Permit C ITY OF TIGARD PLUMBING PERMIT
�l DEVELOPMENT SERVICES PERMIT #: PLM2005 -00671
''� II 13125 SW Ha Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 12/13/2005
PARCEL: 2S 113AA -00600
SITE ADDRESS: 16126 SW 72ND AVE B1 ZONING: I -L
SUBDIVISION: OREGON BUSINESS PARK I LOT: 00B JURISDICTION: TIG
Project Description: TI, replace existing fixtures.
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: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [PLUMB] Permit Fee 12/13/200f $72.50
[TAX] 8% State Surchari 12/13/200: $5.80
Phone : 503 624 - 6300 Total $78.30
Contractor:
ADDISON PLUMBING
1407 HOMESTEAD PLACE REQUIRED ITEMS AND REPORTS
MOLALLA, OR 97038
Contact # : PRI 503 785 - 1840
FAX 503 829 - 9701
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 Utility Notification Center. Those rules are set forth in OAR
952-001 :: ! hrough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calli • 503-246-6.99 • -811 332 -2344.
Issued By: '�d �� -- -1 Permittee Signature:
Call 503-639-4175 by 7:00 a.m. for an inspection that business day.
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.
Building Fixtu '
V t:.
Plumbing Per i �t cation v t:.®
6 4,
I o1i orrlcl ul: ONL.1 •
City of Tigard Pr' 0 5 2005 , L n�s /R S D� Permit N . 6 64„ 7/
13125 SW Hall Blvd, Tigard, O' 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598}, 0 `. yb, - ryf :; ('. , Date/By Other Permit No.: A• .
24- Hour Inspection Line: 503Qf5X14 . ` -•1
. Internet: www.ci.ti d.or.0 ILDING D S%ON - i 17ateR : /®See P age for
8� t3U Notified/Methd/Meth od 6 /' ( Supplemental Information
TYPE OF WORK 1 FEE* SCHEDULE
.p&Paiz-$4 ❑ New construction ❑ Demolition , For special information use checklist
b -, • ' on 1 Qty. 1 Ea. 1 Total
fig 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
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 1b\Z� Sw -72.�q ,Fr.,e Catch basin or area drain 16.60
City /State/ZIP: - r ...,4 i pQ R7zz� Drywell, leach line, or trench drain 16.60
Suit Id /apt. no.: of I Project name: Cov"r` act _A1e =Ntt,rvut},ov.a.% Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
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: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Back flow preventer Page 2
Dev.,,,o . t - w . t t - trw, l - F. 1 W N , wv..d \re.laco - , -k c Backwater valve 16.60
(414-.. Clothes washer 16.60
nfA i tyN �.�7 1 . Dishwasher l 16.60
)l PROPERTY OWNER LA ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: ? �[ - - Expansion tank 16.60
Address: IS ;SO cto Seq v o\o.. P t M '300 Fixture /sewer cap 16.60
City /State/ZIP: ea , r .i c k a Floor draip>'floor sink/hub 1 16.60 j,. L 0
Phone: (Col ) 62,q- 1,„102 ' Fax: (56 y ) 62,4 -77ss Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City / State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basi avato i 16.60 16 . (,o
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
• CONTRACTOR Water closet 1 16.60
(6.100
. Business name: Aa,vS,z,„ Q \ � Water heater i 16.60 l 6 .bo _
Address: Noy No„..„., S1rc.a.,9 Qlo..c.,e. Other:
Subtotal (,(,,9
City / State/ZIP:
1,44,0...‘a.., Off- X11 ; s Minimum permit fee: $72.50
Phone: (503 ) 72$ 1840 %; - 740 -\t, Fax: (56% ) i 2.q -9 7o I Residential backflow minimum permit fee: $36.25 ?A,.5:)
CCB Lic.: iv 7S Plumbing Lic. no.: 5 - 149 pg Plan review (25 % of permit fee)
State surcharge (8% of permit fee) .5,9z)
Authorized signature: 0S2-1:2- TOTAL PERMIT FEE is ,
Print name: 36_y vv,x50r-e- I Date: t 2 -s -o s- 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 \Pennits\PLMF- PennitApp.doc 06/05 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard . \,
Page 2 - Supplemental Information •
''Fee chedule: Residential Fire Suppression Systems:
Site ■ • 'ties Qty. Fee (ea) - Total Square Footage: Permit Fee:
•
Footing . - 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 8220.00
Sewer - 1st 100 ' 55.00 7,201 and greater $309.00
Sewer - each additi. al 100' 46.40
Water Service - 1st 100 55.00
Medical Gas Systems:
Water Service - each ad. ional 100' 46.40
Valuation: Permit Fee:
Storm &Rain Drain - 1st 1 1' 55.00 $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each ad. • 'onal 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $ ,100.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total I additional $100.01 .r fraction thereof to and
includin _ $10 1!1.00.
Commercial Back Flow Prevention a - 46.40 $10,001.00 to $25,000.00 $148.50 for e first $10,000.00 and $1.54 for
Residential Backflow Prevention Devic • each addi . nal $100.00 or fraction thereof, to
(minimum permit fee $36.25) 27.55 and in ding $25,000.00.
Rain Drain, single family dwelling I_ 65 $25,001.00 to 850,000.00 $37'. 0 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or . additional $100.00 or fraction thereof to
specially requested inspections - per hour 72.50 d including $50,000.00.
Subtotal: $50,001.00 and up A $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A' •1mplex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to stem that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace • Any new exterior plumbing site utilities.
Previous Capped Added Existing • A commercial building with installation, alteration or addition
Baptistry/Font ■ nine (9) or more new relocated plumbing fixtures,. • ,
Bath - Tub /Shower ❑ M : 'cal gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool provi • • I g services to human beings.
Car Wash - Each Stall ❑ Plumbin • 'nstallations, alterations or additions to food service
- Drive Thru facilities w e new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being ins . -d for the food service area.
Dishwasher -Commercial ❑ Any new resident : building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
- ❑ Any NFPA 13 -D multi!). ,..se fire sprinkler system.
= Eye Wash
oor Drat /sink ( i. Submit 2 sets of plans any of the above.
-4"
Car Wash Drain Isometric or Riser Di 'ram
Garbage - Domestic [D Isometric or riser diagram is required 'knew buildings
Disposal - Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station Comments regarding fixture work:
Rec. Vehicle Dump Stati ' on
Shower -Gan
-Sidli
Sink /-lar avator 1
- Bradley
-Commercial
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture under this permit results in an
Water Extractor ure wor uner P
Water Closet - Toilet 1 increase of sewer EDUs, a sewer permit will be issued and
. Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
i:\ Building \Pennits\PLM- PennitApp.doc 07/06/05
C O GA RD
BUILDING ITY DIVISION PERMIT #: PI_I ..,..
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 121131 }00
Phone: (503) 639 -4171 , u1�li��l
Inspection Requests (24 Hrs.): (503) 639 -4175 .� _—_- �__..
INSPECTION WORKSHEET FOR DATE: 1/24/2006 TIME: 6 :E8AMvi PAGE: 41
SITE ADDRESS: 16126 SW 72ND AVE B1 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 008 TYPE OF USE:
PROJECT NAME: CONNECT -AIR
DESCRIPTION: TI, replace existing fixtures.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 603 - 624 -6300
CONTRACTOR: ADDISON PLUMBING PHONE #: 503- 761I•1i340
Inspection Request Scheduled For: Date: 1/24/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 02..5593.01 503- 7408311E N
Corrections /Comments /Instructions:
e c (z..,.. e___
['ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED /1-r Inspector: Date: / / j1 //4 Phone #: (503) 718- lJI 3 I
CITY OF TIGARD
BUILDING DIVISION e. PERMIT #: PI_M200 Q )G71
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/13/2005
Phone: (503) 639 -4171 071glii�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/23/2006 TIME: 7 :04AM PAGE: 2
SITE ADDRESS: 1612E SW 72ND AVE 81 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 008 TYPE OF USE:
PROJECT NAME: CONNECT-AIR ' �3�$Q ---417d
l .�
DESCRIPTION: 11, replace existing fixtures. F4Gfis
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 - 621 -6300
CONTRACTOR: ADDISON PLUMBING PHONE #: 603-Mr 1840
Inspection Request Scheduled For: Date: 1/23/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing find 025461 - 01 503 - 740.13116 N
Corrections /Comments /Instructions:
300e141q
t
❑ PASS ❑ PARTIAL APPROVAL ❑] CANCEL ❑ NO ACCESS
[AIL PALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED •
j e / 718- Inspector: / /Zi 2 1 Date: 1. � Phone #: (503) 7
CITY OF TIGARD
BUILDING DIVISION PERMIT #: RN
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/13/2005
Phone: (503) 639 -4171 , 1 "Si t
Inspection Requests (24 Hrs.): (503) 639 -4175 ..__
INSPECTION WORKSHEET FOR DATE: 1/3/2006 TIME: 7 :Q1AM PAGE: 9
SITE ADDRESS: 16126 SW 72ND AVE 81 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 00B TYPE OF USE:
PROJECT NAME: CONNECT -AIR
DESCRIPTION: TI, replace existing fixtures.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503 - 62.46300
CONTRACTOR: ADDISON PLUMBING PHONE #: 503 - 7135.11340
Inspection Request Scheduled For: Date: 1/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 0242913 -01 503-740-13116 N
Corrections /Comments/ Instructions:
_Sd3 --47 2 g -4 e 1
, 42A SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: j V Date: 4_11_61Y__ Phone #: (503) 718-
CITY OF TIGARD _-„,
BUILDING DIVISION t PERMIT #: PLM2005 -00671
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/1312005
Phone: (503) 639 -4171 ,_,.,-....:; 0440,(
Inspection Requests (24 Hrs.): (503) 639 -4175 , 1J1.
INSPECTION WORKSHEET FOR DATE: 12/16/2005 TIME: 7:06AM PAGE: 9
SITE ADDRESS: 16126 SW 72ND AVE B1 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: DOB TYPE OF USE:
PROJECT NAME: CONNECT - AIR
DESCRIPTION: 11, replace existing fixtures.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503.6246300
CONTRACTOR: ADDISON PLUMBING PHONE #: 5034851840
Inspection Request Scheduled For: Date: 12/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 023632 -01 503. 740 -8116 N
Corrections /Comments / Instructions:
•
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: A Date: i i Phone #: (503) 718-