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Permit
CITY OF TIGARD PLUMBING PERMIT l; DEVELOPMENT SERVICES PERMIT #: PLM2004 -00020 '� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/16/04 SITE ADDRESS: 15822 SW UPPER BOONES FERRYRD PARCEL: 2S112DD-00701 SUBDIVISION: B1LIEGON BUS. PARK II 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: B FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Install 1 lay, 1 sink in lunch room and 1 water closet. FEES Owner: Description Date Amount PACIFIC REALTY ASSOCIATES 15350 SW SEQUOIA PKWY #300 -WM I [PLUMB] Permit Fee 1/15/04 $72.50 PORTLAND, OR 97224 [TAX] 8% State Surcharl 1/15/04 $5.80 Total $78.30 Phone : Contractor: ADDISON PLUMBING 17506 SE RIVER RD. MILWAUKIE, OR 97267 REQUIRED INSPECTIONS Phone : 503 Rough -in Insp Top -out Insp 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 ye i. ! a Ill / • Permittee Signature: Call (503 • • • -4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures Plumbing Permit FOR OFFICE USE ONLY • Application Received _ ± fi D ate/By: f - •15 - Plumbing Permit No.: Planning Approval Sewer • City of Tigard Date/By: Permit No.�S(,L 00'/ ovvi`, 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 Erax � ft\ Date/By: Case No.: Internet: www.ci.tigard.or.us e l I Contact tuns.: ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 - Name/Method: Supplemental Information. cV5/ • • TYPE OF'WORK " . ' . . . - FEE *SCHEDULE (for special information :use checklist) " ❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total 10 Addition/alteration/replacement ❑ Other: . New 1- & 2- family dwellings • ' - - • • CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) SFR 1 bath I I 249.20 I ,' ❑ 1 & 2- Family dwelling [] Commercial /Industrial SFR (2) bath 350.00 Accessory Building ❑ 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: i s S:w. capN'r Boev.e5 FV 12-5 Site Utilities •., Suite #: Bldg. /Apt. #: q Catch basin/area drain 16.60 Drywell /leach line/trench drain 16.60 Project Name: SPe c cscf■ c.e Footin drain no. linear ft. Pa e 2 4 Cross street/Directions to job site: Manufactured 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 #: . - '. DESCRIPTION OF WORK - Fixture or Item ' Absorption valve 16.60 Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 © PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60 Name: vp,,_7f..,.41 Expansion tank 16.60 3S s,,,,, Sea wc 1 A P t.,,,,,,,, `• '° Fixture/sewer cap 16.60 Address:IS -C, Cit City/State/Zip: Floor drain/floor sink/hub 16.60 Y P QOQ�(� V,N� rJ � Garbage disposal 16.60 Phone:5'o3 - t2.... -` 3e0 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) A (-- 16.60 Phone: Fax: Sink/basin/lavatory /LA-t/ 1 ('mm Z- 16.60 33.2 E -mail: Tub /shower /shower pan 16.60 CONTRACTOR . ' Urinal 16.60 Water closet - ( 16.60 t L • t v Business Name: pcwso .t..„44.‘ 44. t,K, L.L. c _ , Water heater 16.60 Address: osve se poea- R-o Other: City /State /Zip:,,,,, QQ. qrl ie-, Other: . - - Phone: s-.-1- /vs - t2-' O Fax: so 3 -"MC.- o141 . - , ' . Plumbing Permit Fees *. •, ;. .. , :. Subtotal $ 49 • Vs CCB Lic. #: is't l SSI- Plumb. Lic. #: 3-4,47f6 Minimum Permit Fee $72.50 $ Authorized Residential Backflow Minimum Fee $36.25 A.6 Signature: o..- tMaoY&_ Date: / - f.S261-1- Plan Review (25% of Permit Fee) $ , L - H,,QOV e. State Surcharge (8% of Permit Fee) $ - iIU (Please print name) TOTAL PERMIT FEE $ '7 • 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 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. /Refng. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec Vehicle Dump Station Shower -Gang -Stall Sink -Bar/Lavatory:- i • - Bradley - Commercial - I - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal Other Fixtures: i:\Dsts\Permit Fomis\PlmPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST INSPECTION DIVISION Business Line: (503) 639 -4171 i1 BUP D d , Received Date Requested ( f AM PM BUP / / Location _ ��7 Z CE /��i Suite MEC Z' -6 d d 2-2-/ Contact Person Ph ( ) ZU • E6e PLM -UoO�U Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: Crawl ELR Dr ain / \ q2 Crl Dr � ! � Slab Inspection Notes: _ - - SIT Post & Beam Shear Anchors /1/11 wI' I Ext Sheath/Shear (- Int Sheath/Shear - ------ - -- - - - - - -- Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Other: ' ART FAIL - = ING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan , • - PART FAIL MECHANICAL Post & Beam Rough -In Gas Line Smoke Dampers ` 'A r1 SS) 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 7 ADA Approach/Sidewalk Date /// Ji Inspector Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL