Permit t s iTY OF T I GA R D PLUMBING PERMIT
rr DEVELOPMENT SERVICES PERMIT #: PLM2002 -00208
DATE ISSUED: 6/12/02
�'' 1 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 15862 SW 72ND AVE 150 PARCEL: 2S112DD -00200
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installing (2) water closets, (2) lays, (1) 2" floor drains, (1) primer and (1) water heater.
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT CTR 6/12/02 $116.20 27200200000
15350 SW SEQUOIA PKWY #300 -WMI 5PCT CTR 6/12/02 $9.29 27200200000
PORTLAND, OR 97224
Total $125.49
Phone 1:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 236 -4152 Rough -in Insp
#: L IC 172 Top -out Insp
Reg Final Inspection
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 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 copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: • : AIL jr Permittee Si natur 1411 116./0 i -
CaII (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
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A ,, ikqumbingPermitApplication
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D afereodvoa: (� - / / -o Permitno.:Kat�a -m ��
4 ,i ' ° •i I' Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR -J
City ofTigard Phone: (503) 639 -4171 Project/appl. no.: re date: 13
Fax: (503) 598 -1960 JUN 1 1 2002 Date issued: B I Receipt no.:
Land use approval: v ,, 1r i st t t ti P Case file no.: yment type:
1 1 1 ' 1 01 I' I :10111 --)`
O 1 & 2 family dwelling or accessory Commercial/industrial O Multi - family Tenant improvement
CI New construction ''4 Addition/alteration /replacement 0 Food service 0 Other. '-
JOB SI 1 - E INFO101: I ION FEE 5(' Ill ;Di 1.1: (fi)r special information use checklist)
Job address: 5Fa W l r Total
Bldg. no.: Suite no.: New 1 and 2. dwellings only:
Tax map/tax lot/account no.:
(includes 100 ft. foreach utility connection)
SFR (1) bath •�
Lot: Block: 'Subdivision: SFR (2) bath
Project name: U _ w • , ivA ►v G E SFR (3) bath
City /county: „ G *A= ZIP: •_ __ Each additional bath/kitchen
Description and location of work on premises: .rj✓.s . LC_ Site utilities:
i
a— w c l a_ —LA tJ / /-14/ /f , 1- Catch basin/area drain
Est. date of completion/' inspection: Drywells / leach line/trench drain
PLUMBING CON "I It.1(' FOIL Footing drain (no. lin. ft )
Manufactured home utilities , o
Business name: 0 E 4r.J / .1Q, E.N p 6-; Manholes
Address:. at • e,, ) 3 -tom Rain drain connector
City: Po IPTL ,,, I Ste: i f41 ZIPQ 7 010 R. Sanitary sewer (no. lin. ft.)
Phone - _ Fax__ 7 i E -mail: Storm sewer (no. lin. ft.)
CCB no.: V Plumb. bus. reg. no: - : • A Water service (no. lin. ft.)
City/metro lie. no.: Fixture or item: •
Contractor's representative signature: ���_!1$ Absorption valve
Print name: L ��� Date: , _ Back flow p valve
r
�`��'�' " Backwater valve
CON "FACT PI• ;RSON Basins/lavatory
Name: rs--i E- r✓" rc. L , 4. )$ Clothes washer
Dishwasher
Address: Drinking fountain(s) •
City: 'State: {ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixturelsewer cap
Name not : Su. 3 400 Floor drains/floor sinks/hub 1
(print) �� LAS / Garbage disposal
Mailing address: / 5 3 SO s C,tJ SpQ (.4 Pic1.v Hose bibb
City: b - , g , I State:O ] ZIPQ `f Ice maker
Phone y — (p p p1 Fax: 1 E -mail: Interceptor /grease trap
Owner installatian/residential maintenance only: The actual installation Primer(s) 1
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
E N f; !NUR Tubs/shower/shower pan
Name: Urinal
Address: Water closet a
Water heater 1
City: 1 State: 1 ZIP: Other.
Phone: 'Fax: 1E-mail: Total
,20 Not all jurisdictions accept etedit cards, please call jmiadx6on for more infamatioa Notice: This permit application Minimum fee $ /1 �O jurisjurisdictions
O visa 0 MastezCard P lan review (at %) $
expires if a permit is not obtained �
- Credit card number. 1 / State surcharge (8%) "" $ 9
Expires TOTAL 180 days after it has been
Name at cardholder as shown on credit card accepted as complete. TOTAL $ 1 s 1--)3-----
Cardholder signature Amount , 440-4616 OSVO COM)
PLUMBING PERMIT FEES: .. PLUM ES
. TOTAL New 1 and 2 family dwellings only: PRICE TOTAL' I
,. ' _ d QTY AMOUNT (Includes all plumbing fixtures in
,FIXTURES ndiv)dus the dwelling and the first100 ft. QTY (ea) AMOUNT
16.60 for each utility connection)
Lavatory
Sink 16.60 3 - One (1) bath $249.20
Tub or Tub/Shower Comb. n 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath -
16.60 SUBTOTAL
Water Closet 8% STATE SURCHARGE
16.60
Urinal
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
16.60
Laundry Tray 16.60
Washing Machine
FloorDrain/FloorSink z " 1 16.60 / 6 -� PLEASE COMPLETE:
3 " 16.60
4" 16.60 quantity by Work Performed
16.60 F ixture Type: New Moved Replaced Removed/
Gas piping Heat 0 s a separate 0 like kind
Gas piping requires a separate mechanical I / � i Capped
permit I 46.40 ' Sink
MFG Home New Water Service 46. Lavatory '
46.40 T to or Tub /Shower
MFG Home New San/Storm Sewer _
16.60 Combination
Hose Bibs Shower Only
16.60
Root Drains 16.60 Water Closet as.
Drinking Fountain Urinal
Other Fixtures (Specify) 16.60 Dishwasher
`( Garbage Disposal
P1Q j �f2 Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2" 1
Sewer - 1st 100' 55.00 3"
46.40 4"
Sewer - each additional 100' 46. Water Heater 1
Water Service - 1st 100' 55.00 Other Fixtures •
Water Service - each additional 200' 46.40 • (Specify) /
Storm & Rain Drain -1st 100' 55.00 /Z17Jhi
' 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
1 Inspection of Existing Plumbing or Specially 72.E COMMENTS REGARDING ABOVE:
Requested Inspections per/hr .
Rain Drain, single family dwelling 65.25
16.60 Grease Traps 16. '
QUANTITY TOTAL
Isometric or dser diagram is required if •
Ouantity Total Is > 9 O
*SUBTOTAL li
8% STATE SURCHARGE ■
' act
c
"'PLAN REVIEW 25% OF SUBTOTAL -----
Required only If fixture qty. total is > 9 ,
TOTAL s, a -
'Minimum permit fee is $72.50. 8% state surcharge, except Residential Backflow
Prevention Device. which Is $36.25 • 8% state surcharge.
"All New Commercial Buildings require plans with Isometric or riser diagram and
plan review.
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