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Permit CITY OF TIGARD PERMIT *A DEVELOPMENT SERVICES PERMIT #: PLM2003 -00534 4 A l ; DATE ISSUED: 10/8/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15605 SW 72ND AVE PARCEL: 2S112DC -00100 SUBDIVISION: OREGON BUS. PARK III ZONING: I -L BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS: TRAPS: STORIES: • WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: 1 GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Relocating 1 water heater, 1 urinal, and 1 lave. FEES Owner: Description Date Amount PACIFIC REALTY ASSOCIATES 15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 10/8/03 $72.50 PORTLAND, OR 97224 [TAX] 8% State Tax 10/8/03 $5.80 Total $78.30 Phone : Contractor: ADDISON PLUMBING 17506 SE RIVER RD. MILWAUKIE, OR 97267 REQUIRED INSPECTIONS Phone : 503 - 785 - 1840 Rough -in Insp Final Inspection Reg #: LIC 151754 PLM 3 -449PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Issued By: Permittee Signature: 4_ j. a.,,,. a- Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures Ph mining Permit Application . FOR OFFICE USE ONLY Received l c. ,,, Plumbing RECEIVED Date/By. . 5 Permit No. -0 53 y C l of Tigard Planning App oval Sewer `J b Date/By: Permit No.: • 13125 SW Hall B1vd. ���N ,�' �� Plan Review Other Tigard, Oregon 97223 C'e� 8 2253 Date/By: PermitNo.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 w / /,�iy,,rll Post - Review Land Use pp Internet: ww.ci.tigard.or.us CITY OF TIGAR 'f 1i' Date/By: y Case No.: : _�: Contact Juris • ® See Page 2 for 24 - hour Inspection Request: 5 §AlF7P - _ Name/Method: TI Supplemental Information. - . _ 'TYPE QF WO •- :: - ' TAB* 'SCniimE (fo:speciatinfprmitiwimse checklist) ❑ New construction ❑ Demolition Description 1 Qty. 1 Fee(ea) I Total ® Addition/alteration/replacement ❑ Other: . ,, New 1 -.& 2 fanny d. ellurgs . - ,- '. . (includes 100 ft for act: utility connection) . CATEt;ORY Oli COhTSTRUCTIOPT, SFR (1) bath 249.20 ❑ 1 & 2- Family dwelling © Commercial/Industrial SFR (2) bath 350.00 ❑Accessory Building ❑ Multi - Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 . JOB "SITE INFORMATION;and LOCATION , : Fire sprinkler - sq. ft.: Page 2 Job site address: rrc,,g sw 7z,... Poekin. - aa 0,e_ . ,; Site L?tilities ` . . . Suite #: 1 Bldg. /Apt. #: Catch basin/area drain 16.60 Drywell/leach line/trench drain 16.60 Project Name: 5,;rtv„� Footing drain (no. linear ft.) Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 - 72.-4 a. kabl.c L..0•-e. Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: 1 Lot #: Storm sewer (no. linear ft.) Page 2 Tax map/parcel #: Water service (no. linear ft.) Page 2 . DESCRIPTION OF WORK. Fixture`.or;IteIIi, Absorption valve 16.60 W..auc 1- t,.� , 1- I-0 , ou..d I - w N Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 '1E1 PROPERTY OWNER • .1,•;❑'TENYANT• Ejectors/sump 16.60 • Name: T,,,,,.1z Pwp Expansion tank 16.60 Address: r s' 3S'0 S w 51 ex,' -0 36° Fixture/sewer cap 16.60 City /State /Zip: y , o ,,.ik 0 .,, GK . 2"1 z 22+ Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone: Fax: Hose bib 16.60 ,❑ APPLICANT • - ' • _ • III :CONTACT PERSON Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 Primer • 16.60 City /State /Zip: Roof drain (commercial) 16.60 Phone: Fax: Sink/basin/lavatory I 16.60 f‘. (. E -mail: Tub /shower /shower pan 16.60 . CONTRACTOR:. Urinal J 16.60 16 . fro Business Name: ,x,; ,,,,,,,_e•,.,� L L h L Water loset 16.60 rz���r Water heater 1 16.60 I�. (.0 Address: 17sob s€ Kt.. Other: City /State /Zip: ati;k.Na..,;e, 0,2 q7z. -? other: Phone: sal -78c -wife Faxso3-1 - oiF4-7 • . PlumbingPecin'it i'ees* . ` .. CCB Lic. #: in 7 5 Plumb. Lic. #: p 449 P8 Subtotal $ 1-(c? Minimum Permit Fee $72.55 0 $ Authorized Residential Backflow Minimum Fee $36.25 Signature: 4ra.2 Date: rt. - 7 -a3 Plan Review (25% of Permit Fee) $ T ,} ov -e I State Surcharge (8% of Permit Fee) $ (Please print name) TOTAL PERMIT FEE $ Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri -County Building Industry Service Board. i:\Dsts\Permit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard „, Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: St Utilities Qty: Fee: {raj Total: SquareFlootage - Permit Fee; Footing drain - 1" 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service -each additional 100' 46.40 ValuatiQgc • Permit Fee: Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each. additional $100.00 or fraction thereof, to and Fizfiiire or. Qt3 ' .rt Fee {e otai ; 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 $37950 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: $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 *. quantit by (FutU - Work•Performed Comments regarding fixture work: • mature Type ,'replace,., . s, ... - :. N _ Mdved -. Ladstinz : .. Baptistry/Font Bath - Tub /Shower — - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" • -3" 4 „ ear Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic Disposal - Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach./Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink -Bar ,(7 1 • - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor Water Closet - Toilet Urinal 1 ' Other Fixtures: w , M . 1 i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received / Date Requested / / J 3 AM PM BUP / Location S- ( U.Sr 7 vi'1T Suite MEC Contact Person 90 — Ph ( ) -741v .— ? //' PLM 3 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation Access: Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation j __ ' Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling . 5_ , _ 1(// . ._. ,:. Roof Other: Final , J PASS PART FAIL �� / PLUMBING Post & Beam Z. Under Slab Rough -In , i Water Service ' MSTA '� � � �� -- /` Sanitary Sewer Rain Drains ,/ Catch Basin / Manhole Storm Drain Shower Pan :P _ _ / 1, i • r;,. —_ W*- IMP PART TV.: • NIC . ' II i P•st & Bea Rough - In A MireffAriWr Gas Line O Smoke Dampers Final PASS . PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE 0 Please call for reinspection RE: Q Unable to inspect — no access Fire Supply Line ADA /9").!: Approach/Sidewalk Date Inspector Ext Other: Final ■ 0 NOT REMOVE this inspection record from the Job site. PASS PART FAIL