Permit r•
C ITY OF T I GA R D PLUMBING PERMIT
I�* DEVELOPMENT SERVICES PERMIT #: PLM2003 -00599
III 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/18/03
SITE ADDRESS: 15860 SW UPPER BOONES FERRYRD B -15 PARCEL: 2S112DD-00500
SUBDIVISION: OREGON BUSINESS PARK 1 ZONING: I -L
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: 4 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Relocate only: 4 lays and 1 lunch room sink. No Sewer tally /permit.
FEES
Owner:
Description Date Amount
PACIFIC REALTY
15350 SW SEQUOIA PKWY #300 [PLUMB] Permit Fee 11/18/03 $83.00
PORTLAND, OR 97223 [TAX] 8% State 11/18/03 $6.64
Total $89.64
Phone : 503- 624 -6300
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone : 236 4152 Rough -in Insp
Final Inspection
Reg #: LIC 154919
PLM 26 -736PB
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.
Issued By: X G/iy - � �L� Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed'• y next business day
Building Fixtures
Plumbing Permit Application Received FOR OFFICE USE ONLY
ived Plumbing ems+
Date/By: Permit No ?L 2,003 / - f
003
Planning Approval Sewer
City of Tigard Date/By Permit No.:
4) 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
Date/By Case No.:
Internet: www.ci.tigard.or.us • Vi Contact Juns.: 1E1 See Page 2 for
`^
24 -hour Inspection Request: 503- 639 -4175 -' Name /Method _ Supplemental Information.
( 2 S --R t f TF.C, u I PEn
-,4, - . - . OF 'WORK • ' , FEE* SCHEDULE (for special information' use Checklist) .
❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
ki Addition/alteration/replacement ❑ Other: New 1 - & 2 - family dwellings -
CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection)
SFR (I) bath 249.20
❑ 1 & 2- Family dwelling IN Commercial /Industrial SFR (2) bath 350.00
['Accessory Building [I Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
_ JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft : _ Page 2
Job site address" , ICo $ u. yr,r /l,«] gerry /d Site Utilities _ -
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell /leach line/trench drain 16.60
Pro
1 O/16c,,, � �*� '�S Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Cre-9 6v S /-tie r$ POSt 3. Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: I Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
Fixture or Item • , .
DESCRIPTION OF WORK / Absorption valve 16.60
Pug 1- (4,1- ii G r?kS / - 9iH /'oor1 Backflow preventer Page 2
i ) Backwater valve 16.60
4 / w,� Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
® PROPERTY OWNER I ❑ TENANT • Ejectors /sump 16.60
Name: i',,ac ,5)f Expansion tank 16.60
Address: /1 5 w 5”c" c' °' A��+ welt' Fixture /sewer cap 16.60
City/State/Zip: ^ ,• a'2 . g' 7 3 2 y Floor drain/floor sink/hub 16.60
/" Garbage disposal 16.60
Phone: tea) -‘$ , 7S 1 Fax: 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
1 Phone: Fax: Sink/basin/lavatory 't u 1; i / SI iK, . 16.60
'()
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR • Urinal 16.60
Water closet 16.60
r i Business Name: pe,),,, a,,,,,,,-, ,L. /la 0/n/
`j Water heater 16.60
Ih Address: a Q,,,c IN 7a/ Other:
City /State /Zip: po+-1/4 02 9 7a 5s 3 Other.
u" Phone: .570- N 9 S/y Fax: 323 - 1-9‘-/ 8 ' . Plumbing Permit Fe $
CCB Lic. #: / y y 9/9 Plumb. Lic. #: 26- 736 / Minimum Permit Fee $72.50 $
Authorized `t -- 30 ` 0 Residential Backflow Minimum Fee $36.25 �3
Signature Date: II - � Plan Review (25% of Permit Fee) $
j G 5 eph Raab State Surcharge (8% of Permit Fee) $ (a , (/4-]
(Please print name) TOTAL PERMIT FEE $ vg . jpy
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
t .
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 Valuatlott• 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 and including $50,000.00
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 - h
- Bradley
- Commercial
- Service
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
BUP
Received Date Requested 1— 2 S AM PM BUP
Location 'said It is `- MEC
Contact Person Ph ( 9 g`e k PLM -3 - s, 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi rewal l
Fire Sprinkler
Fire Alarm
Susp'd Ceiling 1%
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other _
PART FAIL
CHANICAL
Post & 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 U x Approach/Sidewalk Date /c;2 v Inspector 7 Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL