Permit CITY TIGARD PLUMBING PERMIT
1 DEVELOPMENT SERVICES PERMIT #: PLM2003 - 00557
c��� DATE ISSUED: 10/27/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10575 SW CASCADE AVE 120 PARCEL: 1 S135BB 00501
SUBDIVISION: ZONING: I -
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: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 1 GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing tenant improvement, demo (4) fixtures.
FEES
Owner:
Description Date Amount
AMB PROPERTY L P
BY TRAMELL CROW NW INC [PLUMB] Permit Fee 10/27/03 $72.50
8930 SW GEMINI DR [TAX] 8% State 10/27/03 $5.80
BEAVERTON, OR 97008 Total $78.30
Phone :
Contractor:
MCKINSTRY CO
5400 NE COLUMBIA BLVD
PORTLAND, OR 97218
REQUIRED INSPECTIONS
Insp existing /capped fixtures
Phone : 331 - 0234 Final Inspection
Reg #: LIC 40981
PLM 37 -22PB
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: 4_ /i i� Permittee Signature: ( i
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed t e next business day
OCT -22 -2003 14 46 MCKINSTRI' CO 503 331 6906 P.04
Plumbing Permit Application ( )Ili( I. is-4. (
Date received: /e/%27 d 3 Permit no.: / -i .55
-�r', Cit�yof Tigard
=1 2- Sewer permit no.: Building permit no.:
Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl. no,: Expire date:
Fax: (503) 595 -1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type:
11 I'I ()I 1'I :i0111
❑ 1 & 2 family dwelling or accessory 0 Commercial /industrial ❑ Multi- family ❑ Tenant improvement
0 New construction giAdditionirdt eretio - , lacement ❑ Food service 0 Other:
.(Olt Silt. iN i OIZ.I. I ION El' It S('ll lt.l)1 I,I'. (fur special inloru u,e chi rl.li,t )
Job address: /05 75 6 � 1.k5 De ad—VP Description Qty. Fee(ea.) Total
Bldg. no.: / I Suite no.: SO ( TE New 1- and 2-family dwellings only:
Tax map/tax lot/account no.: /S/3�/3 00 (oo (includes 100 I L for each minty connection)
SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: C.-RSC r AVE' a LP(' SFR (3) bath
C county: Ti '"6 Ake!) I ZIP: Each additional bath/kitchen
Description and location of work on premises. Oehtb,P.e.tic2Jtlyb s IPAA 1 Siteutilities:
bs4eini .() tt v �.S
� — 111/57 W/t -ro r in «Tc Catch basin/area drain
t. date of completion/inspection: IT) LfW S 41/US / _ , _ _ ells/leach line /trench drain
1'1.1 111{1 \(: ((),\ I It \( ff)It Footing drain (no. lin. ft.)
Business name: NI ocINS�.y co. Manufactured home utilities
Manho es
--AT-dre n-ico Ne cbc-um dl A $3,1-Vb Rain drain connector
City: Pciout_A- U la State: QP_ I ZIP: 97 2.) 8 Sanitary sewer (no. lin. ft.) -
Phone! 6a3.33/.043 Fax: 3 1 -voce I E -mail: S sewer (no. lin. ft,)
CCB no.: ►-l( e I I Plumb. bus. reg. no: #37 -2Z pg Water service (no. lin- ft.) M
City /metro lic. no.: I ( 7 9 Fixture or item:
Contractor's representative signature: - Absorption valve
�
` Back flow preventer
Print name: _N v Date: /0 - 03
Backwater valve
Basins/lavatory
Name: C,G/FAI ,42.ENv Clothes washer _
Address :54W ,f/E Cowmi fit gc_A Dishwasher
Drinking fountain(s)
City: j ,�T l n,(p) I Stete:Q,� ZIP: y Ejector — ,--.
Phone: 33 /. 023 Fax: 331.&90 E -mail; Expansion tank
Fixture /sewer cap
Name (print): 4yy/ /3 'pro }� e Tit .4 , F oor drains/floor sinks/hu
address; Garbage disposal
Mailing a / mmt?.\1 Crow Co . /( .26 S W asea sa ° . Hose bibb
City: - Seaver-4,r I State: one_ [ZIP: 9 700. _ Ice maker
phone: 64 -q 7 I Fax:5 6- 5'4'o6 I E - mail: Interceptor /grease mai
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 (corn
employee on the property I own as per ORS Chapter 447, Sink(s), basin(s , ays(s) , .
Owner's si ature: Date: Sum
Tubs/shower /shower pan —,_—
Name: Urinal
Name; : Water closet if
Water beater
City: State: I ZIP: Ocher: ny1QffinY7UP
Phone: I Fax: E -mail: Total
Not .0 jttt;,idict;oea accept credit cards please cell jurisdiction cot more intimation. Minimum fee $ '. O
Notice: This permit application Plea review (at _ %) S
O Vier O MasterCard expires if a permit is not obtained
Credit card monism: / J
State surcharge (8 %) .... $ 5. TO
tt
p ros within 180 days after it has been ,
demo of oudholder as .hewn on credit card accepted as complete. TOTAL S 7 ( J
S
Cmdholder signature Amount 410.4616 (6,00/COM)
Accumulative Sewer Tally
Tenant Name: Spec Space This SWR# /\)/
Site Address: 10575.SW Cascade Blvd: #;120 ' This PLM# 2003 -00557
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
•
- Jacuzzi/Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 • 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 • 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
-3inch 5 0 _ . 0 0 0 0
- 4 inch 6 0 0 0 0 0
- Car Wash Drr 6 0 : 0 - , 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 48 0 .... 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 : ` 0 0 0 0
Oil Sep (Gas Station) 6 0 • 0 0 0 0
' Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
Stall 2 0 0 a 0
Sink - Bar /Lavatory 2 0 2 4 0 -2 -4
- Bradley 5 0 0 " _ . 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0
0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor _ 6 0 0 0 0 0
Wa r Closet - Toilet 6 0 1: 6 0 -1 -6 •
Urinal 6 0 , : _9 6 0 -1 -6
1 Previous EDU Count 16 :6 • 265.6 265.6
Capped EDU Credit 0
TOTALS 0 265.6 4 16 0 0 -4 249.6
Current Fixture Value 249.6 divided by 16 = 15.6 Current EDU 1 EDU = $ 2,400
Previous Fixture Value 265.6 divided by 16 = 16.6 Previous EDU
Change -16 divided by 16 = -1.0 over (under) $ (2,400.00)
4 Enter EDU Change Here -1 �� � 1 t' /
HISTORY .J <
Notes: PLM# EDU# SWR#
Per Sheryl, 16.6 EDU's PLM# EDU# SWR#
C EDU# SWR#
N me: ,
■
rte � ' . g i Date: /o47/o3
Signature of person that calculated this tally sheet and date perfromed is required
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received C Date Requested / — � AM PM BUP
✓ -
Location / 7 s Suite la U MEC
Contact Person Ph ( l U 6) 25s - 3 6 7 3 PLM - a acT 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
ELC
Foundation
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 / J /' ti / %ar/
Fire Sprinkler _ —
Fire Alarm
Susp'd Ceiling
Roof
Other: r'
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
O l er:
( ► S PART FAIL
HANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date Inspector Ext
Other:
G'
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL