Permit •
C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00560
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/15/2006
PARCEL: 2S 112DD -01600
SITE ADDRESS: 15575 SW SEQUOIA PKWY 160 ZONING: I -
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: JURISDICTION: TIG
Project Description: 1 lunchroom sink •
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: 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 111 $72.50
[TAX] 8% State Surcha 11/15/200E $5.80
Phone : Total $78.30
Contractor:
ADDISON PLUMBING
1407 HOMESTEAD PLACE
MOLALLA, OR 97038 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 785 -1840
FAX 503- 829 -9701
Reg #: LIC 151754
PLM 3 -449PB •
•
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:w J1�..I�.o-. Permittee Signatur .
— Q - akrt
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.
,.. ii,
PiurnMne Permit REGGEIVED iiiimaiiiiitiiiiiiim
City of Tigard Received
13125 SW H>�Blvd, Tigard, OR 9'722NOV 1 5 2006 Date/By. 1 1 I I I S 1 nt., Penult tJlk - c4,49) Phone: 503.639.4171 Fax: 503.598.1960 t „;.Y, Date/By. Other Permit N �/ �6e,2,7
Plan , �., __.
24- Hour Inspection Line: 503.639.4 QATY OF TIGARD f } 1 i ■ Date Ready/By See page 2 for
Internet: www.tigard- or.gov BUILDING DIVISI • Notified/Method 3 uti Sapplemmtal Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demol it ion For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New I- 2-family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ 1- and 2-family dwelling j20 Commercial /industrial SFR (2) bath 350.00
❑ Accessory building 114 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: ( 5-57 rj` Project nam 5e a o/ a Ikeda t / Catch basin or area dra 16.60
City/State/ZIP: �� QM r D J Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: C .2 i6 e: { .1, ad c�/sIM� Footing drain (no. linear R : ) Page 2
Cross street/directions to job site:
I / Manufactured home utilities 1 10.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: f Lot no.: Water service (no. linear ft: ) Page 2
Tax map/parcel no.:
Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Page 2
Add b rl ai room cegAda, 2( 5 (').(k Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
kl PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Name: iqGTV.l,I y D� p �- Ejectoron tan k 16.60 16.60
` Expansion tan Address: f' S 3 J D 6 t ei kick y 36 n Fixture/sewer cap 16.60
City/State/ZIP: r10 Y. -. t K Floor drain/floor sink/hub 16.60
Phone: [503) 6 a 4 `` ` �� ` `���"` ^^^^^����� o Fax: (05) 6 2 ( /-7 75- Garbage disposal 16.60
Hose bib 16.60
❑ APPLICANT X CONTACT PERSON
,,( T r- q„Q ' 4 -
Ice maker 16.60
Business name: 4 (�J.(� �g (� ''."''! Interceptor/grease trap 16.60
Contact name: S� r 9 Lo / d s Medical gas (value: $ ) Page 2
Address: l 55 - ot 5 (49 // _ y � 2 Foy ? Primer 16.60
City /State/ZIP: L Q„ Roof drain (commercial) 16.60
Phone: (503) oZ ®� �'� fr Fax:: (!Oj) �j aS f �� S ink in/lavatory ` 16.60
r s hower /shower pan 16.60
E-mail: 4 t 4/ 1 � aB/ 0244 Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: t $ Q lv v.,V. ".9 L l, c- Water heater 16.60
Address: letp7 Ho .S+ec*� Q1nce her:
City/State/ZIP: Subtotal
YtiOke,\ \a UIz- Q mg Minimum permit fee: $72.50
Phone: (so 3 ) 72v Ig go Fax: ( .523 ) $2i 746? Residential backflow minimum permit fee: $36.25 7,.,,
CCB Lic.: t s 1 yam. Plumbing Lic. no.: .i'- 44 Plan review (25 % of permit fee) ((�yy��
State surcharge (8% of permit fee) 5 i 2
Authorized signature: ., y� email., TOTAL PERMIT FEE l 3o
Print name: ,)a.� In�aore 1 f Date: /r- /y-06. ( 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.
t:\ BuiIding\PemitaPLM- PennitApp.doe 12/30l0s 440- 4616T(I0/02/COM/WEB)
4, : I
Plumbing Permit Application - City of Tigard _•
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ca) Total Square Footage: Permit Fee:
Footing drain - 1 ° 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 $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof to
specially requested and including $50,000.00.
pec y eq rested in spections - per hour 72.50 $50,001.00 "and up ' ' • $742.00 for the fist $50,000.00 and $1.20 for
Subtotal: 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. • .
Quaodty by (Fixture) Work Performed ❑ Any new commercial building r
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 tq human beings. .
Car Wash - Each Stall ❑ Plumbing installations, alteiations or'dditions 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 ❑ Any 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 plan with any of the above.
-3"
-4"
Car Wash Drain Isometri or Riser Diagram
Garbage - Domestic ❑ - Isometric br riser diagratn 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 — f
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture under this permit results in an
Water Extractor ure wor uner Pe
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
is\ Building Termiu\PLM- PermitApp.dot 07/06/05
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM20()G 00560
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/15/2006
Phone: (503) 639 -4171 ..
Inspection Requests (24 Hrs.): (503) 639 -4175 .. !4 '" ■ I �,.
INSPECTION WORKSHEET FOR DATE: 11/22/2006 TIME: 7:03AM PAGE: 36
SITE ADDRESS: 15575 SW SEQUOIA PKWY 160 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: PETROCARD
DESCRIPTION: 1 lunchroom sink
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 60378&1B40
Inspection Request Scheduled For: Date: 11/22/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 040148 -01 503320 -8601 Y
Corrections /Comments/ Instructions:
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[PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ut fl Date: 1 t, .2; . Phone #: (503) 718 - 41,-4
CITY OF TIGARD •
BUILDING DIVISION ^ - PERMIT #: PLM200&00! C0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/15/2006
Phone: (503) 639 -4171 .A '�I ,.
Inspection Requests (24 Hrs.): (503) 639 -4175 _ -' .. IL
INSPECTION WORKSHEET FOR DATE: 11/17/2006 TIME: 7 :01AM PAGE: 25
SITE ADDRESS: 15575 SW SEQUOIA PKWY 160 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: PETROCARD
DESCRIPTION: 1 lunchroom sink
OWNER: PACIFIC REALTY ASSOCIA1ES, PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 503405-1840
Inspection Request Scheduled For: Date: 11/17/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough•in 039968 -01 503- 320 -8601 Y
Corrections /Comments /Instructions: 1 0 M 1
N
1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ ' ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: : IV 6e Le Date: I 1 11 6 Phone #: (503) 718
V
A46„.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006.00G +0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/15/2006
Phone: (503) 639 -4171 .a .
Inspection Requests (24 Hrs.): (503) 639 -4175 !�- �-
INSPECTION WORKSHEET FOR DATE: 11/16/2006 TIME: 7 :00AM PAGE: 28
SITE ADDRESS: 16575 SW SEQUOIA PKWY 160 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #' TYPE OF USE:
PROJECT NAME: PETROCARD
DESCRIPTION: 1 lunchroom sink
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 5037135 - 1840
Inspection Request Scheduled For: Date: 11/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 039876 -01 503320.8601 Y
Corrections /Comments /Instructions: 6 1.. ) 0
,PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v �� uy Date: IP 24'
Phone #: (503) 718 -b •