Permit (162) iii 1114CITY OF TIGARD PLUMBING PERMIT
i.'' COMMUNITY DEVELOPMENT Permit#: PLM2019 00168
TI AR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/24/2019
Parcel: 2S112DD01400
Jurisdiction: Tigard
Site address: 15686 SW SEQUOIA PKWY
Project: Marriott Subdivision: PACIFIC CORPORATE CENTER Lot: 5
Project Description: Backflow preventer replacement on fire supply line.
Contractor: ALWAYS FAITHFUL PLUMBING LLC Owner: PACIFIC REALTY ASSOCIATES LP
PO BOX 757 PO BOX 58990
WILSONVILLE, OR 97070 SEATTLE,WA 98138
PHONE: 503-780-9486 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/24/2019 $31.27
Specifics: 1 12%State Surcharge- 04/24/2019 $8.70
Plumbing
41 ea Minimum Fee Adjustment- 04/24/2019 $41.23
Type of Use: COM
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
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 the 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 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.8.. - .
Issued By: •
r -:-4a.i Si nature: kAi. )
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Site Utilities FOR OFFICE USE ONLY
City of TigardFReceived:
z1/30/1'i permit No.:/04(v1.91)/,
coly
• 13125 SW Hall Blvd.,Tigard,OR 9722 Plan Review
Date/By:Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
Inspection Line: 503.639.4175 APR 2 4 2019
TIGARD Date Read/By Juris ® See Page 2 for
Internet www.tigard-or.gov Notified/Method: f L Supplemental
Information
.;. y .T . r :4•..1,10041r _ 7.., 4. ,,... a 1 .1`�%I y .,,,,,,,,,,,N91 -7'. ,v' qua`
� * .. t For special information use checklist
0 New construction • Demolition
Description Qty. Ea. Total
0 Addition/alteration/replacement ®Other:Replacement New 1-2-family dwellings(includes 100 ft.for each utility connection)
6ATEGORY OF G oN x SFR(1)bath 312.70
❑ 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
J I ITE 1`l nitl" tONATION ' Site utilities:
Job site address:15686 SW Sequoia Pkwy Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Portland,OR 97224
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:Marriott Backflow Device Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer j 31.27 3 1 ,,)-'?
m ,, \\ DESCRIPTION o1 Backwater valve 12.51
&.,,, 7' '. Clothes washer 25.02
Replace 6"double check backflow device (...o F((ZC L.(N,,t) Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY Q `r' F • , ,I• ,TENANT Expansion tank 12.51
Name:Pacific Realty Associates,LP. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:15350 SW Sequoia Parkway,Suite 300
Garbage disposal 25.02
City/State/ZIP:Portland,OR 97224 Hose bib 25.02
Phone:(503)624-6300 Fax:(503)624-7755 Ice maker 12.51
'''12'1411403C NT ,,` oNTA.Cr PERS---006.IInterceptor/grease trap
I t 25.02
Business name:Pacific Realty Associates,LP. Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:John Wiitala
Roof drain(commercial) 12.51
Address: 15350 SW Sequoia Parkway,Suite 300 Sink/basin/lavatory 25.02
City/State/ZIP:Portland,OR 97224 Solar units(potable water) 62.54
Phone:(503)624-6300 Fax::(503)624-7755 Tub/shower/shower pan 12.51
E-mail:JohnW@PacTrust.com Urinal 25.02
Water closet 25.02
f o TRACTOR ,,
_ -- ,,,, -,,, : Water heater 37.52
Business names- Gr/141,4 y S �T i fli4 / /9 ,Czt/r Water piping/DWV 56.29
Address: Z//k -)$-7 Other: 25.02
City/State/ZIP: 44,/; S . A / , 40 I 0 7c2 Subtotal 3 i )--7
Minimum permit fee: $72.50 ��
Phone:(�J) "'��� - l`7�r�'�jU Fax:(503)624-7755 � �"T
Plan review (25%of permit fee)
CCB Lic.: ��7r At 1,/ Plumbing Lie.no. l' �� ' o
l State surcharge(12%of permit fee) 6.-_-7-0
Authorized signature: -` TOTAL PERMIT FEE (P/,
Print name:John Wiitala Date:4/24/2019 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
C\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
15686 SW SEQUOIA PKWY, TIGARD, OR, 97224
Record Type: Record ID:
Commercial - Plumbing PLM2019-00168
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Replace 4" back flow device for domestic water service to Bldg.- Approved with test.
Note: test results were sent to public works.
Violation Summary:
Inspector Contractor