Permit CITY TIGARD PLUMBING PERMIT
a1 1A DEVELOPMENT SERVICES PERMIT #: PLM2001 -00078
-41" „� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/14/01
SITE ADDRESS: 15862 SW 72ND AVE PARCEL: 2S112DD -00200
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: DEM GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH:. BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: . ft
Remarks: Cap one mop sink, located on first floor.
FEES
Owner:
Type By • Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT CTR 3/14/01 $72.50 27200100000
15350 SW SEQUOIA PKWY #300 -WMI 5PCT CTR 3/14/01 $5.80 27200100000
PORTLAND, OR 97224
Total $78.30
Phone 1:
Contractor:
DEAN WARREN PLUMBING
3111'. SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 236 -4152 Insp existing /capped fixtures
Final Inspection
Reg #: LIC 172
PLM 26 -83PB
•
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 ofissuance, or if work is suspended for more
thn 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notifcation Center. Those rules are set forth in OAR 952- 0001 -0010 through OAR 952 - 0001 -0080.
You, m- • • a spies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issue. =y: ` •_ //a,fiteai> Permittee Signature: All14 I — _
Call (503) •39 -4175 by 7:00 P.M. for an inspection needed the next business day
'- �` ' A Plumbing Permit Application
Datereceived: j / Q/ Permit no.: 114/ -eel!) 7g
g City of Tigard
.
.4 � `, Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223 -
City ofTigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: By: I Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PERi111T
❑ 1 & 2 family dwelling or accessory 6Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE 1NFORI 1ATION FEE SCIIEDULE (for special information use checklist)
Job address: /Sg 2 S w - 7a 1 �"rF� Description Qty. Fee(ea.) Total
Bldg. no.: ,[� Suite no.: New 1- and 2- family dwellings only:
map/tax lot/account no.: (includes 100 It. for each utility connection)
Tax ma
P/ SFR (1) bath
Lot: Block: I Subdivision: SFR (2) bath
Project name: (JA CI Ft L IQ G p, E wo E, 12 SFR (3) bath
City /county: 7"' 64,'-4 I ZIP: tr, , a a y Each additional bath/kitchen
Description and location of work on premises: Site utilities:
b EA" O / IsAoP S t ;v, Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: ®S�}..• IAJAl22ew °/....66-.. Manholes
Address: s k „SE. / 3 IL Rain drain connector
City: pe y-L,q I Statepie I ZIP: q -7 ale a Sanitary sewer (no. lin. ft.)
Phone: 3( -I y 5 3(e -1 ?7 E-mail: Storm sewer (no. lin. ft.)
CCB no.: d I -, a I Plumb. bus. reg. no: p'Z $3 p Water service (no. lin. ft.)
City /metro lic. no.: i q 9.1
Fixture or item:
Contractor's representative signature: }, Absorption valve
Back flow preventer .
Print name L.l..ivr P t,.+ Date: / - Backwater valve
Basins/lavatory
Name: e_ N A,/ L—Arel 14,; Clothes washer
Address: Dishwasher
State: ZIP: Drinking fountain(s)
City: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): 1 , 4 - t : M K ST .--- S u.ZT1o. 3 00 Floor drains/floor sinks/hub
o S Lea SE(k to P14.140 Y Hose bibb
disposal
Mailing address: J S-4 se, bibb
City: 7' 6- A}0 I State: , ZIP: 97 aa_•-■ Ice maker
Phor a 4 .— A 3 0 ,4 Fax: E-mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
.J
Not all jurisdictions accept credit cards, please call jurisdiction for more infomtation Minimum fee $ 7s�
N otice: This permit application
❑ Visa ❑ MasterCard expires if a perrnit is not obtained Plan review (at %) $
Credit card number: within 180 days after it has been State surcharge (8%) .... $ 0
Expires TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616. (6/00/COM)
PLUMBING PERMIT FEES: .• .....
PRICE .: TOTAL New 1 and 2- family dwellings only:
'FIXTURES (individual) QTY - (ea) • AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
One (1) bath $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL
Urinal 16.60 8% STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE: .
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 - Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
16.60 Tub or Tub /Shower
Hose Bibs Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16.60 Dishwasher
M J} I�
OP S�N� / Garbage Disposal
Laundry Room Tray
Washing Machine .
Floor Drain /Sink: 2"
Sewer - 1st 100' 55.00 • 3"
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater
•
Water Service - each additional 200' 46.40 Other Fixtures
(Specify
Stone & Rain Drain - 1st 100' 55.00 NA-OP s//;t k 1
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60
QUANTITY TOTAL
Isometric or riser diagram is required if •
Quantity Total is > 9
*SUBTOTAL
8% STATE SURCHARGE
**PLAN REVIEW 25% OF SUBTOTAL
- Required only if fixture qty. total is > 9
TOTAL $
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** Ail New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms\plm - fees.doc 10/10/00
/• Accumulative Sewer Tally
Tenartt Larne: 1 • (2072 C % C.�L / This SWR# A Address: i g L09 dcr ) 7i� %' �� ` /� ` �� This PLM#: t.!1 / 7g
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
Value Capped off value added # added #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2
- 3 inch 5
- 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
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2
- Bradley • 5
- Commercial 3
- Service 3, 1
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6
Urinal 6
TOTALS 0 G o o 5
Total fixture values: (9-0`J
cc £!. c iJ a '-' ' ' Sao
divided by 16 = /off• $ EDU lh.
HISTORY
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# _ PLM# EDU# SWR#
i:\dsts\swrtaly.doc
•
CITY OF TIGARD BUILDING INSPECTION DIVISIO MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
• q BU P
Date Requested 3-I / AM PM BLD • ��-
Location l , j G S i- 2 Z---/ ( Suite MEC
Contact Person Ph 0,k '(( '- PLM 06-‘4
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear _ _ - -- - . -- - __
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler j / r
Fire Alarm
Susp'd Ceiling
Roof _
Misc:
Final - -_ - - -
- - �SSRT - FAIL
Post & Beam
Under Slab /
Top Out � 4'f A 1h
Water Service
Sanitary Sewer
• rains
yap, PART FAIL
ANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA
Approach /Sidewalk Date /i9/6/ Inspector _7 Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.