Permit CITY TIGARD PLUMBING PERMIT
It DEVELOPMENT SERVICES PERMIT #: PLM2001 -00439
` 'f) 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/20/01
SITE ADDRESS: 15865 SW 74TH AVE 110 PARCEL: 2S112DC -01400
SUBDIVISION: CREEKVIEW INDUSTRIAL PARK ZONING: I -P
BLOCK: LOT: 004 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: 1 URINALS: 1 GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Plumbing tenant improvement.
FEES
Owner:
Type By Date Amount Receipt
PACIFIC AMERICAN PROPERTY EXCH PRMT CTR 9/20/01 $149.40 27200100000
PACIFIC SANTA FE CORP PLCK CTR 9/20/01 $37.35 27200100000
17700 SW UPPER BOONES FERRY RD 5PCT CTR 9/20/01 $11.95 27200100000
PORTLAND, OR 97224
Phone 1: Total $198.70
Contractor:
EAGLE PLUMBING
13801 S FORSYTHE RD
OREGON CITY, OR 97008 REQUIRED INSPECTIONS
Phone 1: 503 - 650 -8703 Rough -in lnsp
Reg #: LIC 47914 Underfloor /Underslab
PLM 3 -154PB Final Inspection
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 OA-1 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by callin• :0 98
Issued B / -iv, Permittee Signature: / _ i ►k . . � �
all (503) 639 -4175 by 7:00 P.M. for an inspection needed the sine -�- A
�*'
rI 1 ki .5604.2OOl-oo0� �-
_.DO33-�
Plumbing Fermi : 1 m ' tion
City Date received: f, 0 1 Permit no.: ( F 20/'00 '
1 > � � . CI of Tigard
- � b Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, d
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date: \
Fax: (503) 598 -1960 Date issued: By:�,/3 Receipt no.:
/� a
Land use approval: Case file no.: Payment type:
", TYPE OF PERMIT . ° ` , `
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi family D Tenant improvement \
❑ New construction Cl Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: / j e (n S S LJ 7 4 Description Qty. Fee (ea.) Total
Bldg. no.: I Suite no.: 10 New 1- and 2 -family dwellings only: `�
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: IBlock: I Subdivision: SFR (2) bath
Project name: SAAi,y) iy1 t40'J t4TDR.J SFR (3) bath
City /county: O 114 I ZIP: Each additional bath/kitchen
Description and location of work on premises: Site utilities: '
. 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: otee, L Pte*, Manholes
Address: ( 3 o p ( S Fp TN.; A0 Rain drain connector
City: a s ct ; • n State: ZIP: 97011 Sanitary sewer (no. lin. ft.)
Phone:40jb 57 a3 Fax: 87v) E -mail: • Storm sewer (no. lin. ft.)
CCB no.: ci 7 5 1 y Plumb. bus. reg. no: _ (j y Water service (no. lin. ft.)
City /metro lic. no.: 13 ( 7 (S o 7'V - ) 23 y - it, ' Fixture or item:
Contractor's,representative signature: CQ_ C -` Absorpt valve
Back flow preventer .
Print name: _ i C_At.t73 Date: ; .-U Backwater valve
CONTACT PERSON Basins /lavatory
Name: A" if Q/.4. CO c:T3 j k ou 1- Clothes washer
Address: 1, Dishwasher
i 7 v lJ>i'r. -- �L T Drinking fountain(s) •
City: fb�f Si StateOg_ I ZIP.0 72.2 Ejectors/sump
Phone: , 70 Fax: E -mail: Expansion tank
OWNER Fixture /sewer cap •
Name (print): p L t--;1* Floor drains /floor sinks/hub
Mailing address: 1.77 00 5‘,„,) f fit - _ Hose bibb
disposal
Hose bibb
City: (J, 4_ I State: C3A_ ZIP: Ice maker •
Phone: I 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) .3 '
Owner's signature: Date: Sump
ENGINEER : - Tubs /shower /shower pan
Urinal
Name: tkI<AD I Dt0 /6/4 Water closet 4
Address: 1 ( 8 3,3 Kt -le.... Pax_ t, Al Water heater
City: ( ice a s-wet , I State012 - ZIP: 1703 Other: d
Phone: 2,4 etsz Z Fax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Minimum fee $ /09 3 7 . 3 35 5
Li Visa ❑ MasterCard expires if a permit is not obtained Plan review (at %) $ 3 7 �� , F6---‘ Credit card number: / / within 180 days after it has been State surcharge (8 %) $ ?O
Expires TOTAL $ / q '
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4616. (6/00 /COM)
-XIC_ ff//S
,.,
' PLUMBING PERMIT FEES:
- TOTAL '':New'-te:OcII4OlniIYAWelliiii*Ofify,;,, ., - .,
F, IXT,U11 Ea ",.(i rid i 4 i Ci u a I) -::-.-:::: ":- -,: ' (ea) '' , AMOUNT ',1(i4100411 plumbing tixlyr64In .- ' ;4 'ORME , : TOTAL ,
Sink / 16.60 p, GO ..101ei1■011199 firstIOOtt.:' - ;;C/Ty: , :(ea) ,... Ai■ibijkt,;
- lor?eiCh utility connection) ' - ', , ' - '; , , i: "' : : - :' ;'
Lavatory - 16.60 ; . 2.
_ 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 Y 16.60 q ci, I N
SUBTOTAL - -
Urinal / 16.60 /6 , (12.0 8% STATE SURCHARGE
Dishwasher / 16.60 f 6 a 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
- 3" 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
/ AO • 19 ° ,
FiZtureT00:-• - ;• . :New ': Moved m
, Replaced ,Reove0/
permit. - »• . • , : , , . : , 44 ' „'' ''' : '''.. ' '"- ' .t -- c apped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 - Lavatory
- Tub or Tub/Shower
Hose Bibs 16.60 - Combination
Roof Drains 16.60 Shower Only
-
Drinking Fountain 16.60 Water Closet
•
Other Fixtures (Specify) 16.60 - Urinal ,
. Dishwasher
_
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)
Storm & Rain Drain - 1st 100' • 55.00
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 f ;
Quantity Total is >9 ., ,, ,
- *SUBTOTAL ,•': '- j yy 0
8% STATE SURCHARGE ;; ' .. .:,,**p - ; .2.S::
**PLAN REVIEW 25% OF SUBTOTAL *:'*"' ' * , •• =•-- ` 7 3 •
Required only if fixture qty. total is > 9
TOTAL '::',,:- i ,,,,' , . '
. :. ,,.
* 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.
. .
i:\dstsVorms\plm-fees.doc 10/10/00
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
j � l I�7 '70 BUD
`/�`/ / Dat c � e � R " equested , • I / AM PM BLD
Location / 5 p !0 `j e) 7 ' 77 ‘ Suite /( MEC
Contact Person Ph c7 6 7 PLM r ���� 2 2/3
Contractor Ph SWR
BUILDING - Tenant/Owner ELC
Retaining Wall ELR
Footing •
Foundation Access: 7°� FPS
Ftg Drain 7)4r k vac 7
Crawl Drain Inspection Notes: SGN
Slab SIT
Post & Beam
Ext Sheath /Shear _
Int Sheath /Shear
Framing
Insulation
,Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
- PAS PART FAIL
M IN
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
! 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
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 / / �, / _a °�
Approach /Sidewalk Date 1 / — 7 7 Ins 1 ! / - ��"r� cw -f- Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.