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Permit
CITY TIGARD PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT #: PLM2004 -00090 c �' � i_ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/26/04 .04 SITE ADDRESS: 15780 SW UPPER BOONES FERRY RD PARCEL: 2S112DD -00700 SUBDIVISION: BLDG D ZONING: IP BLOCK: LOT: JURISDICTION: TIG 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 Remarks: Installation of (1) break room sink. FEES Owner: Description Date Amount PACIFIC REALTY ASSOCIATES 15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 2/26/04 $72.50 PORTLAND, OR 97224 [TAX] 8% State Surcharl 2/26/04 $5.80 Total $78.30 Phone : Contractor: ADDISON PLUMBING 17506 SE RIVER RD. MILWAUKIE, OR 97267 REQUIRED INSPECTIONS Phone : 503 Rough -in Insp Top- outInsp Reg #: LIC 151754 Final Inspection 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 Issue c: L ,z . V / (1,_,A14 Permittee Signature: „ fr Call � (503) -6 175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures Plumbing Permit Application FOR OFFICE USE ONLY PU Received n � Plumbing p i DateB : i . , Pe rmit No.: � /i oy / 2/ Planning A ..roval Sewer • i1 Q %'V City of Tigard Date/By: Permit No. + 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By. Permit No • Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use Uaa d�� ( Date/By Case No. Internet: www.ci.tigard.or.us r!' Contact Juns : ® See Page 2 for 24 -hour Inspection Request: 503- 639 - 4175 '""" --11 Name/Method: Supplemental Information. , '�' • TYPE'OF�WORK': - ' : = , ', . ' ,: FEE* SCHEDULE (for special iriformationaise checklist)-. '' El New , construction ❑ Demolition Description I Qty. I Fee(ea.) I Total ® Addition/alteration/replacement ❑ Other: .. • . • . New 1- & 2 - family dwellings", . . • - CATEGORY OF CONSTRUCTION , : " (includes 100 ft. for each utility connection) , 1 & 2-Family dwelling Commercial/Industrial SFR () bath 249.20 ❑ Y g © C l /Industrial SFR (2) bath 350.00 ['Accessory Building ❑ Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 . " s .' JOB: SITE lI4FORMATION_and_LO,CATION : Fire sprinkler - sq. ft.: _ Page 2 Job site address: is7�so sw ucper « e,.r t y RD .Site Utilities - . • : -: - - ' Suite #: CBI4 /Apt. #: `D Catch basin/area drain 16.60 Project Name: Drywell/leach line/trench drain 16.60 Pro l 6u9 li*.ife C:cw,,c'wt@srS (LC. Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Water service (no. linear ft.) Page 2 Tax map /parcel #: Fixture or•Item. ," > ry " DESCRIPTION-OF WORK' • Absorption valve 16.60 Qow7 ,. �„, o .,..�ei.v skos\ t re - Q.--Y - moo+-- S:--k.. . Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 '°n PROPERTY OWNER • •• , I ❑ TENANT ' , , Ejectors/sump 16.60 Name: 14.,, , r,,.st 10 Expansion tank 16.60 Address: 1S37 sw 5el4a:- PKw 41.360 Fixture /sewer cap 16.60 City /State /Zip: ev,- tto-r• O'er 9'12 L'f Floor drain /floor sink/hub 16.60 Garbage disposal 16.60 Phone: s03- 62. - 1.3 o o Fax: 5 Hose bib 16.60 :❑'APPLICANT - ' . .. ❑ CONTACT.PERSON - Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Primer 16.60 City /State /Zip: Roof drain (commercial) 16.60 Phone: Fax: alabasin/lavatory i 16.60 /L. bo E -mail: Tub /shower /shower pan 16.60 '''a` ' ' CONTRACTOR ;:: `••_' Urinal 16.60 Business Name: p W....._\,-,,...1 L� Water closet 16.60 Water heater 16.60 Address: 1'tsac sr. R-w, q.._ D Other: City /State /Zip:v.,.;tww► -`we o42_..1 -1 z. Other: Phone:so3- /ss -iS' Fax:s • :., • • -,_'� •..Plutiibing,Perinit ,y,.. =. :"_. -. , Subtotal $ /C. two CCB Lic. #: istzs _ Plumb. Lic. #: 3-<4�g 4'4 Minimum Permit Fee $72.50 $ Authorized . Residential Backflow Minimum Fee $36.25 IO . 5 c J"] Signature: ctsa.2_ Date: z - 2.C-04 Plan Review (25% of Permit Fee) $ 3o•y ( (, uav - - State Surcharge (8% of Permit Fee) $ 6 86 (Please pnnt name) TOTAL PERMIT FEE $ 78 , 50 Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri -County Building Industry Service Board. i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities • - : . 'Qty. Fee; (ea) 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 additional $100.00 or fraction thereof, to and Fixture or Item Qty. Fee (ea) Total 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or d , and including $50,000.00 p specially requested inspections - per hour 72 50 $50,001 00 and up $742 00 for the first $50,000 00 and $1.20 for Subtotal: each additional $100 00 or fraction thereof Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees *. - Quantity by (Fixture) Work Performed Comments regarding fixture work: • Fixture Type: • Replace . New Moved Existing Capped Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" -3" -4" Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradle - ommercia • - ervice Swimming Pool Filter Washer - Clothes Water Extractor Water-Closet - Toilet Urinal Other Fixtures: i : \ Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST Received Date Requested Z Z AM PM BUP Location / s7 SL) iQAA �F -rr �#> SuiteD MEC �) Contact Person .�J�P 0 pp Ph ( )3 Z d - R'6 o! O Y Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: IT Post & Beam - I _ Shear Anchors lnt Sheath/Shear Sheath/Shear ar I n Int th /Shar ► . ' I"I `--✓ � Framing Insulation .r 7� /`x� Drywall Nailing 1 Firewall Fire Sprinkler - � - - _ Fire Alarm Susp'd Ceiling Roof Other: Final PASS PART FAIL 1 PLUMBING / Post & Beam Under Slab Water he Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: PART FAIL ANICAL • & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE Please call for reinspection RE: ❑ Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk Date ) ' Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL