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10225 SW HALL BLVD-1 OA13 'IIVH MS 5ZZO L 0 ti is N X D r r- oa r n 10225 SW HALL BLVD CITYOF T I G A R D BUILDING PERMIT PERMIT#: BUP2003-00691 DEVELOPMENT SERVICES DATE ISSUED: 1/15/04 13125 SW Hall Blvd., Tiqard. OR 97223 (503) 639-4171 PARCEL: 1 S135AA-01901 SITE ADDRESS: 10225 SW HALL BLVD 103 ' SUBDIVISION. METZGF-R ACRE TR4CTS ZONING: C-N BLOCK: LOT: 037 JURISDICTION: TIG REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION _ CLASS OF WORK: AL f FIRST: sf N: S: E: W: TYPE OF USE: LOM SECOND: sf _ PROJECT OPENINGS? N: TYPE OF CONST: 5N sf S E: W: OCCUPANCY GRP: B TOTAL AREA: 0 sf ROOF CONST: FIRE RET? OCCUPANCY LOAD: 15 BASEMENT: sf AREA SEP. RATED: STOR: HT: ft GARAGE: sf OCCU SEP. RATED: BSMT?: MEZZ?: REQC SETBACKS _ _ REQUIRED FLOOR LOAD. psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET' DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM HNDICP ACC: BEDRMS: BATHS: IMP SURFACE: PRO CORI,: PARKINS. VALUE: $ 23,520.00 Remarks: Tenant improvement, new chiropractic clinic existing shell building. Owner: Contractor: WAYNE I_ GERIG OD OWNER 10225 SW HALL BLVD TIGARD, OR 97223 Phone: 503-244-1004 Phont-: Reg #: FEES REGlUIRED 114SPECTIONS Description Date Amount Mechanical Permit Require If11.1PPI.NI Pln Rv 12/16/03 $177.91 Electrical Permit Required JFLS] FLS Pin Rv 12/16/03 $109.48 Plumbing Permit Required JBIJILD] Permit Fee 1/15/04 $273.70 Framing Insp Oyp Board Insp I'AX1 8",,State Sureharl 1/15/04 $21.90 Final Inspection (additional fees not listed here) I otal- - — $975.99 v - 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 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 952-00 ough OAR 952-001-0100. You may obtain a copy of these rules or direct questions to Ol1NC by C al' (503)246 or 1-800-332-2344. Is ed By: t� / Ps rm ittee LSignature: l Call 639-417514 7 p.m. for an inspection the next business day Buildinc,r Pe ASO n �Nt'C' , c��,ur� Receive City of TYgard PlarmingA vat other ---- 13125 SW Tall Blvd, DEC 1 � X003 Dutell3 : Permitplan Re No. Tigard,Oregon 97223 �( pF 11GkBo DetelB view other PertrJt No. Phone: 503-639-417! F G 1 ►0 ^-!� Post-Rr ew band Use Intejw rnet: ww.ci,r • rgard.o. A C:a,eNo, Contact 24-hour Iusppction Request: 503-639-4175 7 See Page I for NArne Method: ��--_— — S4 pletlfetltal Iaformatittn J RE�:;IREh 1DA'I'A: ❑New construction Demolition 1;gr,2>rA►fiQ.Y DWELLING I Addition/alteration_/replacement Other: - - �- L ©f"Cu4iv3RidCTPO -,�^ Vote: Permit fees are ba,�a on the[ora!value of the work performed. indicate 1 &2---Falnil dwellin CommereieUlndusttxal the value(rounded to the newest dollar)of all equipment,materials,labor, -r moi-" overhead and profit for the work indicated on this applicanon. Accessory Building _ Multi-Famtl� _Master Builder _ other Valuation 40A;Sx(T_1'1N_hr01th fill NR0dkIOCATIION_ No.ofbcdrooms. No.ofI,adis:_— TOh 51te address: Q Z '�" j W V,t 'Total number of floors... ... - New dwelling arca(sq.f'.)......... Garage/carport arca(sq-fi' . ... . [_Project i,Vatt1C'--- _ U Covered r ...... �� ... ..... ------------ porch arca(sq.ft.I. _ Crjo�ss streevDirections to lob Site: — — Deck area(sq.ft.)............... Jf �Lad M,W c� (�b(..tA'a�'t�� I Othcr structure area(::q.ft.) ....... ........ 0 Y\ g hs� (C)1y 1RL �\� t�42 Lvtrn DATA. I RCIAL-i1SE CIfECIkLl§.'� Sub(l,islnil: GC��e�(- �_C,Y � L of#' Note: t'crmit fees'are based on the latul value of �— Tax mag ipcuce!#;� I � UZ j v _ _ ___._1_.. _ he work performed inricate ION 21 WQR1K �� the value(rounded to the nearest dollar)of all equipmen[•materials,labor, �`` { +"""" overhead and profit for the work indicated on this application. ��h 11'r7t' �1'V�p,lO�J E. 1(V`II�n.. — -- Valuation.......................... $)-1 S 0 — Existing building area(sq,ft,)...... .. . ....... _ -- - ----- -----_--_ __ he a-building area(sq it.) . _ Iti TY O �- _ Number of stories... _ . . _... ... __p01' lM1'ItiER — ['ENi'►NT _ _ _ Type of construction - Na117C: .4 \01"K�`O _ Occupancy group(s). Existing _ Addms r�l1 �rC' NOTICE: All contractors and subcontractors are requited to be Phone: _� t APP1I(�Als Ti licensed with Tthe Oregon Construction Couttw;tors Board under ' Oh BU51rieSS Narilf:: •Q � provisions of ORS 701 and may be rcquirc1 to be licensed in the D 'r � �..I `�_ jurisdiction where work is being performed. If the applicant is exempt Contact NLua e: � pj t � P' I from liccnsmg,the following reason applies- Atidres� oa�% ,�W 1 ��va o t t�'l�!State-'Zip:'" R f� c � holle: tt4 � Fa � 0 ? - E-mail: IlG>7111NC PFIR► N M$* Please refer to fee sched'ale. CONTRACTIIR -- u `n 57 Business Name: �� ,��� ! FM due p rpplicanon.............. ............ $ �o7g?� Address: - Amount received.................. .. s Cit /State.!Zi : ,3 x.( t, l% 4 —s:.»G — rPhone:r Fax: pate received: CCB L c. — __ — - - -- -- _I Authoriz d Notice: This rrmit application expires if a ermit is not ohtained Nithin Signature _ Date (r, IN dacs afterithas been accepted as complete. •Pet methodololLv set b)TN-County Building Industri Srrrirr Board. ( lease print name) �/ / _ f i `.Osis Permn i ormsJ3ldgi crmitApp doe 01.03 ti Plan Submittal Requlremeni Matrix i Corrrrnercial & Nlalti-Family Cit), of Tigard i New, Additions or Alterations ^�^ TYPE OF SUBMITTAL # of Plans 1 (Includes New, Additions or Alterations) Required at Submittal Site Work 4 (must include location of all accessible parking) Plumbing - Site Utilities 2 Building �* Fire Protection System 3** Mechanical 2 Plumbing - Building Fixtures 2 Electrical 2 Plan review is depe lent upon su�mittal of a completed application and plans. After plan review approval, the Plans Examiner will contact the applicant to request additional sets of plans for distribution purposes (for Contractor, City of Tigard, Washington County, and Tualatin Valley Fire & Rescue). *For over-the-counter commercial tenan' improvements, submit 2 sets of plans. **"New" fire protection systems require that plans bear the original seal of an Oregon licensed fire suppression engineer, or NICET level "3" technicians. i\Building\Forms\PlansubMatrix.doc 04/03 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503) 639-4175 INSPECTION DIVISION Business Line: (503) 639-4171 MST Received Reque ted_a � PM_- -13111!3 Location —_ r/I�2 — Suite--/.0 MEC Contact Person _ - _ Ph PLM - Contractor Ph SWR BUILDING Tenant/-)Nner - ELC Footing Foundation Access: -- EL.0 -- - Ftg Drains ELR --__ Crawl Drain .> - - Slab Inspection Notes: SIT Post& Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing - Insulation - -- ---- - Drywall Nailing -- Firewall Fire Sprinkler --- ----- ire Alarm Susp'd Ceiling -- Roof Fin I -- -- SStG ART FAIL --- - —� - - - - -- - ost& Bdam Under Slab - --- - Rough-In -- —" -- Water Service Sanitary Sewer --"— Rain Dig ins - -- — Catch Basin/Manhole — Storm Drain - - -- — -- _ Shower Pan — Other: Final — — PASS_ PART FAIL - ------ --- MECHANICAL w — — Post&Beam -- - Rough-In - —- -------—- ---- Gas Line -- ------------ _. Smoke Dampers --- _-------..___—.— — Final — PASS PART FAIL — — ------__ _-- -_-.-__-_ ---._ ELECTR_ ICAL -- Rough-In UG/Slab -----_--- ---- ------ -- �— Low Voltage Fire Alarm - --- . ----- -- --- --- Final Reinspection fee of$_A._.__— required before next inspection, Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL_ SITE___ [:] Please call for reinspection RE: _ Unable to Inqpect-no access Fire Supply Line ADA 4. Approach/Sidewalk Date aInspector _.. Ext - Other: - Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL CITY OF TIGARD 24-Hour BUILDING Inbpectior. Line: (5C3)639-4175 INSPECTION DIVISION Business Line: (503)639-4171 MST BLIP Received Date Requested AM—_ PM BUP Location `�' `'--2 1,o � Suite �O',— __ _— MEC _ Contact Person —_-- Ph(. 3(ou) /U `� C�a PLM _ Contractor _ _J16,4 _ Ph( ) _ S%VR BUILDING Tenant/Owner __. __ ---_- -_—_ ELC �1 aoDzr Footing ELC Foundation Access: Ft a ----%�! -- -- F ewi Drain ' ' -F i E LR -- Slab Inspection Notes: SIT --_---_ -_____.- Post&Beam Shear Anchors - Ext Sheath/Shear _ Int Sheath/Shear Framing _ insulation Drywall Nailing - - - - - - - -- Firewall Fire Sprinkler ----- - -------- ----- Fire Alarm ,_� `, J- �''✓1 /.�� �' Susp'd Ceiling Root Other:-.-- Final ther:-.-Final _ UMPASS_ PART FAIL —- - -- - PL_ BIN4 Post& Beam Under Slab Rough-In Water Service - —----- -- --- - -- - Sanitary Sewer Rain Drains - Catch Basin/Manhole / Storm Drain — ---- -- - -— - - ---- ------- - Shower Pan Other: — ------ Final ----Final --------� PASS PART FAIL -- --- ----- - ----- --_- _ MECHANICAL _ Post& Beam -- Rough-In Gas Line Smoke Dampers - -_ Final PASS PART FAIL -- - - -- L _ L Service -- ---_-- --�--^` Rough-in UG/Slab Low Voltage --- --- ----�- _-- - ----_ Fire Alarm nu Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd ASS ART FAIL 81 y _— [ I Please call for reinspection RE:_ Unable to Inspect-no access Fire Supply Line ADA Approach/Sidewalk Data Other: Final DO NOT REMOVE this Inspection record frontM tho joh sit . PASS PART FAIL / CITY O C TIG /� R n ELECTRICAL PERMIT PERMIT#: ELC2004-00029 DEVELOPMENT SERVICES DATE ISSUED: 1/21/04 1:3125 SW Hall Blvd.,Tiqard, OR 97223 (503) 639-4171 PARCEL: 1S135AA-01901 SITE ADDRESS: 10225 SW HALL BLVD 103 SUBDIVISION: METZGER ACRE TRACTS ZONING: C-N BLOCK: LOT : 037 JURISDICTION: TIG Project Description: Install 11 branch circuits, _ RESIDENTIAL UNIT _ TEMP SRVC/FEEDERS '_—_ MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: PUMP/IRRIGATION: EACH ADD'L 500t3F: 201 - 400 amp: SIGN/OUT LINE LTG: LIMITED ENERGY: 401 - 600 amp: SIGNAI-/PANEL: MANF HM/ SVC/FDR: 601+amps 1000 volts: MINOR LABEL (10): SERVICE/FEEDER _ _BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: ( W/SERVICL OR FEEDER: PER INSPECTION. 201 - 400 amp: 1st W/O SRVC OR FDR: I PER HOUR: 401 - 600 amp: EA ADD'I_ BRNCH CIRC: I(1 IN PLANT: 601 - 1000 amp: PLAN REVIEW SECTION 1000+ amplvolt: >=4 RES UNITS: �~ > 600 VOLT NOMINAL_ Reconnect only: SVCIFOR>= 225 AMPS: CLASS AREAISPEC OCC: _ Owner: Contractor: WAYNE L GEP,IG OO AMP ELECTRIC 10225 SW HALL BLVD 08503 NE 272ND STREET TIGARD,OR 97223 BATTLEGROUND,WA 98604 Phone: 503-244-1004 Phone: 360-892-4499 Rag#: LIC 78152 --_-"---- --- --- — SUP 3869S FEES _ _ P LE z7-501C Description Date —Amount Required Inspections (CLPRh1"I'I ELC I'crmit 121/04 $113.3!; ------_-- ---- [TAX]8%State Surcharge - 1/21/04 — — $9.Oft Rough-in Elect'I Final Total $122.43 Ii This Permit is issued subject to the regulations contained in the Tigard Municipal Code,State of OR.Specially Codes and all other applicable laws. Ali 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 suspende'' 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 952-001-0010 through OAR 952-001-0100. You may obtain copies of these rules or direct questions to OUNC at(503)246-6699 or _ - 1-800-332-2344. r J_ Issued B y Permit Signature: 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: —.---.___ -_—,-,- ---.__.__.---_-----___ DATE: LICENSE NO: — Call 639-4175 by 7:00pm for an inspection the next business day Electrical Permit Application Date received: Permit(' no.:)-ity of Tigard - --- Projccl/alppl.w, � Expire date: Citil(of Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223 � --> Date issued: Phone: (503) 639-4171 By Receipt no.: rax: (503) 598-1960 Case file no.: Payment type: Land use approval: 7UUN 2 family dwelling or accessory U Commercial/industrial U Multi-family U Tenant improvement w construction U Addition/alteration/replacemcni U Other: U Partial JOB SITE'INFORMATION Job address: /QZ2S sc,. 131d_no.: Suite nu.: 0-; Tax map/tax lot/account no.: Lot: Block: Subdivision: - Project names j5Vtl, D,Q Description and location of work on premises: - 1""linuitctl tint•of crmlrlriinn!inslu c1it,!r _- -- _- — - I .Inlr no i t — -- _ Fee Mav Business named ��G��r Uesrriptiou Qty, (ea.) 'Total no .ins Address: sLr Z �- New residential-single or multi-famlhIN,r dwelling:unit.Indurks attacked garage. City: G c, Slate:1441 ZIP: ,&(d Service included: Phone: p ,t rax36p Pbu L-mail: IMY)sq ft or lessCCB 110.; E S/ C Fochadditional5(x)ay it or portion thereof 7 !�/ S� Elee.no: Limited energy,residential T Clt)/1 Ile.no.: 2Limitedenergy,non-residential 2 ��p � _ Foch manufactured home or modular dwelling mume tsrFG 'ng elects ician(re uired) fate Service and/or feeder Sup elect,oame(print):JCr2cry, // nae no: Services or feeders-Installation, - 1 t alteration or relocation: 200 amps or less 2 Nanie(print): 201 amps m 400 amps 2 Mailing address _-- 401 amps to 600 amps 2 — 601 amps to 1000 amps 2 City: State: ZI P: Over 1000 amps or volts 2 Phone: Fax: E-mail: R-•eonnectonly Owner installation:The installation i.,being made on property I own 'femporaryservicesorfeeders- which is not intended for sale,lease,rent,or exchange according to installation,alteration,or relocation: ORS 447,455,479,670,701. _'1x1 amps or less 2 201 amps to 400 amps i— - 2 Owner's signature: Date: 41)1 to 600 arta rs Branch circuits-new,alteration, Name: or extension per panel: A. Fee for branch circuits with purchase of Address: service or feeder fee,each branch circuit 2 City: -- Stale: ZIP: H. pee for branch circuits without purchase Phone: Fax- I i i : i I of service or feeder fee,first branch circuit: 2 Each additional branch circuit: Misc.(Service or feeder not included): U Service over 225 amps-commercial U Health-carefnc I II N Fachpumpon irrigation circle 2 U Service over 320 amps-rating of 1&2 U fiaxardouslocationEachsit,noroutlinclip! ting 2 family dwellings U Huilding over 10,000 square feci four or Signnl ciwuilW m a limited energy panel, U System over 6W volts nominal more residential units in one structure alteration,orextension+ 2 U Building over three stories U Feeders,400 amps or more •bcscri pion: _ U t h,ul,:uit I 0,ver 99 persons U Manufactured structures or RV park 1 Filch additional Inspection over the allowable In any of the slave: U I:)!res/lighungpl:ut U Other: Lich Inspection E-7 Submit,_W_sets of plans with env of the above. Investigation fee The above ere not applicable to temporary couttrudlon servlee. other Not all Judxdictions accept credit cants,please call judxtiction for mar information. Notice:This permit application Permit fee..................... U Visa U Mastercard expires if n permit is not obtained Plan review(at __ %) $ _ Crrd0 card number_ within 180 days efler it has been State surcharge(8%)....$ ---- Expiresaccepted as complete. TOTAL, . $ Name of ser alsir as shown on credit card Cardholder 0gnemreS Amount 4404615(60WOM) ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES. r— TYPE OF WORK INVOLVED -RESIDENTIAL ONLY rry Coietc Fee Schedule Belew: ---- --�. ---- ---- � Restricted Energy Fee..................................................... $7 .00 Number of Inspections per permit allowed (FOR ALL SYSTEMS) Service included: Items Cost Total Check Type of Work Involved: Residential-per unit 1000 sq ft or less _ $145.15 __ 4 Audio and Stereo Systems' Fach additional 500 sq.ft.or portion ther6of $33.40 1 Limited Energy $75.00 ❑ Burglar Alarm Each Manufd Horne or Modular Dwelling Service or Feeder $90.90 2 ❑ Garage Door Opener' Services or Feeders ❑ Heating,Ventilation and Air Conditioning System' Installation,alteration,or relocation 200 amps or less $80.30 2 201 amps to 400 amps ___ $106.85 2 ❑ Vacuum Systems' 401 amps to 600 amps _ $160.60 2 601 amps to 1000 amps _ $240.60 2 ❑ Other Over 1000 amps or volts $454.65 _ 2 reconnect only _ $66.85 2 Temporary Services or Feeders TYPE OF WORK INVOLVED -COMMERCIAL ONLY Installabon,altoration,or relocation Fee for each system.......................................................... $7500 200 amps or less $66.85 _� 2 (SEE OAR 916-260-260) 201 amps to 400 amps $100.30 i 2 401 amps to 600 amps $133.75_„ 2 Checl(Type of Work Involved: Over 600 amps to 1000 volts, see"b"above. E:I Audio and Stereo Systems Branch Circuits F-1Now,alteration or extension per panel Boiler Controls a)The fee for branch circuits with purchase of service or ❑ Clock Systems feeder tee. Each branch circuit $6.65 + 2 ❑ Data Telecommunication Installation b)The fee for branch circuits without purchase of service ❑ or feeder fee.or Alarm Installation First branch _ $46.85 Each additional nal brbr anch circuit 1 <' Wo.fiS HVAC Miscellaneous Instrumentation (Service or feeder not included) Each pump or irrigation circle $53.40 _ Each sign or outline lighting $53.40 _ ❑ intercom and Paging Systems Signal circuits)or a limited energy panel,alteration or extension �� $75.00 Landscape Irrigation Control' Minor Labels(10) $125.00 Each additional inspection over y ❑ Medical the allowable In any of the above ❑ Per inspection $62.50 Nurse Calls Per hour _ $92 50 In Plant $73.75 __ _ Outd.)or Landscape Lighting' Fees: ❑ Protective Signaling Enter total of above fees q' Other 8%State Surcharge $ h—s�� --_--Number of Systems 25%Plan Review Fee See"Plan Review"section on $ ' No license3 are required Licenses enses are required for all other Installations front of application. -- 'T-i` Fees: Total Balance Due $ � — �— — Enter total of above fees S_ ❑ Trust Account tY_ -- 8%State Surcharge Total Ralance Due $ i\dsts\farms\eic-fees,doc 06/07/01 CITY OF TIGARD 24-Hour BUILDING Inspection Line: (503)639-4175 INSPECTION DIVISION Business Line. (503) 639-4171 MST SUP Received a� _�0 20ate He ue ed_c:; � AM___..._____- PM ____ BLIP Location LI!2- 2--S _ Suite_ L•�-� — MEC Contact Person pLJ d 1 Contractorc a—_ /� Ph --'�----- — ( ) - - -- SWR BUILDING Tenant/Owner - .-----.____ ELC _-- Footing ELC Foundation Access: / Fig Drain ELR Crawl Drain Slab Inspec,o s: ,; �- - SIT Post& Beam Shear Anchors -- Ext Sheath/Sheer Int Shea.h/Shear �- Framing -- --- Insulatio^ Drywall Nailing - - - - Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling - -- - ----- Roof Other: Final PASS PART FAIL - - -"- -- -- - PLUMBING — Post& Beam Under Slab - - -- Water Service _ -- - --- - Sanitary Sewer Rain Drains — Catch Basin I Manhole Storm Drain - - ----- — — Shower Pan eA F PART FAIL C_HANICAL Post&B3am Rough-In ---- Gas Line Smoke Dampers - ----- .._.-- - -- - Final PASS PART FAIL—1 -- ------ --- -- __ — ELECTRICAL Service - -- — F,ough-In UG/Slab — — Low Voltage Fire Alarm Final F] 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 Approach/Sidewalk flats - i._- Inspector _ _ ---- _--Eut Other: _ ff Final �DfONZEMOVE this Inspection record from the job site. PASS PANT TAIL CITYOF TIG /` R D PLUMBING PERMIT ^ _ DEVELOPMENT SERVICES PERMIT#: PLM2004-00031 13125 SW Mail Blvd., Tigard, OR 97223 (503) 639-4171 GATE ISSUED: 1/23/04 PARCEL: 1 S 135AA-01901 SITE ADDRESS: 10225 SW HALL BLVD 103 SUBDIVISION: METZGER ACRE TRACTS ZONING: C-N BLOCK: LOT: 037 IURISUIC TION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: C,CCU 1ANCY GRP: B FLOOR DRAINS: I TRAPS: STORIES: WATER HEATPRS: I CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS. URINALS: G►3EASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: UB/SHOWERS: SEWER LINE: ft WATT R CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Rough-in & finish, (1)water heater, (1)hub drain for water heater, (1)lav&(1)water closet. FEES Owner: ------- `- Description Date Amount WAYNE L GF_RIG OD 10225 SW HALL BLVD [PLUMI3J Permit Pee 1/22/04 $72.50 TIGARD, OR 97223 [TAX]$9,4.State 1/22/04 _$5.80 Total $78_30 _ Phone : 503.244-1004 Contractor: _ CASCADE PLUMBING CO. 2630 N HAYDEN ISLND DR. #503 PORTLAND,OR 97217 REQUIRED INSPECTIONS Phone : 503-544-7464 Ruugh-in Insp Top-outlnsp Reg #: LIC 120893 Final Inspection PLM 34-412PB 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 OAP, 952-0001-0100. You may obtain copies of these rules or direct questions to OUNC by calling (503) 2.46-6699. Issued By: 1�� 1�12 �. Permittee Sionature C Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day _ ,rrrrrWrr Ji4n " 1 04 Cascade Plumbing Co. 5032896699 p -2 RECEIVED JAN 22 1 2004 Plumbing X!t-rM-jt AMR_jfif d'la City Of Timid 1IM MOF DGMADA 13 125 SW H"Blvd.,Tigard,QR 9-r.12J3 U I LO I N G 0 1 V Icj'lON Daum N Phone .5011394171 F" 503.59g.l%q wm,— — n RaI 24-HOW WpWior Une. 503 639.4175 OU"re"Vidt Isla earl vfwwc,,bg;ud.or,S Do"hardy:Nawkww"l�d. 7 — 1112MI Ll New commuctial" El Dm-olition Newt-24s dwallialts(includes 100 ft.lbrcuh udli comecd T =717 249.20 �--�-i r;� SFA(1)both CO3 I- 2-&aWy diaIdling CominerevNioduStrial SM(2)bath A-gMary bUU -----— J50.00 3 dfttg Mukti-flunily SFR(3)oath 399.00 ❑—kww bui-z ❑ Otb.. Each additional batwtrhen 45.00 "'ireKprink*r C q. T. sq. post 2 Job.she Site G*XI)busin or dmin --Iwn or"M are, QtY--IS 1)rY-I!Tl,leash&K or OUCh drain c.6U Suit Wg/apL no.:1(j 3Prmjtfctteemu 'T; rooting;drain(no.linear-tL: Page 2 C—;sin-Wirattiow to job SitL- Minvulketiaed balm witilwas IMOO Manholes —16-.u u Ram drain connector 16.60 Sanif-Y-ewer(no.linear ft.; PW2 St—sewer(no,linear It.: ___j hag 2 Sumvisiun: Int no. water—vi-(ria.linear a.; --L * waterI [TAX rmp/pmgl 4 11ft" dian wlvv A ...r p 4' i.jj4fi, , Backilow prcvcnrcr 16.60 A) I Backwater valve 16,60 Clothes wesher 16.60 Diahwartra __ 16,60 l Making fouinwit, 14.60 Name: 16.60 WAD FixwTwnwcr 011111 16.60 Phan: an; �iirbap disposal Hose bib ix P 'One' awnper nine: 1—5,22 Ise maker 16.60 Dinism unne. Madicull ps A�A- prima 16.40 oto pol M 1 Roof dtain(comm"ati) 16.69 Maine: q q wdo werI pan 16.60 Urinal —T-16---- 60 WOW closel16-60 /(.P L'Ln Water heater 16.60 Afta City/Sesta/LIP: V?n CA Subtotal Plane:(LS—D 2,) 4— --7 4/ 4p Mittivinurn permit lec., S72.30 Fax!(4_; Residential bprk1law rridninium liftirnit fee: $36-25 7J,57( 0a.) _99 "A Plumbing Lie.no..- 3LI- Plan Mview (23%of pc"it(CC) CCB Ur-: 1�2-cj L Authititited Sivas StAhl W!"chliffle(rA Oftleirmit fee) TOTAL PERM17 FLUE lidil PI p;7r.1j,I.-of owl It" 'within __j J911 day$isfirr it hot been P,crpitd as onnilogl'. "ree atelliodolop set by Tri-County y widing Industry Set'let Baud, c—) I 1 CITYOF TIGARD -_SEWERCONNECTION PERMIT DEVELOPMENT SERVICES PERMIT#: SWR2004-00021,'! 13125 SW Hall Rlvd., Tigard, OR 97223 (503)639-4171 DATE ISSUED: 1;23/04 SITE ADDRESS; 10225 SW HALL BLVD 103 PARCEL: 1 S 135AA-U 1001 SUBDIVISION: METZGER ACRE TRACTS ZONING: C-N BLOCK: LOT: 037 JURISDICTION: TIG TENANT NAME: DR. TORKKO USA NO: FIXTURE UNITS: CLASS OF WORK: NEW DWELLING UNITS: TYPE OF USE: COM NO. OF BUIL DINGS: INSTALL TYPE: BUSWR IMPERV SURFACE: Remarks: ,5 EDU increase Owner: — _ _ ___ _�_ FEES_ WAYNE L GERIG OD 10225 SW HALL BLVD Description `— Date Amount TIGARD, OR 97223 [SWUSA] SwrCunnect 1123/04 $1,200.00 1SWUSAJSwrUoinlcct 1/23/04 $0.00 Phone: 503-244-1004 — Total $1,200.00 Contractor: Phone: Reg #: Required Inspections ----- - This App!irant agrees to comply with all the rules and regulations of the Clean Water Services. The permit expires 180 days from the date issued. The total amount paid will be forfeited If the:permit expires. The Agency does not guarantee the accuracy of the side sewer laterals. If the sewer is not located at the measurement given, the in,taller shall prospect 3 feet in all directions from the distance given. If not so located,the installer shall purchase a"Tap and Side Sewer" Perm r I Issued by: `� �Gf_; - �Cc•L�� t Permittee Signature:' Call (503) 639-4175 by 7:00 P.M.for an inspection needed the next buslne s day Accumulative Sewer Tally Parcel# 1S135AA-01901 Ten; !ane: D(.Torkko This SWRA2004-00023 Site Address: 10225 SW Hall Blvd#103 This PI-M#'2004-00031 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added i total total count off#s count # value #S values Baptisery/Font 4 0 0 0 0 0 Bath -Tub/Shower 4 0 0 _ 0 0 _0 _ __Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash- Each Stall 6 0 0 _ 0 0 0 -Drive through 16 _ 0 0_ 0 0 0 Cuspidor\Nater Aspirator 1 _ 0 0 _ 0 0 0 Dishwnsher-Curnmercial 4 0 — 0 0 0 0 -Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 _ 00 0 0 Eye Wash 1 0 _0 _ _0 0 i 0 Floor Drain/Sink-2 inch — 2 0 0 _J _ 0 0 - 3 inch 5 0 U _ 0~ 0 U 4 inch 6 0 _ 0 _ 0 i 0 _0 Cr-,-Wash Dn 6 0 0 0 _ 0 0 Garbage Disposal — -- Domestic(to 3/4 HP) 16 0 0 0 0 0 Commercial(to 5 HP) 32 0 0 _ 0 _0 0 Industrial (over 5 HP) 48 0 _ 0 _ _0 0 C Ice Machine/Refrigerator Drain 1 0 — 0 0 0 0 _ Oil Sep(Gas Station) 6 _ 0 0 4_0 0 0 Rec Vehicle Dump station 16 — 0 - _ 0 _ 0 0 0 Shower- Gang(per head) 1 0 0 0 0 0 - Stall _2 0 0 0 0 0 Sink - Rar/Lavatory _ ! 2 0 0 _ 1 2 _ 1_ 2 Bradley 5 0 0 _ 0 0 0 Commercial 3 0 0 _ 0 0 0 Service 3 0 0 _ 0 _ 0 — 0 SwimrTiing Pool Filler 1 0 0 Q 0 0 Washer-Clothes 6 0 0 0 0 ` 0 _ Water Extractor_ V 6 _ 0 0 0 0_ 0_ Water Closet lToilet 6 _ 0 _�— �0 1 6 s _ 1 6 ' Urinal 6 _ 0 _^, 0 0 0 0 V Previous EDU Count 0 0 Capped EDIJ Credit 0 '0IALS0 0 0 1 0 ;t 8 2 8 Current Fixture Value 8 divided by 16 = 0.5 _Current EDL' 1 EDI I - $ 2.400 Previous Fixture Value 0 divided by 16= 0.0 _Previous EDU Chang; 8 divided by 16= 0.5 over h-nder) $ 1.200.00 Enter EDU Change Here 0.5 Notes:Per Miriam, CWS, the h 4jn for the water heater doe,- have any fixtures values. Sign tore: ' _- �Dm,,on Date: G Hull Not- The property owner ahall retain the ORIGINAL sewer tally record_If credits exist, this document will serve as a voucher hich must be submitted to th:,,City of Tigard Building Division to redeem credits towsirds futures stem development chards i,\Building\SewerTally�SewerTallySheet.xls 11'19/03