Permit CITY TIGARD PLUMBING PERMIT
I� DEVELOPMENT SERVICES PERMIT #: P 14/200 -00057
' �� 11 -- ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/14/2005
SITE ADDRESS: 10575 SW CASCADE AVE 130 PARCEL: 1S135BB-00501
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: B FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
R emarks: Plumbing TI in office space. Other fixture is an ice maker.
FEES
Owner:
Description Date Amount
AMB PROPERTY L P
BY TRAMELL CROW NW INC [PLUMB] Permit Fee 2/14/2005 $83.00
8930 SW GEMINI DR [TAX] 8% State Surcharl 2/14/2005 $6.64
BEAVERTON, OR 97008 Total $89.64
Phone:
Contractor:
CASCADE MECHANICAL SYSTEMS INC
PO BOX 399 REQUIRED ITEMS AND REPORTS
ESTACADA, OR 97023
Phone : 630 - 4492
Reg #: LIC 127012
PLM 3 -324PB
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 -66 . / //,,' /
Issue By: I/ Permittee Signature: - - y ia. 1
Call (503) 639-4175 by 7:00 P.M. for an inspection needed th. - t busin day
Plumbing Permit Application , 0 FOR OFFICE USE O,�NI Y ,s '. :
City of Tigard
Date/By r G k Pernut No: PG '(JO6 'OQ[�
'7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / - *?� ryf,: , '� . DateBy. Other Permit No.. t f i 5,r
24- Hour Inspection Line: 503 639.4175 i ) t ons
_ _ Date Ready/By. ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
PiCddition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1)bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
CI Accessory building ❑ 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: / (J 5 7,5" S L. ' G C r a,.� iiJ - ,/ � Catch basin or area drain 16 60
City/State/ZIP �'/`� Drywell, leach line, or trench drain 16.60
CO/bldg./apt. /bldg. /apt. no.: ` 30 I Project name: ff.G,, i Footing drain (no. linear ft.: ) Page 2
® � � Manufactured home utilities 110.00
Cross street /directions to job site. Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no • /6/ 35 66 —Qp 3 Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Page 2
4 c6' _ <;4 k Av e -e J,- Backwater valve 16.60
v Clothes washer 16.60
Dishwasher ' 16.60 Flo' /00
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address Fixture/sewer cap 16 60
City /State /ZIP: Floor drain/floor sink/hub t f 16.60 /gyp .6'0
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker / 16.60 /4 ,
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Sink/basin/lavatory p f-(,L / 16 60 4. 67U
Phone: ( ) Fax•( )
Tub /shower /shower pan 1 . 16.60
E -mail: Urinal 16.60
CONTRACTOR !! Water closet 16.60
Business name: ec..l�G�/ e, % s-'f� Water heater / 16.60 /eto • 6
Address: Pp , D c p i c 3 7 7 S''s( Ga.Gt/a. Other:
City /State /ZIP: c)2 y ? d 2-3 I Subtotal
Minimum permit fee $72.50 C v
Phone: (,.23) 6 3 C9 — C'P2 Fax: (j53 ) 6 3D 'S^f� / O Residential backflow minimum permit fee: $36.25 $� -
CCB Lic.: /a -, 0 / 7_ 0,4 /os Plumbing Lic. no.: 3 - 3 '_. Y /'d Plan review (25% of permit fee)
Authorized signature: /aa� -C7rl -�"" 6 4 — 7/I State surcharge (8% of permit fee) �, , (�
C2
TOTAL PERMIT FEE +� 6C�
Print name. 3 S an..., G u 2 I Date: D VIVCP3 — This permit application expires if a permit is not obtai fe within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I \Building\Pennus\PLM- PennitApp doe 12/03 440-4616T(1 W02/COM/WEB)
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 - I" 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 inspections - per hour 72.50 and including $50,000.00.
Subtotal: r $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
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
Fixture Type: Replace
Moved Existing Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower r /
- Jacuzzi/Whirlpool
Car Wash -Each Stall I
-Drive Thru
Cuspidor /Water Aspirator l y
Dishwasher -Commercial /
- Domestic
Dnnking Fountain
Eye Wash
Floor Drain/sink - 2"
- 3"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial
*Note: If the fixture work under this permit results in an
- Industrial
Ice Mach./Refi;g. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) / fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink - Bar /Lavatory
Bradley Qua ntity Total
- Commercial ' Isometric or riser diagram is required if fixture quantity
Service total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor - Plan Review
Water Closet - Toilet Plan review is required if fixture quantity total is >9.
Urinal'
Othei Fixtures:
I \Buildmg\Permits\PLM- PennitApp doc 3/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200S -00057
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 2/14/2005
Phone: (503) 639 -4171 'il
Inspection Requests (24 Hrs.): (503) 639 -4175 '- _..
INSPECTION WORKSHEET FOR DATE: 3/24 /2005 TIME: 7:09AM PAGE: 63
SITE ADDRESS: 10575 SW CASCADE AVE 130 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HEMCON EXPANSION
DESCRIPTION: Plumbing TI in office space. Other fixture is an ice maker.
OWNER: AMB PROPERTY L P, PHONE #:
CONTRACTOR: CASCADE MECHANICAL SYSTEMS INC PHONE #: 630 -4492
Inspection Request Scheduled For: Date: 3/24 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
■
399 Plumbing final 002657 -01 360-903-7364 N
Corrections /Comments /Instructions:
('",
--- -- '''.( e- ./ AP/ .."7"
I
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date. , A,, Phone #: (503) 718 -