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7250 SW DURHAM ROAD STE J-900-1 Ai 006-r ad WVH?ina M5 09ZL N Cl1 4 cn C V C Z D ic C7 L 0 Cl 7250 SW DURHAM Rp J-900 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 --- --�-- - r AM -- _ PM - - BLD _ __Date Requested. n �� Lor,.ation_~ Z S ,Ovl.�.�l a Y� Suite _ MEC —__— Contact Person _ Y�1.� -_ Ph 2 3 - 7 rLM Contractor _ Ph — —_ _.__� SWR BUILDING - Tenant/Owner �e.S�/l TC'� - ELC -C?��l Retaining Wall ELR _ Footing Access: FPS Foundation ---�s-� Ftg Drain _ SGN Crawl Drain Inspection Notes: Slab -- -- — SIT `-- ---- Post&Beam Ext Sheath/Shear - --- Int Sheath/Shear Framing Insulation Drywall Nailing -- ---- - ---- Y—. _--- - Firewall vv Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: — Final PASS PART FAIL ---` PLUMBING — - ---- Post& Beam Under Slab -_ --- - — Top Out Water Service - -- -- -�- Sanitary Sewer Rain Drains --- .. - - --- -- - -� Final PASS PART FAIL ----- - MECHANICAL _— Post&Beam -.-- Rough In - - - ---- - --- Gas Line --- - - Smoke Dampers Final — - — - - PASS PART FAIL E f rRsc t — -- Service -._—__- Rough In UG/Slab --- -— Low Voltage 11 t tS PART FAIL -- -- -- --~ 7ackfill/Grading Sanitary Sewer Storm Drain ]Reinsrwired before next inspection. Pay at City Hall, 13125 SW Hall Blvd [ P:tion fee of$__ Catch Basin [ Please call for reinspection RE: - - [ )Unable to inspect-nc access Fire Supply Line r ADA Approach/Sidewalk Ext Other _ -- Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. , +1 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -- �� BOP _-Date Requested_ � � _.—AM PM BLD 1-ocation D 11VL�/1 _ quite — C MEC r;ontact Person P 'H } PLM Contractor Ph SWR BUILDING Tenant/Owner ELC Retaining Wall _ ELR Footing AccessFPS Foundation Fig Drain SIGN Crawl Drain Inspection Notes. Slab __ __ SIT _. Post& Beam Ext Sheath/Shear - - - Int Sheath/Shear Framing — - — Insulation Drywall Nailing - -- - ----- --— — Firewall Fire Sprinkler - - — ------ Fire Alarm Susp'd Ceiling Roof Misc: --- Final PASS PART FAIL UMBIN - ---_-.-.- Post&Beam Under Slab - - — Top Out Water Service --- -- Sanitary.Sewer RaJ'n Drains R2S PART FAIL -.-�-- — -- ECHANICAL. _ Post& Beam Rough In I r Gas Linn - Smoke Dampers Final PASS PART FAIL ELECTRICAL. Service ----- Rough In UG/Slab1.ow Voltage Fire Alarm Final PASS PART FAIL -------- SITE Backfill/Grading —�— Sanitary Sewer Storm Drain I ] Reinspection fee of$ _—required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin ] Please call for reinspection RE _-— __ i ]linable to inspect-no access Fire Supply Line ADA Approach/Sidewalk 6 1 Inspector-' / _— Ext Other Date - -- Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. V` CITY OF TIGARD BUILDING INSPECTION DIVISION MST f � 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 BUP _ __ D�a1te Requested,/1 c -AM PM BLD :.ocation Suitel,q QQ _ MEC �_G `UZJLZ �S Ph S "� l PLM Contact Person — --- --- Contractcr Ph — SWR BUILDING Tenant/Owner _- ELC -,-_ Retaining Wall I ELIR - - Footing Access: FPS Foundation -- Ftg Drain S Crawl Drain Inspection Notes _--- Slab SIT -- - - - Post&Beam Ext Sheath/Shear - -- Int Sheath/Shear Framing ---- -- Insulation Drywall Nailing - - - Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling - Roof Mise ---- -- - Final PASS PART FAIL PLUMBING Post& Beam Under Slab -- - - ---- ----- --- -- Top Out Water Service — -- - Sanitary Sewer Rain Drains --- - - - Final PASS, PAR FAIL - ANICAL-- - - Post& Beam ---- Rough In --- — - -- - Gas Line - - -- Smoke Pampers _ ---- AS PART FAIL --- ---- ELECTRICAL (� Service - ---- -_�.----- _ --- — Rough In UG/Slab - - - - -- ---- — _-- - Low Voltage Fire Alarm -- — Final PASS PART FAIL ------------------- - -SITE Backfill/Grading - Sanitary Sewer Storm Drain [ j Reinspection fee of$, required before next inspection Pay at City Hall, 13125 SW Hall Blvd Catch Basin [ ]Please call for reinspection RF Unable to inspect- no access Fire Supply Line ADA '� / ) / 1^7 Approach/Sidewalk Date 5 C/ _Inspector_-, � _____._._ Ext Other -- Final PASS PARI FAIL DO NOT REMOVE this inspection record frorn the job site. ._BUILDING PERMIT CITY OF TIGARD PERMIT#: BUP2000-00084 DEVELOPMENT SERVICES DATE ISSUED: 04/25/2000 13125 SW Hall Blvd , Tigard, OR 97223 (503) 639-4171 PARCEL: 2S113AC-00102 SITE ADDRESS: 01250 SW DURHAM RD BLDG J-900 SUBDIVISION: COUNCIL VIEW ACRES NO. 2 'ZONING: I-P BLOCK LOT: 025 JURISDICTION: TIG REISSUE: FLOOR AREAS_ _ EXTERIOR WALLCONSTRUCTION _ CLASS OF WORK: '1' ( _ FIRST: sf N: S: E: W: TYPE OF USE: COM SECOND: sf PROJECT OPENINGS_? TYPE OF CONST: sf N: S E: W OCCUPANCY ORP: TOTAL_ AREA: sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED: STOR: Hl": ft rARAGE� sf OCCU SEP. RATED: BSMT?: MEZZ?: READ SETBACKS _ REQUIRED__ FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: Y SMOK DET: DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALV : '151;r/ I Remains. In$laft*lon of a wet sprinkler system for tenant improvements. Owner: Contractor: PACIFIC REALTY FIRESTOP CO 15350 SW SEQUOIA PKWY 9384 SW TIGARD ST SUITE 300 TIGARD, OR 97223 TIAARD, OR 97223 one Phone: 620-6140 Reg#: LIC 00063946 _ FEES REQUIRED INSPECTIONS Type By Date Amount Receipt Sprinkler Rough-In PRMT GEO 03/22/2000 $68.50 0000605 Sprinkler Final 5PCT GEO 03/22/2000 $5.48 0000605 FIRE GEO 03/22/200C $27.40 0000605 r' Total $101.38 (OD This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be stone 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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503)246-1987. Pe rmitee ` Slonature: Issued By: _---__ _-- Call 639-4175 by 7 p.m. for in inspection the next business day Fire Protection Permit Application Plan Check# 3 -ZzG PITY OF TIGARD Commercial or Residential 13125 SW HALL BLVD. Recd By O— TIGARD, OR '97223 Print or T Date Recd tC>'2lYY) Type Date to P.E. -� (503) 639-417.11, x. 304 Incomplete or illegible applications will not be act,cpted Oct-to DST t(,!;.l ' Permit# N�y�o6Q -OG1'3gj/ Called A Job Name of bee l p�nUProject -- -- — — Type of System(Complete A or B as applicable) Address Address - --- � ®`5,ml 17WI NA 01 R D Ott) p A•)Sprinkler Wet [lam Dry ❑ Name Standpipes -r•RUSr Owner Mailing Address 0 r v.UO+.A DKwi "Poo Additional Hazard Group Ci /State Density Ip PQQ'��i30u Information - Name Design, ren Occupant Mailing Addreas — 72 /Z W d r N�r.�R D („ fE `)o( K Fo r City/state Zi Phone - A. Sprinkler Project Valuation !'P Q,4/V 17ZZ $ 3 300 -- Contractor Na/m --- B. Fire Alarm (Sprinkler or r//2776 :2 Alarm Company) Mailing Addrress -� Submittal Shall Include Battery Calculations YES❑ Prior to permit ),j6 q ,W r00/ issuance,a City/State Zip Phone Individual Component YES[j — COPY 67-0-045 / Cut Sheets of all licenses 912L 3 V L�' rib are required It st rye Con t.cont.Boats Lic.# Exp.Date — g,1) Fire Alarm Project Valuation $ expired In COT database 6 DRQ{, 1/r�L{ Project Valuation Subtotal(A 8 or B) $ ame 11Permit fee based on valuation $ Architect Mallin /jddress _ see chart on back) --ee�• �14,,� A' 30C� �% Surcharge $ CLy/I'ale / Z� Nhon --- — ---— t P� 71 C�14-- �� FLS Plan Review 40% of Permit $ 7DescdbeworkA.)New O Addition O Alteration 0, Repair O _— Z�------ - - ------ - TOTAL $B.) Moditicatlon to sprinkler heads onl y -s—=—�— —1 1-10heads=Noplans required Plans required Submit three sets of plans,including a vicinity map and 2. 11+=Plan review required the location of the nearest hydrant. --'----------•------------------ ------------------- I hereby acknowledge that I have read this application,that the Information given is i Numbef of s rinkler heads 3� j �__ correct,that I am the owner or authorized agent of the owner,and that plans submitted Additional Descrlptlon et Work: are In compliance with Oregon Slate laws Signlature o Owner/Agent Date A.)In Existing Building New Building -M C Buildin )� ,�7. 1'l�lf •��`I,'i:-o Contact Perna ame Phone Data a.) Commercial © Residential —-- ` , FOR OFFICE USE_ONLY: No of stories Plat# MaplTL#: Sq Ft - --- _ Notes — Occupancy Class Type of Constructior, i•\dsts\forrns\firesupr.doc 7/2/99 Valuation of project Permit fee Tax 8% FLS 40% Total 12,000 50.00 4.00 20.00_ 74.00 _ 2,001 - 3,000 59.25 4.74 23.70 _ 87.69 3,001 - 4,000 68.50 _ 5.48 27.40 101.38 4,001 - 5,000 ^ 77.75 6.22 31.10 __115.07 _ 5,001 - 6,000 87.00 _ 6.96 34,80 128.76_ 6,001 - 7,000 96.25 7.70 38.50 142.45 7,001 - 8,000 105.50_ 8.44 42.20 -156.14 _ 8,001 - 9,000 114.75 9.18 45.90 189 .83 _ -_9,001 - 10,00') -_ 124.00 9.92 49.6_0 - 183.52 10,001 - 11,000 133.25 10.66 53.30 197.21__ 11,001 - 12,000 _ 142.50 11.40 57.00 210.9_0_ 12,001 - 13,000 151.75_ 12.14 _ 60.70 224.59 13,0_01 - 14,000 161.00 12.88 64.40 238.28 - 14,001 - 15,000- 170.25 13 62 68.10 251.97 15,001 - 16,000 179.50 14.36 71.80 265.66 1_6,001 - 1_7,000 188.75 15.10 75.50 279.35 17,001 - 18,000 194.00 15.84 79.20 293.04 _ 18,001 - 19,000 -T 207.25 16.58 82.90 306.73 19,001 - 20,000 _ 216.50 17.32 88.60 320.42 20,001 - 21,000 _ 2_25.75 18.06 - 99.30 334.11_ 21,001 - 22,000 _ _ 235.00_ 18.80 94.00 347.80_ - 22,001 - 23,000 _ _ 244.25 10.5497.70 361.49_ _ 23,001 - 24,000 253.50_ 2028. -101.40 375.18 24,E 01 - 25,000 262.75 21.02 105.10 388.87 _ 25,001 �6,�00 289.50 21.58 107.80 _ 26,001 - 27,000 278.25 _ 22.10 110.50 y 408.85 27,001 - 28,000 _283.00- 22.84 _ 113.20 _ 418.84 28,001 - 29,000 2_89.75 23.18 115.90 _ v__-428.83 29,001 - 30,000 _ 298.50 23.72 116.60 438.82 30,001 - 31,000 303.25_ 24.26_ 121.30 448.81 _ 31,001 - 32,000 _ 310.00 24.80_ _124.00 458.80 _ 32,001 - 33,000 316.75 25.34 126.70 468.7_9__ 33.001 - 34,000 _ 323.50 2_5.88 129.40 - 478.78 _ 34,001 - 35,000 330.25 26.42 _132.10 4_88.77 35,001 - 36,000 337.00 26.96 _V 134.80 _498 76 38,001 - 37,000 343.75 27.50 137.5_0 _ 509.75 37,001 - 38,000 350.50 28.04_ 140.20518.74 38,001 - 39,000 35725 28.58 42.90 _ 528.73 39,001 - 40,000 364.00 29.12 145.66 538.72 T 40,001 - 41,000 370.75 2966---- 148.30 548.71 _41,001 - 42,000 377 50 30.20 151.00 4_2,001 - 43,000 J 38425 30.74 153.70 568.69 - 43,001 - 44,000 391.00 31.28 156.40 578.68 40601 - 45,000 397.75 _31.82 159.10 588.67 45,001 - 46,000 404.50 32.38 161.80 598.66 46,001 - 47,000 411.25 32.90 164.50 608.65 - -- 08.65 47,001 -- 48,000 _ 418.00 3344 167.20 _.64_ 48,001 - 49,000 424.75 33.98 189.90 _ 828.E3 - ----------- 49,001 50,000 _431.50 34.52 172.60 838.62 _ is\dsts\forms\M*esupr.doc 12/23/99 04,'21,,2000 08:11 FAX 5036208141 FIRESTOPCO 01 FIRESTOP COO AUTOMATIC FIRE PROTECTION 9384 SW TIGARE)5TREF TIGARD,OREGON 9TW (503)620.6140 FAX-(503)620-6141 FAX TRANSMISSION DA E:— 4-j7/k lax _ $4-707._ FRO NUMBER OF PAGES:____ _(Including cover page) f1 MES�C'E:� = STp ,4LT I 'dlrcon>foe 1A)" Et Al CJ. 4iF�e J irk 41s auP_2 ��� �s o�s�►f f //j �w Ino fooEg _ 4' dad oy aeo, 4.-'xw--AoP/e�vf ,Snips✓ for If you halve received tf1;lax in en ror,please accept our apology and call(503)620.6140. Thank rou HAVE A WONDERFUL DAY! i 04/21/2000 08:11 FAX 5018208141 FIRESTOPCO Q02 l -77-7z !;id- Paxw*v A , Af Alen ---- c,�,a�SC� LCou��N4 _ ul 1 ?slb --- March 24, 2000 ' Firestop C��.y. �� �'�AR® 9384 SW Tigard Avenue CITY Tigard, Oregon 9722.3 OREGON RE: Stash Tea BUP 2000-0008 7250 SW Durham J900 Dear Applicant: Your application for a Fire Protection Permit cannot be processed for the following reasons: 1. Plans shall show the following information (a) Hazard Classification ( Ord. Haz. 2) (b) Location of most remote. 2. Provide new hydraulic calculations. Provide three (3) sets of revised plans and associated documents. If you have questions, please call me at 639-4171 X392. c,G7ct au.� Ro ert Poskin, CBO Senior Plans Examiner 13125 SW Hall Blvd., Tigard, OR 07223 (503) 639-4171 TDD(503)684-2772 ---------- -- ,I A EM Fire Systems Sprinklers - 4.5 "Automatic" Standard Glass Bulb Sprinklers ■ Madel H -- 1/2" Orlflce x 1/2" NPT- Uprlght & Pendent K = 5.6(8.1) ■ U1_ Listed - FM Approved" �P COD Q 2.7/92- 2.7/32• (56 mm) I (5e mm) A a O Upright Sprinkler I I Pendent sprinkler "Temperature Ratings: Discharge Curve: ❑ 135° F (57°C) Cl 155° F (68°C) O 175° F(79°C) 50 (345) ❑ 200° F (93°C) 1541 O 286° F(141°C) (310) 40 ❑ 360° F(182°C) (276) ❑ Open(No rating) ro (2;) **Finishes: ( 7) C7 Plain Brass o 25 ;,72) O Chrome Plated(Bright) 20 ❑ White ( ) 15 ❑ Bright Brass (' 1) O Coro Coated (Wax) (6q) O Coro Coated over Lead 5 (35) 35 40 C7 Lead Coated (19) (•A) ('57) (i6) (9) (,11) (32) ( 51) Dscher"in ppm(Umin) White finished sprinklers are t=FM Approved. See back of page for available style;, tempera- ture rating, and finish combinations. 01987, 1989 Figgie International Inc,All rights reserved (7/89) �1 4.6 • Sprinklers Fire Systems "A.utumatic" Standard Glass Bulb Sprinklers 10 <2) ua 1. Deflector 2. Compression Screw' 3. Glass Bulb 9 r4) 4. Thimble' 5 Spnng Seal 66. Frame C5J \ • Satin in tin plated on while finished sprinklers rinklers for p decorative purposes rrm'T nate C2} 0 Upright Sprinkler Pendent Sprinkler ORDERING INFORMATION FOR: "Automati;" kilinffal 'A- 1/2"Orifice x 1/2"NPT- Upright & Pendent - --- --- -- - - ----- _-- - Upright- pendent I Maximum Color Code - Temperature Ambient Finish & Symbol Stock S•-"bol Slack Rating Temperature Location No. Code No. No. Coda No. 135"t-(57°C) too*F(38"C) Brass - - None 386010 H 8486010 38.7010 H 8487010 (Orange Bulb) Chrome None 38-601114 8486011 38.7011 H 8487011 1 earl Coated None 38-601314 8486013 38.7013 H 8487013 White None 38.601114 6486017 38.7017 H 8487017 Bright stars Nune - - 3a 7018 H 8487018 ; 155°F(68"C) t00°F(38•C) Brast Nonc 38.6020 H 8486020 38.7020 H 8467020 (Red Bulb) Chrome None 38 6021 H 6486021 3q•7021 H 8487021 Coro-Coaled(Wax) None 38.6022 H 8486022 38-7022 H 6487022 Lead Coated None 38-602314 8486023 387023 H 6487023 Coro-Coated over Lead None 38-602614 8466026 38-7026 H 8487026 White None 38-6027 H 8486027 38.7027 H 84117027 Bright Brass None - - 38.7028 H 8487028 175'F(79°C) 150°F(66°C) Bross White c-Frame Arm 38 6030 H 84860- 38-7030 H 8487030 j (Yellow Bulb) Chrome White on Deflector 38.6031 H 8486031 38-7031 H 8487031 Coro-Costed(Wax) White on Deflector 38.6032 H 8486032 38.7032 H 8487032 Lead Coaled White on Dellector 38-603314 8466033 38.7033 H 8487033 Coro-Coated over Lead While on Dellector 98.6036 H 8486036 38.7036 H 8487036 White White on Deflector 38.6037 H 8486037 38-70374 8487037 Bright Grass White on Deflector - - 38.7038 H 6487028 200'F(93•C) 150°F(66•C) Brass White on Frame Arm 38 E040 H -8486040- 38-7040 H 8487040 (Green Gulb) Chrome .- White on Deflector 38.6041 H 8486041 387041 H 8487041 Coro-Coa,ed(Wax) White on Deflector 386042 H 8486042 38.7042 H 8487042 Lead Coated White on Deflector 38 6043 H 8486043 38-7043 H 8487043 Coro-Coated ow--f;end Whop on Deflector 6046 H 8486046 38-704614 8487046 White White on Deflector j4?H 8468047 38-704714 8487047 Bright Brass White on Deflector - - 38.7048 H 8487048 286°F(141•C) 225°F(107•C) grass Blue on Frame Arm 3"6050 H 8486,050 38.7050 H 8467050 (Blue Bulb) Chrome Blue on Deflector 386051 H 8486051 38.7051 H 6487051 Coro-Coated(Wa)r)' Blue on Deflector 386052 H 8486052 38.7052 H 8487052 Lead Coated Blue on Defleclor 386053 H 8486053 38.7053 H 8487053 White Blue on Deflector 38-6057 H 8486057 387057 H 8487057 360 ( (t82°C) 300•F 11491 C) Braes Red on Frame Arm 38.6060 H 8486080 38.7060 H 8487060 ;Pu,p:e Bulb) Chrome Red on Dellector 38.6061 H 6.86061 38.7061 H 848706 Lead Coated Red on Deflector 386063 H 8486063 38.7063 H 8487063 White (led on Deflector 38.6067 H 8488,`167 38.7057 H 848706' Oro Brass None 36.600014 8486000 38-7000 H 6487000 Chrome None 38.6001 H 3486001 387001 H 848700' Lead Coated None 386003 H 8486003 38 7003 H 8487003 White None - 1 28.6007 H 8486007 38 71X17 H 8487007 286'F with 212"F Com-Coot Maximum ambient tempe-raturo 1So`F(FM Approved only) -- 1B9) g,1937, 1989 Figgie International Inc All rights reserved �_Y S �� ������ ___ ELECTRICAL PERMIT PERMIT#: ELC2000-00132 DEVELOPMENT SERVICES DATE ISSUED: 03/24/2000 13125 SW Hill Blvd.,Ti lard, OR 97223 (503) 639 41'11 PARCEL: 2S113AC-00102 SITE ADDRESS: 07250 SW DURHAM RD BLDG J-900 SUBDIVISION: COUNCIL VIEW ACRES NO 2 ZONING: I-P BLOCK: LOT : 025 JURIc�DICTION: TIG Proiect Description: Install 2 service/feeders and 25 branch circuits in existing commercial building. RESIDENTIAL UNIT TEMP SRVCIFEE_DERS --MISCELLANEOUS 1000 SF OR LESS: 0 200 amp PUMP/IRRIGATION: EACH ADD'L 500SF: 201 400 ar,-1: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL: MANF FIM/ SVC/ FDR: 601+amps - 1000 volts: MINOR LABEL (10): SERVICE/FEEDER BRANCH_CIRCUITS �. ADD'L INSPECTIONS 0 • 200 amp: 2 WISERVICE OR FEEDER: 2;i PER INSPECTION 201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT: 601 - 1000 amp: _ _ _ PLAN REVIEW SECTION 1000+ amp/volt: >=4 RES UNITS: Vs > 600 VOLT NOMINAL: Reconnect only_ . SVC/FDR >=225 AMPS: __CLASS AREA/SPEC-OCC:. ____._ Owner: Contractor: BACHOFNER ELECTRIC INC 55 SE MAIN PORTLAND, OR 97214 Phone: Phone: 233-2006 Reg#: LIC 00044569 ORIGINAL SUP 28()8S ELE 26-451C FEES _ Required Inspections Type By Date Amount Receipt Elect'I Service PRMT KJP 03/24/2000 $262.25 0000920 Elect'I Final 5PCT KJP 03/24/200C $20.98 0000920 Total $2.83.23 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 Oregooi Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rub-5 or direct questions to OUNC at(503) 246.1987. PERMITTEE'S SIGNATURE �, ISSUED BY: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: ____— -_. — DATE:-- CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: l Lam- �* DATE:___ LICE!,4SE NO: I i c) Call 639-4175 by 7.00pm for an inspection the next business day CITY OF TIiARU Plan Check p 13125 SW HALL BLVD. RE-JE1 flCal Permit Application - Rac'd By_ 'TIGARD OR 97223 Date Recd Phone (503)6394171, x304 MAR 2 3 ZOnri Date to P E _ in�pection (503)639 Date to DST 4175 COMMUNITY DFVFI OPMI N 1 Print of Type permit#47 — Fax (503) 598-1960 Incomplete or illegible will not be accepted Called 2._ 1. Job Address: 4. Complete Fee Schedule Below: Name of Development _ Number or hrspections per permit allowed Name(or name of business) Stash _ _ Service included: Items Cost Sum Address 72so qA jil,21M Srwi Cj�f _ 4a. Residential-per unit City/State/Zip TLrgind. CR 1000 sq n.or less _ — $ 117.75 _ 4 Each additional 500 sq,it or - - portion thereof S 26.25 i Commercial El Residential ❑ Limited Energy — $ 60.00 Each Manuf d Horne or Modular 2a. Coniractor Installation only: Dwelling Service or Feeder $ 7275 2 (Prior to pernat issuance,applicants must provide contractor license 4b.Services or Feeders — Information for COT data base). Installation,alteration,or relocation Electrical Contractor B2digftgr Mjaruzic. Ir>c. _ 200 amps or less $ 64.25 1&•9Q 2 Address._ 55 SF Mijn 201 amps to 400 amps $ 85.50 2 City R rUand State CR Zip 97214 401 amps to 600 amps $ 128.50 2 Phone No. 503 20(Xi "33- — 601 amps to 1000 amps $ 19250 2 --�--- ` Over 100n amps or volts _ $ 36375 2 Job No. r13�)j Reconnect only _— $ 53.50 2 Elec. Cont. Lice. No. 26451C Exp.DateI U 4c.Temporary Services or Feeders OR State CCB Reg No 94568 Exp.Date �- Installation,alteration,or relocation COT Business Tax or Metro No. Exp.Date 200 amps or less $ 53.50 _ 201 amps to 400 amps $ 80.25 _ Signature of Supr. Elec'n�� �� r 401 amps to 600 amps — $ 107.00 - 7 Over 600 amps to 1000 volts, — Liconse No 2808S Exp.Date /o/i/(Ju see"b"above. Phone No503L 2006 233. 4d.Branch Circuits -�— _ New,alteration or extension per panel a)The foe for branch circuits 2b, For owner installations: with;.,urchaseofservice or feeder fee. Print Owner's Name Each branch circuit 25 s 5 35 133.75 Address b)The fee for branch circuits -- without purchase of service City V _ _ State Zip� or feeder fee. Phone No. _ First branch circuit S 37.50 Each additional branch circuit S 5.35 The installation is being made on property I own which is not 4e.Miscellaneous Intended for sale, lease or rent (Service or feeder not r,cluded) Each pump or irrigation rircle $ 42 75 Owner's Signature Each sign or outline lighting $ 42 75 Signal circuit(s)or a limited energy - - 3 Plan Review section (if required):' panel,alteration or extension _ $ 6000 — Minor Labels(10) $ 10700 Please check appropriate item and enter fee in section 5B. 4f.Each additional Inspection over 4 or more residential units in one structure the allowable In any of the above Service and feeder 225 amps or more Per inspection $ 5000 _ System over 600 volts nominal Per hour $ 5000 Plant $ 5900 Classified area or structure containing special occupancy as --- described in N.E.0 Chapter 5 5. Fees: Be.Ener total of above fees $ 262.25 Submit 2 sets of plans with application whore any of the above apply. j Surcharge(05 X total fees) g Not required for temporary construction Ices. Subtotal -�'�-- s NOTICE 5b.Enter 25%of line 5a for --- Plan Review if required(Sec 3) $ PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED Subtotal $ --� IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS ❑ Trust Account#__ AT ANY TIME AFTER WORK IS COMMENCED Total balance Du s $ I\dsts\f'orms\elcctric.doc �1 CITYOF TIGARD SEWER CONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2000-00046 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 03/22/2000 SITE ADDRESS; 07250 SW DURHAM RD BLDG J-900 PARCEL: 2S113AC-0010 SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I-P BLOCK: LOT: 025 JURISDICTION- TIG TENANT NAME: STASH TEA CO USA NO: FIXTURE UNITS: 62 CLASS OF WORK: ALT DWELLING UNITS: 2 TYPE OF USE: COM NO. OF BUILDINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: Tenant improvement. Add 2 to the current EDU count of 2. Fotal fixture count now 62. Owner: - _ _ FEES PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt 15350 SW SEQUOIA PKWY #300-WMI PORTLAND, OR 97224 PRMT K.iP 03/21: :OOC $4,600 00 0000860 Phone: Total , $4,600.00 --- — — Contractor: Phone: Reg #: Required Inspections [his Applica.)i agrees to comply with all the rules and regulations of the Unified Sewage Agency The permit expires 180 days from the date issued The tote! amount paid will be forfeited if the permit expires The Agency does riot guarantee the accuracy of the side sewer laterals If the sewer is not located at the measurement given, the installer shall prospect 3 feet in all directions from the distance given If not so located, the installer shall purchase a"Tap and aide Sewer' Permit and the Agency will install a lateral ATTENTION Oregon law requires you to follow rules adapted by the Oregon Utility Notification Center Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080 You may obtain copies f these rules or direct questions to OUNC by calling (503) 246.1987. Issued by: Permittee Signature: L�,, ; Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day D CITYO F T I GAR D PLUMBING PERMIT — DEVELOPMENT SERVICES PERMIT#: PLM2000-00085 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 03/24/2000 SITE ADDRESS: 07250 SW DURHAM RD BLDG J-900 PARCEL: 2S113AC-00102 SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I-P BLOCK: LOT: 025 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS: 1 TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS: SINKS. 1 URINAL-S: 1 GREASE TRAPS. LAVATORIES: 2 OTHER FIXTURES: TUBISHOWERS: SEWER LINE: ft WATER CLOSETS 2 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Installation of one sink, two lays, two water closets, one urinal, one 3"floor sink, and one water heater. FEES Owner: —'" Type By Date Amount Receipt PACIFIC REALTY ASSOCIATES PRMT KJP 03/24/200( $92.00 HAND RECPT 15350 SW SEQUOIA PKWY #300-WMI 5PCT KJP 03/24/200( $7 36 HAND RECPT PORTLAND, OR 97224 — Total $99.36 Phone 1: Contractor: DEAN WARREN PLUMBING 3111 SE 13TH PORTLAND, OR 97202 REQUIRED INSPECTIONS Phone 1: 236-4152 PLM/Underfloor #: LIC 172 Top-out Insp Reg Final Inspection PLM 26-83PB 0r JAL This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law,. All woik will be done in accordance with approved plans, f his 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.-0001-0080. You may obtain copie f these -�s or direct questionS to OUNC by calling (503) 246-1987. Issued By: C �2JC Yr�_d,_• Permittee Signature:_AIL — Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Application 13125 SW HALL BLVD. Commercial and Residential Plan Check TIGARD, OR 97223 Recd By (503) 639-4171 Date Recd Date to P E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit#�i?eaoo Related SWR Called_ p Name or Development/Project FIXTURES (individual) Job __ _ QTY PRICE AMT 1Y lL;1 1 1 ;ink 11.SU Address Street ddress �uile Lavatory ' i, _ 11.50 Bldg# Tub or Tub/Shower Comb. 11.50 9 c _ City/State Zip J �; L• Shower Only - - 11.50 Name afar Clos Unnal (Specify) 11.50 e Dishwasher ---- Owner alling_Addresa - 11.50 5C9w A Sulte� Urinal 11.50 13 0Q City/State Zip Phone Garbage Disposal 11.50 -- ),/6A '•" ^,I Laundry Tray _- --- 11.50 LName Washin Machina/Laund-Tray g ry Y (Specify) 11.50 Floor Drain/Floor Sink Occupants Suite _ 11.50 11.50 Zlp Phone _"- 4" 11.50 _ Water Heater O conversion Irks kind 11.50 Name Gas I ing requires a separate mechanical ermit. _ N MFG Home New Water Service 28.00 Contractor Mailing Address Suite MFG Nome New San/Storm Sewer t� 28.00 7 t'� ~ L" Hose Bibs - - Prior to permit Ity/State ZIP Phone 11.50 Issuance,a copy Root Drains 11.50 all licenses are Oregon Const.Cont Board Lic# Exp.Date Drinking Fountain 11.50 required It Other Fixtures(Specify) -- expired In COT Plumbing Llc.# Ex Date 15.00 database F __ lame ArchitectSe -- wer•1st 100' 3A.00 Or Mailing Address Sulle - 100 Sewer- ach-additional ' 32.00 Engineer City/St ate Zip Phone - Water Service-1st 100' 38.00 _ Water Service-each addltlona1200' 32.00 Describe work to be done: Storm d Rain Drain-1st 100' New )e Repair O Replace with like kind: Yes O No O 38.00 Residential C Commercial Storm 6 Rain Drain-each additional 100 32.00 Additional description of work: Q t -I r �_ ,-r - Commercial Back Flow Prevention Device 32.00 �^• ";/,S r 17 Residential Backflow Prevention Device- 19.00 Are you capping, moving or replacing any fixtures? -- catch Basin - 11.50 Yes O No O Insp.of Existing Plumbing or Specially Requested 50.00 If yes, see back of form to indicate work performed b Inspections er/hr Raifixture. F=AILURE TO ACCURATELY REPORT FIXTURE Gre Drain,single family dwelling 45.00 WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50 I hereby acknowledge that I have read this applirafion,that the information QUANTITY TOTAL �y given Is correct,that I am the owner or authorized agent of the owner,and Isometric or riser diagram Is required it Ouanlity Total is 9 D that plans submitted are In compliance with Oregon Slat Laws "SUBTOTAL Signeturepf OwReriAgent Date 9� 8%SURCHARGE Contact Person Name P one _ "PLAN REVIEW 25%OF SUBTOTAL 1 BATH HOUSE j1 T8.00 --` Re wired only If fixture qty total is>9 RATH HOUSE$250.00 TOTAL !ATH HOUSF-$285.00 y? 1 r his fee Includes all plumbing fixtures In the dwelling and lire firstv - 100 feet of sanitary sower ratomt sewer and water service) 'Minimum permit fee Is s50•8%surcharge,except Residential BecMlow,prevention Device,which Is$25+B%surcharge All New Commerclal Buildings require plane with Isometric or riser diagram and plan review 4lstslt01m 5 Oum app dot 10/1/99 PLEASE COMPLETE: Fixture Type V — Quantity by Work Performed New Moved Replaced Removed/capped Sink ----_._.— — I --- -- - - - - —�— Lavatory Tub or Tub/Shower Combination Shower Only _ Water Closet Dishwasher Urinal Garbage Disposal _Laundry Room Tray Washing Machine__ _— Floor Drain/Floor Sink 2" ---- — _" 411 Water Heater Other Fixtures (Specify)_ COMMENTS REGARDING ABOVE- I V.1,W1mM,1,plumapp doc 10/1/99 I' Accumulative Sewer Tally Tenant Name i�� `/' Ems_ This SWR fA)Xaoo0 - aooy� Address: 4-e'1/.-t-�-, Tnis PLM#:_ 601 ;7000 - .� Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New t7 Value Capped off value added# added #s total Count off#s count value values Baptistry/Font -- 4 - Bath -Tub/Shower 4 _ -JacuzziM/hirlpool 4 Car Wash - Each Stall _ _6_ I - Drive Through 16 �-- Cuspidor/Water Aspirator 1 - Dishwasher-Commercial 4 _ - Domestic _-2Drinking Fountain Fountain 1 Eye Wash — 1 Floor Drain/sink -2 inch 2 - 3 inch 5 -- - --- - — - S'- - - - 4 inch 6 _ - - -Car Wash Drn_ 6 _- Garbage Disposal 16 - _ -Domestic(to 3/4 HP) -Commercial(to 5 HP) 32-Industrial(over 5 HP) _ 48 h_e Machine/Refrigerator Drains 1 Oil Sep(Gas Station) _ _6_ Rec.Vehicle Dump Station 16 Shower-Gang (Per Head) 1 - Stall 2 _ Sink - Ba avatory) --__- 2 Bradley -- 5 — — Commercial 3 -- - Service_ 3 Swimming Pool Filter 1— Washer-Clothes _ 6 _ Water Extractor _ _ 6 Water Clos Toilet _- 6 Unnoli� _ - 6— ---- _ - - -- --- TOTALS Total fixture values __ _ 02 _ divided by 16 = �, �� _ EDU HISTORY _ �i,.j �'���`t��tlC��l� �� _ 1 PLM# EDU# �Z SWR# EDU# SWR# PLM# EDU# SWR# PLM# - - EDU# SWR# PL-M# EDU# _ SWR#_ PLM# _ _ EDU# _ SWR# PLM# EDU# SWR# PLM# EDU# SWR# r�dstswsw:,aly doc 1�,I - BUILDING PERMIT CITY OF TIGARD PERMIT#: BLIP2000-00082 DEVELOPMENT SERVICES DATE iS3UED: 03/22/2000 - 13125 SW Hall Blvd.,Titiard, OR 97223 15031 639-4171 PARCEL: 2S113AC-00102 SITE ADDRESS: 07250 SW DURHAM RD BLDG J-900 SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I-P BLOCK: LOT: 025 JURISDICTION: TIG REISSUE: _ FLOOR AREAS EXTERIOR WALL_CONSTRU_CTIO14 _ CLASS OF WORK: ALT FIRST: sf N: S: E: W: TYPE OF USE: COM SECOND: sf _ PROJECT OPENINGS? _ TYPE OF CONST: 5N sf N_ S: E: W: OCCUPANCY GRP: B TOTAL AREA: sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 94 BASEMENT: sf AREA SEP. RATED. STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: ME7_Z?: _ READ SETBACKS_ _ _ REQUIRED FLOOR LOAD: psf LEFT ft RGHT: ft FIR SPKL: Y SMOK DET- DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING: VALUE: $ 100,000.00 Remarks: Commercial TI Owner: Contractor: PACIFIC REALTY ASSOCIATES H L GREEN 15350 SW S1.=000IA PKWY #300-WMI 15350 SW SEQUOIA BLVD PORTLAND, OR 97224 STE 300 RR gg77�� Phone: 684 4914 TII onDe'. W4 771 4 ORIGINAL Req #: LIC 4132A FEES _ REQUIRED INSPECTIONS Type By Date Amount Receipt Framing Insp PRMT KJP 03/22/200( $664.00 0000859 — GYP Board Insp Susp Ceiing Insp PLCK KJP 03/22/200C $431.60 0000859 Final Inspection 5PCT KJP 03/22/200C $53.12 0000859 FIRE KJP 03/22/200C $265.60 0000859 Total $1,414.32 This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All wol k will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-1987. You may obtain a copy of these rules or direct questions to OUNC by calling (503) 246-1987. Pennitee Signature: 14L Issued By: r Call 639-4175 by 7 p.m. for an inspection the next business day ci ry OF TIGARD Commercial Building Permit Recd By—, 13,125 SW HALL BLVD. Tenant Improvement Date Recd zc TIGARD, OR 97223 Date to P.E. ZP--lftV (503) 639-4171 Date to DST Permit Stbf' B i- Print or Type Related SWR x ` Incomplete or illegible applications will not be accepted Called �- Name of DevelopmenuProlect - Existing Building New Building Cl Job AA,(;r" h=s�,+!/�=a 5- l'G ' Address Street Address Suite" '/guilding ._ Data Bldg s City/State Zip Existing Use of Building or Property: Name Property PACIFIC—REALTY ASSOCIATES, L.P. Proposed Use of Building or Property: Owner Mailing Andress Suite 15350 SW SEQUOIA PAWY_ 300 - No. Of Stones: / City/State ZIP Phone PORTLAND, OR 97224 624-6300 Sq. Ft. Of Project Occupant Name - ; J-ly / Occupancy Class(es) Name / Contractor H. L. GREFN_COMPANY Type(s)of Const tion Prior to p(.rmit Mailing flddress � Suite ----- �✓ issuance,a ropy 15350 SW SE" Will this project have a Fire Suppression System? SEQUOIA PKWY 300 of all licenses _ _ Yes� No � are required if City/State Zip Phone- expired in C.O.T. Americans with Disabilities Act ADA) database PORTLAND, OR 97224 624-7717 Valuation X 25% =$ Participation Oregon Const Cont.Board Lic.R Exp.Date — Complete Accessibility ForJ- 41328 Project o n� Name Valuation Cirf� j Architect JOHN H. ROMISH Plans Requires;: See Matrix for number of sets to submit Mailing Address Suite on back 2216 SE 24TH AVE. CityiState Zip Phone I hereby acknowledge that I have read this application,that the information PORTLAND, OR 97224 236-6306 I given is correct,thet I am the owner or authorized agent of the owner,and — that plans submitted are in compliance with Oregon Stale Laws. E=ngineer Name Signature of OwnenAgent Daje Mailing Address Suite — p► � - / �1 / „ X71 Contact PersdirlifName Phone City/State Zip Phone FOR OFFICE USE ONLY _ _ Indicate type of work: New O Addition O Demolition 0. MapR1# Land Use A-cessory Structure O Foundation Only O Alteration[ Repair O Other O / -- Notes' Description of work: u TIF: —_— Parks: Estimated*of Employees ----------------- 'tote: Site Work Permit Application must precede or accompany Building Permit Application IICOMNEW.DOC (DST) 8/97 I CITYOF TIGARD MECHANICAL PERMIT DEVELOPMENT SERVICES PERMIT#: MEC2000-00091 13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 03/22/2000 PARCEL: 2S 113AC-00102 SITE ADDRESS: 07250 SW DURHAM RD BLDG J-900 SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I-P BLOCK: LOT: 025 JURISDICTION: TIG CLASS OF WORK: ALl' FLOOR FURN: EVAP COOLERS: TYPE OF USE: COM UNIT HEATERS: VENT FANS: OCCUPANCY GRP: F1 VENTS W/O APPL: VENT SYSTEMS: STORIES: BOILERSICOMPRESSORSHOODS: FUEL TYPES 0 - 3 HP: 1 DOMES. INCIN: LPG i ! 3 - 15 HP: COMML. INCIN: MAX INPUT: BTU 15 - 30 HP: REPAIR UNITS: FIRE DAMPERS?: 30 - 50 HP: WOODSTOVES: GAS PRESSURE: M 50 + HP: CLO DRYERS: FURN < 100K BTU: 2 AIR HANDLING UNITS OTHER FURN >=100K BTU: 2 <= 10000 cfm: GAS 1 UNITS: GAS O > 10000 cfm: Remarks: Mechanical TI. Owner: _ FEES _ PACIFIC REALTY ASSOCIATES Type By Date Amount Receipt 15350 SW SEQUOIA PKWY #300-WMI PRMT� KJP 03/22/20( $72.70 0000844 PORTLAND, OR 97224 PLCK KJP 03/22/20( $18.18 0000844 5PCT KJP 03/22/20( $5.82 0000844 Phone: Total $96.70 Contractor: �! PROTEMP ASSOCIATES INC 807 NE COUCH PORTLAND, OR 97232 REQUIRED INSPECTIONS _ Gas Line Insp Phone:233-6911 Mechanical Insp Reg#:LIC 00038868 Duct Inspection ELF 201JHA Final Inspection nRI I1 AL phis permit is issued subject to the rAgulations contained in the Tigard Municipal Code, State of Ore. Specialty Codes and all other applicable law ; All work will be done in accordance with approved plans. This permit will expire if work is not started with':n 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted in the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules or direct questions to OUNC by calling (503)246-9189,. Issue By: Permittee Signature: Call (503) 639.4175 by 7:00 P.M. for inspections needed he next business day Plan Preck CITY OF TIGARD Mechanical Permit Application Rec'a By t 13125 SW HALL BLVD. Commercial and Residential Date Recd TIGARD, OR 97223 Date to P E !' V-oU (503) 639-4171, x304 Y Date to DST lelay Print or Type = Permit#11i Incomplete or illegible applications will not be accepted Called Name of Developmer.VProleri Description _Table 1A Mechanical Code Oty Price Amt A) Permit Fee ___-- .'•F " 16.00 Jub Street Address SLMO 1) Furnace to 100,000 BTU �j_ Address �1, 0 Nd �rI including ducts 8 vents — see footnote 1,2- �L" 9.65 ��� BldgN CRY/State Zip 2) Furnace 100,000 BTU+ i I p y including ducts&vents— see footnote 1,2 1200 n� Nader name of business) 3) Flour Furnace t,�2 _ _including vent see footnote 1,2 — 965 / _- Owner �C /i�U 5/` 4) Suspended heater,wall heater Mailing Address or floor mounted heater _see footnote 1,2 965 ra1r p S 1n/ q� ,Q �C� 5) Vent not included in appliance permit 4 75 — Chy/State Zip Phone Check all that apply 'Boiler Heat Air For items 6-10,see or Pump Cond Qty Price Amf Name(or naamemeoof �business) ~ footnotes 1,2 Comp --- - 6)<3HP,absorb unit to !, _ 100K BTU _ 9 65 Occupant Mailing Address 7)3-15 HP,absorb unit 100k to 500k BTU 1765 ChylGlate — — z p rhn��- 8)15-30 HP, absorb -- — unit 5-1 mil BTU _ 24 15 9)30-50 HP,absorb Contractor Nai unit 1-1.75 mil BTU _ _ _ _..__ 36.00 /7!r J C• TN 10) >50HP,absorb unit Prior to permit Malling Address >1.75 mil BTU C0_1 5 Issuance,a copyr, C��CN 11 Air handling unit to 10,000 CFM of all licenses Guy�state zip phone _ 7.00 _ are required iff 12)Air handling unit 10,000 CFM+ 11.85 expired in COT Oregon const Cont Board LICA ate — database $�G � C` 13)Non-portable evaporate cooler 7.00 Architect Name 14)Vent fan connected to a single duct 475 _ Mailing Address or 15)Ventilation system not included in appliance permit 700 EngineerCIIylSlele Zip Phone 16)Hood served by mechanical exhaust _7.00 Describe work to be done - T 171 Domesbc incinerators _ 1200 New O Repair O Replace with like kind Yes O No O 16)Commercial or industrial type incinerators 4825 _ Residential O Commercial- 19)Repair units _! 8.40 Additional information or description of work ` 20)Wood stove/gas Mother units/clothe dryer/etc. _ 7.00 NOTE: For Commercial projects only,Units over 400 lbs require 21)Gas piping one to four outlets 375 structural gas talcs _^ See footnote 1 _ as LPG O electric O 22)More than 4-per outlet(each) 75 Type of suet. all O natural g_ —� Minimum Permit FOR 150.00 SUBTOTAL �'{'6 i I hereby acknowledge that I have read this application,that the tnformetion 8%SURCHARGE `l divan is correct,that I am the owner or authorized agent of PLAN REVIEW 25%OF SUBTOTAL Required for ALL commercial permits only . the owner,that plans submitted are in compliance with Oregon Slate laws -- -�--- TOTAL Signature of j nerlAgent — Date Other Inspections and Fees t i 1. Inspections outside of normal business hours(mininum charge-two Contac arson Nar Phone hours) 150.00 per hour 2. Inspections for whhh no fee Is specifically indicated (minimum �c:ommer�c�lalprojects charge-half hour) view rp per hour 3. Additional plan review required by changes,add tions or revisions to Foonotes only: plai,j(minimum charge-one-half hour)$50.00 per hoer 1 Provide full schematic of existing and proposed gas line and pressure 2. Provide drawings to scale showing existing and proposed mechanical 'State Contractor Boiler Certification required units — — - -Residential A/C requires site plan showing placement of unit I:Vnechperm doc rev 7/19/99 OVER-THE-COUNTER (OTC) PERMIT COMMERCIAL MECHANICAL PERMIT CHECK LIST Description of Project: ___ ��''�r+/�►� ___—____-- ----._ Class of Work: def _ Floor Furnace: Evap Cooiers: Type of Use: - Unit Heaters Vent Fans: _____ Occupancy Grp: / / Vents W/O Appl: Vent Systems: Stories: _ Boilers/C,-)mprsrs: Hoods: Fuel Types - 0 - 3 HP. _ Repair Units: 3 - 15 HP. Wood Stoves: Max Input. _ Btu: _ Air Handling Units CIO Dryer: Fire Dampers: _ 10000 cfm: _ .__ Oth Units: Gas Pressure: H / 4� L > 10000 cfm: _ comas Outlets: No. Of Units: Furn < 100k Btu: Furn - 100k Btu: NOTES: f _ COMMERCIAL INSPECTION ACTIONS FEE MENU _s� L Gas Line I $ �� Permit Fee ns ectig� � "--"' $ Plan Review Mechanical Inspection — Cooling Unit Inspection $ 8% State Surcharge Shaft Inspection $ Additional Permit Fee Hood Inspection $ Additional Plan Review Fee Fire Suppr Inspection $ _ Inspection Fee Duct Inspection $ Miscellaneous Fee Fire Alarm Inspection - — REMARKS: Fire Damper Inspection Miscellaneous Inspection --- Fire Alarm Inspection �- - _�-final Inspection - ---FOR OFFICE USE ONLY: TYPE OF USE OPTIONS(COM-commercial CMS=commercial manufactured structure) ;LASS OF WORK OPTIONS FOR ALL PERMIT-S(NEW=new;ADD=addition;ALT=attention;ACS=accessory; FND=foundatiun;OTH=other;DEM-demolition;:SEP=repair,FPS-fire protection system NOTE=USE OTH FOR FENCES,REIAINING WALL,DETACHED DECKS,SIGNS, AWNINGS,CANOPIES) V/dsUforms/otcmech,doc O/99 i,\dsts\forms\otc-mech.doc9/99 j 1 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -- - --- BLIP Date Requested_-_- ` —AM__ PM _ BLU --�` - - Location r_ 1-�St" "'&e tzL�PJ Suite 'MEC ------ --- Contact Person Ph ���y':.���� PLN; Contractor_— ,� -zzc Ph __ SWR BUILDING Tenant/Owner _ 44-5-A Ew ELCy�- Retaining Wall ,-JL- 4*t-- ELR _ Footing Access: Foundation FPS Ftg Drain Crawl Drain Inspection Notes SGN Slab ----------------- -- -- ---- - SIT Post& Beam Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall -- ---- Fire Sprinkler Fire Alarm Susp'd Ceiling Roof - - - ------ Misc: Final PASS PART FAIL -L��- _ - ----- - - - -- - -- - PLUMBING -� Post& Beare - ----- ------ ----- Under Slab Top Out -- -- - Water Service Sanitary Sewer -- Rain Drains Final y -- PASS PARI FAIL MECHANICAL Post& Beam - ---- - -- ----- -- --- Rough In Gas Line - - --—� Smoke Dampers Final - - -- -_ PASS PART FAIL LE.CTRICA Service Rough In UG/Slab _ Low Voltage Fire Alarm a SS ART FAIL Backfill/Grading — Sanitary Sewer Storm Drain ( J Reinspection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin ( J Please call for reinspection RE _ ( J Unable to inspect-no access Fire Supply Line ADA Approach/Sidewalk Other Dae _Inspector Ext _^ Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. 1 `\ CITY OF TIGARD F-I. ECTRICAL. PERMIT DEVELOPMENT SERVICES PERMIT #: ELC99-0042:' 13125 SIV Hall&J., Tiyard,OR 97223(503)639.4171 DATE I SSIJED: 01/113/99 PARM71-: `7'C31I3()C,--001.02 TF ADOPEGS. . . :V 7EC;0 SW DL.1RHnM RD #,T -900, 113D I V I S 7'IN. . . . :f"MiNC.,I I 1.'T EJW ArPF10) Nt). E ZnN I NC,: T--F' OCK. . . . . . . . . . .. L.n'r. . . . . . . . . . . . . :025 JLJRISDICTICIN: TTG n-jert Descriprtitan: Stash Tea Co IM 3026-14 - REr,T DENT I AL. IJN I T--•----- TEMP SRVC/FEE MRS-. _.._ -._.___- M T SCEL_1_..A1VEnLJ5,,-•- ­oo SF ()R I FM'). . . . : 0 0 - E'00 Amp. . . . . . . : 0 P(JM1='/IRRTC,ATION. . . . . 0 )GH ADD' L 5009F. . . : 0 201 - 400 ramp. . . . . . . : 0 SIGN/OtJT LINE LTP 0 IMI TED E"NE RGY. . . . . : 0 401 - 600 amp. . . . . . . : 0 S I CANAL./PANEL.. . . . . . . : 171 114F. HM/ SVC/FDR.. . : 0 601+amps-• 1000 vial t s. : 0 MTNOR LABEL ( lug) . . . : 0 SFE?VICE/FEEDER __...,._. -_-.—_.BRANCH ('IRCLIITS-_—•-­ -----ADD' I_. INSPECTIONS- -- 2100 amp. . . . . . : 0 W/51":RVT(.,.E (IQ FE'FT)FR: 0 PER TN5PECTIC)h1. . . . . s 0 '11 - 400 amp. . . . . . . 0 1st; W/O 5RVC: OR FDR, : 1 PEP HCILJR. . . . . . . . . . . . 4) ' 1 GOO amp. .. . . .. . : 0 EA nDD' L- HRNCH CIRC: IN PI-ANT. . . . . . . . . ,. . : 1h 71. _ 1.000 amp. . . . . . 0 RE=V I FW 9FT'T ION----•-------_---_._—_.-... 00 vamp/volt. . ,. . . : 0 ) =4 RES IJNITS. . . . . . . . . ) 600 VCII_T NC;+lINAL.. . : t nr7nt?ct. only. . . . . : 0 SVC/FT)R > - 225 AMPS. . : CLASS AREA/SPEC OCC. . mer: __._.____._..._-........_.__ ........_.._..__...._._.___.___._......_..._._ -_..___.._._..... .,_.-... __._....._....._ . ._ .... .. FECES - __.___..__... ......_...._.__._._ ')CIFTC REALTY A55n('TnTFS t;ype "amo+.tr7t by cilate rerpt ��0 rW !:' GIJni4i PKI�IY #k; fj�fh C',RMT 4 4`.1. 00 J90 01 '19/99 99 ;31 2i'46 IMAND OR 97'F�'4 'jPCT r'. 25 JSD OJ /1,9/99 99--312246 or,e #: ir]F hl T X FLECTR I C Cn 47. ,-'S TOTAL W TE=CH CE"NTE"R DR. RE0 J T RFD I Nfi1''E=CT I ONO ._..._ 't;ow) OR 97P27 Coiling Cover CII?r-t .l. 5ervir: . erre #f: 684--3600 Wall Cover Elect' 1. Final cl #. .. 0005C2, This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of Oregon Specialty Ccdes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work i,; not started with'n 180 nays of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires yout,61folluw the rules adopted by the Orrgon Utility Notification Center. Those rules are met forth in ORP. 95.' M-0010 through OAR 952. - 987, You may obt�ywfirop� or these rules or direct questions to by calling 1,0246-1987. i a n i t;t e e ),i gl n a t It r e : _._.� _._. I s s r t e d B v k INSTALLATION e installation is be•in!j mane on propeorty I taws LJI-iicll is not intended For le, lease, or rt~ni;. 1�117 Re r r I GNATLIRE•: ___..—_._._....._..___. _ _ DOTE: _._.__..._._.-_..._.. .. .._... . CONTRACTCJR INSTALLATION ONLY —— _ _....._._.---.._._._..._.__ trt'1TI..IRE= OF aOVIR. E'L.E'C' N: DPTF '1_I,JGE NO: -++++•+4-4-+++++•t~4.4,4++,+.++•+4-4-++++•+4-+++++++++++4•++•4-+-1-++++++++++++++ t-+++...4-+++++++ Call f",3`3- 417':5 by 7:00 p. m. for an inspection nepderd the next hi_ts; tness tiay +-+++++•++++++++++•+++++++...++++++++++r•+-++•+++•++.+-++++•r+++++-t•+++4-+++++++++++-1-+•F++ F + JWIR-9�1 MON 10:48 AM PHOENIX, ELEC'T'RIC CO FAX NO, 15036843611 P. 02 CITY OF TIGARD Electrical Permit Application Finn Chocks41- 71- Recd lay ,._r/"IV, 13125 SW HALL BLVD. Date Rac'd— TIGARD OR 97223 Date;o P.E. Phone (503)639-4171, x304 Print or Type Date to DST,_ Inspection ! 03)6394175 Incomplete or illegible will not be accepted Called_ Fax (503) 684-7297 ?. Job Address: � l 4. Gomplere Fee Schedule Below: Number of inspections per perm!t allowed —' Name of Development_____—_ -- Name(or Annie of b-.jsine,,. f 2►rte — ---- Service Included: Items Cost Sum 1 ,�_ 4a. Residentlel-per unit 1nC�11 C.. r Address/"t�2'��.1l1J 000 sq.It or less ____ $110.r)o - a Cit1r/State!!tp f`� rc�. rt{L. _ Each addilinnal 500 sq.It or �� —- -- portion th,reof $25,00 OmmefClal Residential lJ Limited Fnetgy $25.00 ---- " Eeuh Manul'd Home or Modular W4,V �T �l)r �CAq 1Lu UA.J(��Qt� Dwelling 5ervica or Faoder $158.00 -- - 2a. Contractor installation O`A 1, 4h.Services or Feeders (Attach copy-et II current license ) ( Installation.Atteratian,or relocation Electrical r r ctor y1. ' �r J t ,-P�---- - --- 200 amps or less $60.00 -- q �S/1 ° � 2.01 amps to 400 amps 3u0 00 � r 401 amps to 1300 amps 5120 00 CityIL State .—_ZP. - ��--- — (� 601 amps to 1000 amps $100.00 Phone Nd.._ __ � - Over 1000 amps of volts — $340.00 —_- Job No. -- Rucunnect only $50.00 'x .Date --_ t'R Cont.LicCB eq P 4c.Temporary S,3rvlces or Feeders OR State CCB Req No Exp.gatr3__ - _ _ P Y Ex .Daft'___—_—__ lnst.tllAhvn,alteration,or relocation COT Business Tax or Metro No P _ zoo amps or leas $50 or — 201 amps to 400 ampr $75.00 — Signature of Supr.Elec'n,��!a--_�•_ '' � � — 401 amps to 601)amps 5100.00 --_ _ --- Over 800 amps to 1000 volt 6, C /C C� Fx ,Date ,...-_ _ see"b"above. License No. � — P Phone NO. a f l� ----- -— - - 4d.Branch Circuits New,Alteration or erlension per panel 2b. For owner installations: a)The fee for hranch ctrcu-ts with purchase or service or leader fee. Print Owner's Namer- _ _. - ---- — Each branch rir uil $5 00 2 Address—_ _ ------- b)T:ie Irr for brahch r rcurts CitySlate - -, Zlp____,-�--, Without purchase or -- ... Phone No. ______- _- - - --- -- h �'-� First rstr.or reader fee. hranch circuit � 535.00 2-+� Each additinnal branch circuit 35.00 The installation Is being made on property I own which is riot intended for sale,Isasa or rent 4e.Miscellaneous (servire or teedrr not Included) Each pump or Irrigation circle �._ $Io p0 Owner's Signature -- �. —T-- stv on 2 Each sign or outline lighting _ Signal ctreuit(s)of a limited energy 5,10 Uu 3. Plan Review section (if required). panel,alteration or extension St o0 oU Minor Labels(10) ---- Please check npproprlate!tem end enter fee In section SO. 41.Each additlonal Inspection over 4 or more rntsidentlal units in one structure the allowablp in any of the above Service and feeder 225 amps or more For insper lion _System over 600 volts nominal Per hour ---- Clailsifird arra of structure containing special occupancy In Plant $55,00 - as de�cnbnd In N F.G.Chapler 5 a 5ubmlt 2,rts of plane with application where Any n1 the 5. Fees:above apply Sn.Enter total of above Ices $ Not tagjlred for temporary construction services. 5%Surcharge(05 X total leas) $ NOTIta� Subtotal $ 5b.Enter 259:of line 5a for $ PERMITS RFCOMF VOID IF-WORK OR CONSTRUCTION AUTHORIZED IS Plan Review If reuir (Sec.3) S NOT COMMENCED WITHIN 18o DAYS,OR IF CONSTRUCTION OR WORK Subtotal ) IS SUSPENDED OR ABANDONED FOR A PERIOD OF 1 R0 GAYS AT ANY Trust Aecount M_r;�/C TIME AFTER WORK IS COMMFNCED. � Total balance Due .%O%Ts%CLc9r.AvP n.v trce , -7 CITY OF TIGARD __ PLUMBING PERMIT DEVELOPMENT SERVICES PERMIT#: PLM2003-00041 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 2/4/03 SITE ADDRESS: 07250 SW DURHAM RD BLDG J-90C PARCEL: 23113AC-00102 SUBDIVISION: COUNCIL VIEW ACRES NO. 2 ZONING: I-P ^ BLOCK^ LOT: 025 JURISDICTION: T IG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: UNK FLOOR DRAINS: TRAPS: STORIES: WATER HEA'rERS: rATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TR^PS: LAVATORIES: OTHER FIXTURES: 1 TUBISHOWERS: SEWER LINE: ft WATER CLOSE IS. WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: 1,%,0oL iI Lo cekfloui �rcvQ.,Je r I r' (acs_ e_,xr'sf�'►_ Owner: FEES —" Description Date Amount PACIFIC REALTY ASSOCIATES -- 15350 SW SEQUOIA PKWY #300-WMI [PLUMRI PCI'nlll I rr 2/4/03 $72.50 PORTLAND, OR 97224 [TAX]8%State I,u 2/4/03 $5.80 Total $78.30 Phone : Contractor: POWER PLUMBING CO P0BOX 19418 PORTLAND, OR 97280 REQUIRED INSPECTIONS Phone : 503-244-1900 RP/Backflow Preventer Final Inspection Reg #: LIC 52378 I'I.M 34-1501'13 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 Issued By: / _ Permittee Signature: eAl Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day JHN 31:1 2003 1 1 : 22RM HP l_HSERJET 320171 P. 1 iumbmg Permit Application �.1tof Tigard RECEIVED 13tu rexeivod: Y g Sewer permitno.: Huildingpermit no: Address: 13125 S W Hall Blvd,Tigard,OR 97223 — --- Ctry ojTigard HvJ , a:dappl.nn.: l�xpire date: Phone: (503) 639.4171 11 Fax: (503) 598-1960 S ) j(J(J Date issued- By t Recciptnu.: Ladd use approval: .ase file no. _ 1'a;mart type: U I &'2 family dwelling or accessory U Cornntercial/)ndustriA ❑Multi-family U Tenant improvement i U New constructicmt U Additioo/altemtionlreplacement 11 Food service U Other Johaddress: �Z 5 0 S �rn Description i� . Fee(ea. Total Nen I- Bld .no.: S Suite no.: qpQ mW2- y tmoan � -- (LseludalOYQ.furexrehfrutllkre•owndbe) Tax map/tax lot/account no.: _ SFR(1)bath Lot: Blcxk: Subdivision: — FR�2)hat --- -- Vntject name: S-ro t.)N eeL__ - --- SN (3)bath — - — ('ity/county: _ ZIP: adcliuon:il atlt/kitchcn _ Description and Irx:at f work on prnmism:iniL_ mSltesarllFties: Q Q-0 A2 4L �apc,,,c„ Catch bmin/area drain F-ht�date�oi`completicx>rnspect�on: [.►rywell�lleach lineltrenc t drain _— Footit drain t'no.lin. Miami I �"_annfactured �an; hurne utilities Buslne9![UttnC: 7 aMh es --- - -- Address: 77-1Ratn drain connector -- -- - -City, �„ --- SIAMV-L-1 ZIP:-j7Sanitary sewer(no.lin. ft_) Pttc+ne:' -/qbC) _ Fa;:, +OY .i E-mail: , fitorm sewer(no.lin ft-) CCB no.: .5- 'L! 1 B Plumb.bus.reg no; 3y /Sd Water_ service(no.lin.fl.) t ilplmctm tic.no.: / Z - Flxtare or hem: Absorption valve contractor's representadve signature: Bsc�prevents r — —y� -iso Print name: -'-N�c. Date: Backwater valve Bisio—TN avawry - -^ — Name: � �}' C1ot�cr washer D ish was r Address�(I� — _ i�n�fou�ntain(s) City 1 __ State: y 'LIP Gj �3 rsV p — _ -- Phone:l-y y - 9 c)p Fax: 144. E-mail: cion twrkturelseweror drains/Boor sinks/hub Name(print), —� "s' Garbage die prKal _Mailing address: ose iM) J Start: LIF: ce maker Phone - - aa C trail: _ lntettr cnrleasa tit __� _� towner imta!lad on/residential maintenanrx only: The actual installation Printer(s) will he matte by me or the,maintenance and repair made by my regular c—K f drain(commere- lT- __ _— — empluyee on Vie pniperty I own as per ORS Chapter 447. to (s),basin(s).lays(s) Ownes sigirimm: Date: �- _ -- Ms s�iowe showerE_an l nnal Name: irr closed _ Address: wer heetr r Vity ------ - Suite:-- ZIP: -- --r: : - / °fat `U mail ----- F• --- — Mininntm fez........ .......S _.22il- i-- Net rl Wxbedaw amop rndll Cab.0006 wt pairacdua rar aero tdore=V& Notlee.71tis;xrmit application Visa OMastarCnrtl Plan review(at � 9F.) S __ —' OYf --- expires ifa permit is not nbodned State surcharge(876)....S _ S a= Gatw card owa r+. within ISO days filer it his been -- r: R, TOTAL. ...................... NaaM ofd-ii r6one oe� � accepted aft Complete. - � - AjWI 440-4A 16(SRYWOM) ' l I CITY OF TIGARD 24-Hour t3UILUING Inspection Line: (503) 175 INSPECTION DIVISION Business Line: (503) MST •� UP '�U�``UUU�Z Rereived _ pate Requested 7 _- AM- �� ` 'o u - G -- Location _ v�1 �-1 �( _____Suite_ -- MEC Contact Person Ph PLM --- - Contractor -_ -_ Ph SWR ErUILDINWTenant/Owner ELC Foo i - - ---- - -- — --- ------ — Foundation Access: ELC _ Ftg Drain tLR Crawl Drain - --- Slab Inspection Notes: v �— SIT Post&Beam - — Shear Anchors Ext Sheath/Shear Int Sheath/Shear - — Framing Insulation --- Drywall Nailing Firewall Fire Alarm Susp'd Coiling — Roof Other: - PART FAIL - PLUMBING Post&Beam Under Slab Rough-In Water Service Sanitary Sewer Rain Drains Catch Basin/Manhole Storm Drain _ Shower Pan Other: Final _ _PASS PART FAIL MECHANICAL Post&Beam — Rough-In Gas Line --- --- - Smoke Dampers Final - PASS PART FAIL ELECTRICAL _— - -�. Rough-In UG/Slab --- - - Low Voltage Fire Alarm - Final Reln PASS PART FAIL spection fee of$ required before next Inspection. Pay at City Hall, 13125 SW Hall Blvd. SITE E] lease call for reinspection RE:_ _—_ Unc+ble to inspect-no access Fire Supply Line ADA Approach/Sidewalk Dates - - �� Inspector 777�� W Other: — __ _ _ _ — Final - DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL 1 I j' CITY OF TIGARD. 24-Hour BUILDING Inspection Line: (503)639-4175 I°JSPECTION riws!JN Business Line: (503) 639-4171 MST BUP Received Rate Requested a /G AM - PM _ 9UP ----------- I-oration Suite---- DMEC Contact Person __ _ _ _ Ph( ) Y y- / 7 oG _ PLM 2- 0 0 -40 a / Contractor _ _ SWR BUILDING - ` Tenant/Owner ELC Footing _ -- - --- Foundation Access: ELC Ftg Drain ELR Crawl Drain _ -- - -__ Slab Inspection Notes: SIT Post& Beam - Shear Anchors - - Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall y, Fire Sprinkler Fire Alarm Susp'd Ceiling Roof --" Other: Final PASS_ PART FAIL. PLUMBING-�-_ - -- - ost Beam - -- Under Slab Rough-In -- Water S3rvice Sanitary Sewer _-- Rain Drains - - Catch Basin/Manhole Storm Drain Shower Pan - Other: Final - PASS _PART FAIL ME - - - - - _ - CHANICAL_ Post& Beam - -- Rough-In Gas Line -- - - ----- Smoke Dampers --__- Final --- PASS PART FAIL CT ELERICAL - _ Service Rough-In UG/Slab -- -- - - - ---- --- Low Voltage Fire Alarm _.---- -- -- -- _ —_.— Fina! PASS PART FAIL Reinspection fee of$ required before next inspeMion. Pay at City Hall, 13125 SW Hall Blvd. SITE F] Please call for reinspection RE: Unable to inspect-no access Fire Supply Line - _ - --- - ADA 10 .•-O Ext Approach/Sidswalk Data - - Other- - IespertOr--- --- -- _ - - --._ Final DO NOT REMOVE this Inspection record from the job site. PASS PART FAIL 526629 'EfNF.W • ❑EXISTING PNWS-AWWA BACKFLOW ASSEMBLY TEST REPORT [3 REMOVED � PROPERTY ❑REPLACEMEN'r OWNER: STASH TEA CO PHONE: 503.884-448^2 X325 MAILING nrmRFss: PO BOX 18418 PORTLAND STATE. OR z I P _97280 crry --- ASSEMBLY 6611 SW MULTNOMAH#900 TIGARD OR 97224 ADDRESS: — STREET — — )�JR.P.H.A. ❑ D.C.V.A. ❑ R P I)A.^❑D.C.D.A. ❑P.V.B.A. ❑S.V.B.A. G AN.H. ❑AIR (;AP S17.E: L1J•LS1 MAKE: W I1 S MODEL: WATER SERIAL 1'UkVI'YOR: _— ASSEMBI,Y LOCATION: -- — REDUCED PRESSURE ASSFMBI,Y P,V.H.A' / S.V.B.A. IN Ill A1, TEST MI r'HRCK DOUBLE CHECK AIR CIIECK PASSED A INLET FAILED ❑ PRESS DROP I CIIECK #I INITIAL RELIEF VALVE LI { (I7)ITIGIIT ® OPENED AT. PRESS DROP D f DAT;.. TEST OPENED A -WIN 2. PSID BUFFER RESl11.TS LEAKED❑ �1/J 1 Z 6 I PSNi PSID A-B.. CHECK q2 MIN 7 PSI IND NoT FAILED SYSTEM RELIEF VALVE 111(711 r I.EAKrD❑ van IIPI•N O ❑ PSI I'ASS-'1M FAIL ❑ Y A RIPAIPS ANI)IuR PARTS RFDU(TDPRESSURFASSFMIIL� I'\ It 11 A V'1I R 111TAIRS III CHECK DA I I( PRESS DROP (A) CI1I?CK #1 TEST OPENED AT PRESS DROP RELIEF IB) I'rlGirr PSID ANIT•,R OPENED ❑_ �— R FPA IRS BUFEEa I(III ECK N2 _. PnSSEU ❑ A'B' TIGHT ❑ PSIO PSID PSID IN COMPLEI7NG AND SUBMITTING T1IIS TEST REPORT,171E TESTER CERTIFIES THAT T..E ASSEMBLY HAS BEEN TESTED AND MAINTAINED IN ACCORDANCE WMf ALI,APPLICABLE RULES AND REGULATIONS OF 711F WATER SYSTEM, AND STATE RECIULA11ONS GAUGE CALIBRATION T F, DETECTOR METER RF.ADINO TESTLR SIGNATURE � CERTM 7E5FERS NAME PRINTED MKIE- VfGAU13E N d M E R I C A E,I_'1 fl L V�- S V V 1TS1'ERS ADDRESS Jr!!ll Cf H l 11 rou; 1�.0 5 N_.1�I1 LS_R TATE AVE ._ i i LV>s"F Py COMPANY NAME CERT 4019 GAG# W7072_(:At 1 -01 IS,Z3ERVICE RESTORED REPORT RF.CCIVFD BY (RLPRESENTAPVE OF OWNER) WHITE•Welel Syilem Copy PINK•Cuuonwr Copy YELLOW•?Uw cwy `