Permit C ITY OF TIGARD PLUMBING PERMIT
zr DEVELOPMENT SERVICES PERMIT #: PLM2004 -00437
'� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/21/2004
SITE ADDRESS: 15865 SW 72ND AVE BLDG -C PARCEL: 2S112DC -00201
SUBDIVISION: OREGON BUSINESS PARK III ZONING: I -P
BLOCK: LOT: 003 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: 1 GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing fixtures. Relocating 1 lay. and 1 water closet, others fixtures new. Other fixture: primer.
FEES
Owner:
Description Date Amount
PACIFIC REALTY ASSOCIATES [PLUMB] Permit Fee 9/20/2004 $116.20
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [TAX] 8% State Surcharl 9/20/2004 $9.30
Total $125.50
Phone:
Contractor:
ADDISON PLUMBING
17506 SE RIVER RD.
MILWAUKIE, OR 97267 REQUIRED INSPECTIONS
Phone : 503 - 785 -1840 Rough -in Insp
Top -out Insp
Reg #: LIC 151754 Final Inspection
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
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246 -6699.
Issued By: Permittee Signature: c1 ,7./ . CA
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures C D A S(ia.De-- o o a 1 6 a )-.4 _ (� 300
G 1v
Plumbing PerniMrvNication FOR OFFICE USE ONLY
C � l.�+O� Received •
City of Tigard 2�3 `� ® Da g /� / a� PermitNo.PL/ /_ p j} �f3
13125 SW Hall Blvd., Tigard, OR 97 SkGARD ®�
i Plan Reviel
Phone: 503.639.4171 Fax: 503.5 Q � / / ;.h �. . y Other Permit N° cl�/12. �/ -
(�
24- Hour Inspection Line: 503.639 I G ® �v� _ e�� \ Date/By: Date Ready/By: rU ® See Page 2 for
Internet: www.ci.tigard.or.us et.) 1 Notified/Method: ' LC.1 Supplemental Information
TYPE WORK ..FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
IS Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION. SFR (1) bath 249.20
❑ 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
• - JOB SITE INFORMATION AND LOCATION . Site utilities
Job site address: 15 g 65 1 W - i 2 ,$ ytiv .. Catch basin or area drain 16.60
ell, leach line, or trench drain 16.60
City/ State/ZIP: Q of._ Drywell,
no.: I Project name:G Footing drain (no. linear ft.: ) Page 2
4ae A. Sy5 }ew S Manufactured home utilities 1 10.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
- DESCRIPTION OF WORK Backflow preventer Page 2
12-0.- iv. oa,-.1 ' I v . ska-U l - tov -e..e, f- w ov .. S ,,,.:41.. 1 - La r t 1 ■ w e Backwater valve 16.60
Clothes washer 16.60
l - v_4- • , ■ - F D 1 1/4.....rt1 -
Dishwasher 16.60
Drinking fountain 16.60
❑ PROPERTY OWNER ' I ❑ TENANT
Ejectors /sump 16.60
Name: Ao.c..•C Expansion tank 16.60
Address: / S'3 So f W S,p �o,o - e k_tN ki •�)oo Fixture/sewer cap 16.60
City/State/ZIP: porl\e O'g C r draafloor sink/hub ( 16.60 (G.A.°
Phone: (�•; ) C•,Zq_- 6 ? ao Fax: (.5 )124 77S'S Garbage disposal 16.60
❑ APPLICANT Hose bib 16.60
❑ CONTACT PERSON
• , 7 • Ice maker 16.60
Business name:
Interceptor/grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: •me ( 16.60 lt... %.,6
City/ State/ZIP: Roof drain (commercial) , ,,,e.. 16.60
Phone: ( ) Fax: : ( ) .. 1n asin vato �� ;L 16.60 3 3.20
Tub /shower /shower pan 16.60
E-mail: Urinal 1 16.60 (1 t,o
CONTRACTOR Water closet 4 16.60 1 b .60
Business name: tA49,.g;sov. Pty i„. i, C. Water heater ), / 16.60 I (t, . (
(0 Other:
Address: 1-1&-at. ,f e- g c,,c Subtotal (It ,2..0
City/State/ZIP: wu ‘w `.. • K, e Oe• cl'•l Lbw i %
" I Minimum permit fee: $72.50
Phone: (ro; ) 7 .e1 - IT to Fax: (5 ) 72‘ - a14-1 Residential backflow minimum permit fee: $36.25
CCB Lic.: t t' �• t 7 s' . Plumbing Lic. no.: -1-4q P Q Plan review (25% of permit fee)
State surcharge (8% of permit fee) ' 30
Authorized signature: TOTAL PERMIT FEE
( 5
Print name: J 44,0 . 0 ,,,i_ Date: q - zo -o$4 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.
i:\ Building \Perrnits\PLMF- PermitApp.doc 12/03 440 I 0/02/COM/WEB) 7 6'71 0 A _ CAi_ a&,
Plumbing Permit Application : City of Tigard •
Page 2 - Supplemental Information -
Fee Schedule:' Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total • Square Footage: Permit: Fee: ..
Footing drain - 1' 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
Valuation: 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 • Fixture or Item - Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and
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 $379.50 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 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 * .
Quantity by (Fixture) Work Performed
Fixture Type: Replace
New Moved Existing - Capped Comments regarding fixture work:
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain
A te Want
or Dr/sink ®' /
- 3"
-4"
Car Wash Drain
Garbage - Domestic
Disposal - Commercial *Note: If the fixture work under this permit results in an
- Industrial
Ice Mach./Refrig. Drains increase of sewer EDUs, a sewer permit will be issued and
Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the
Rec. Vehicle Dump Station plumbing permit can be issued.
Shower -Gang
-Stall
Sink -Bar vato
- Bradley Quantity Total
ommercta ' Isometric or riser diagram is required if fixture quantity
-• , total is >9.
Swimming Pool Filter
Washer - Clothes
Water Extractor Plan Review
Water Closet - Toilet 11 Plan review is required if fixture quantity total is >9.
Urinal 1
Other Fixtures: fet -e,--
i:\ Building \Permits\PLM- PemtitApp.doc 3/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested /6- 24 AM PM BUP
Location 41 Suite // MEC
Contact Person k'.Q•�f_ Ph ( ) / 1 4 /6 6 — �// (P PLM o?O 2 Y -00 '13 7
Contractor �� Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
R Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
4 . PART FAIL
CHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line ADA [� G 6 L Approach/Sidewalk Date v Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL