 Ph 3 (o /S 2 SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: ' SIT
Slab
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall 1(0,5 4tiq
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PAS • ' T FAIL
`. M
Po • - - - m
Under Slab n
Top Out 9
Water Service
Sanitary Sewer
Rain Drains
fs..5 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 ins pect - no access
ADA �/
Approach /Sidewalk Date 71 // 7 /d(/ Inspector 7 Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line:. 639 -4171
/� 11 �// BUP 0700
7S Date Requested 7 -7 `�-oo AM PM BLD
Location / S -3 0 5 0...o z-i /' // D suite 17,0 MEC //++
Contact Person Ph A ���� i t1 A DO(" "
Contractor l � /L2 --� Ph SWR
UILDIN 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
Roof
Misc:
ART FAIL
LUMBING
P
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
• \ MECHANICAL
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 �(� (7.04---t
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.