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Permit CITY OF TIGARD PLUMBING PERMIT ' AA& DEVELOPMENT SERVICES PERMIT #: PLM2004 -00231 M 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/24/2004 SITE ADDRESS: 07204 SW DURHAM RD Q300 PARCEL: 2S113AC -00103 SUBDIVISION: PACTRUST 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: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 4 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Resetting (4) water closets. FEES Owner: Description Date Amount PACIFIC REALTY ASSOCIATES 15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 5/24/2004 $72.50 PORTLAND, OR 97224 [TAX] 8% State Surcharp 5/24/2004 $5.80 Total $78.30 Phone : Contractor: DEAN WARREN PLUMBING & REMODEL PO BOX 14701 PORTLAND, OR 97293 REQUIRED INSPECTIONS Phone : 503 Rough -in Insp Top -out Insp Reg #: LIC 154919 Final Inspection PLM 26 -736PB 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 -0011- -049.. You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -%.99. Issue. By: � ' k Permittee Signature:, Call (503) 639 -4175 by 7:00 P.M. for an inspection needed next business day Building Fixtures Plumbing Permit Application FOR OFFICE USE ONLY �N R ece i ve d � Plumbing P :, 6 � ft/ -� a3r Date /By: (! T e l Permit No.: City of Tigard D an / y App oval Sewer Date/By: Permit No.: p444. 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use 1 � Internet: www.ci.tigard.or.us �.I I i II' Date/By: Contact act Case No.: J ® See Page 2 for 24 -hour Inspection Request: 503- 639 -4175 Name /Method:Q Supplemental Information. ,F2' �ZIS m r '° . _ _ ` ata 'MtFEE *:SCHEDULE foss e' c it informati6ia, 8' checklist) , . ; :.������:�, � 2��a.�_•.:T�YP�E.OF, WORK: .��..t_ � ..�.,K.�� .� P Description Qty. Fee(e Ell New construction Demolition P I I I Total ❑ Addition/alteration/replacement ❑ Other: � : New i4 :& 2 fauiii dwellings ' i r� s �. �.�.� a-= �, �„ >� -°mss. � � �.� s � .,� a °� �� _ � � �., �+ ��„ ��?( m cludesJ100gft: foreach ;utd�ty,�connecYion)���a_,�,: ,t , i CATEGORY cif CQNSTRU 01$1. _4 1 ;,` SFR (1) bath 249.20 0 1 & 2- Family dwelling ❑ Commercial /Industrial SFR (2) bath 350.00 ['Accessory Building ❑ Multi- Family SFR (3) bath 399.00 ❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00 w' :V;MVt SITE IN'FORMATIONva'idl LOCATION T ;f. a Fire sprinkler sq. ft.: Page 2 Job site address: - I k S 4 i 64- /l'et 3kSk333331'AINF3t3f3Sff Srte [Itiitttes'y, " A34343mmicv103 Suite #: rBldg Apt. #: Q 500 Catch basin/area drain 16.60 Project Name: ti a,'" line /trench drain 16.60 Pro C �c`L'"� C h/ f Footing drain (no. linear ft.) . Page 2 Cross street/Directions to job site: Manufactured home utilities 110.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.) Page 2 Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2 Water service (no. linear ft.) Page 2 Tax ma /parcel #: ; rk ::•=< :<. a •:� 51Tf eats y •:z p I e g 3 343 I ESCRhPT OIKOF, W .: ,. � - �� �. �. �- �cht or t m �• ,.�., � _ C�z- k 0 �'' ��..,- w Absorption valve 16.60 L( e Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 _ _ :.. i D TENANTu • ilk 4, :' �[]�PROP�ERT�Y ® ��„ � � � Ejectors /sump 16.60 Name: ,v pr' Expansion tank • 16.60 Address: / j 3 A 5 -f./ sei c.ova lJ cc-ay Fixture /sewer cap 16.60 City /State /Zip: /J,,, (,s2,, 9 7 yyy Floor drain/floor sink/hub 16.60 Garbage disposal 16.60 Phone: ‘2.16--63,7,.Q., Fax: Hose bib 16.60 FhttPLIeOr ? , 3333k3 3 ; CONTrOFPERSO1∎033;` s Ice maker 16.60 Name: 0.4a,t.- ta.;A,wyv,v %j d- .2.0,,+ Interceptor /grease trap 16.60 Address: P. 6 /34, GY let Medical gas - value: $ Page 2 /State /Zi ©n.- '7 W Primer 16.60 • Cit y F •/° Roof drain (commercial) 16.60 Phone: Lill-- qi Sly Fax: ,-/C-- zu i Sink/basin/lavatory 16.60 E -mail: Tub /shower /shower pan 16.60 `w , � .,, , ' 0 CONTRACT %OQR °. :.v - ;�r Urinal 16.60 _ Business Name: rD� -� b to , Water closet L ,R0 y 16.60 «. YG Water heater 16.60 Address: Other: City /State /Zip: Other: Phone: Fax: n ' ifiN : Vlitiiia gzPermtt FekM ,, t : _ t CCB Lic. #: / 51/ '3 / 1 • Plumb. Lic. #: Z6 3C .Po Subtotal $ 6c. Ka _ Minimum Permit Fee $72.50 $ .7a'5-(,) Authorized Residential Backflow Minimum Fee $36.25 Signature: �3 Date: 5"-'"eat Plan Review (25% of Permit Fee) $ ov A 4', State Surcharge (8% of Permit Fee) $ r 5 6e to (Please print name) TOTAL PERMIT FEE $ " ' ' 14 A Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or 180 days after it has been accepted as complete. riser diagram for plan review. *Fee methodology set by Tri -County Building Industry Service Board. is \Dsts\Permit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard . -Page 2 Supplemental Information. 1, ; Fee Schedule: Residential Fire Suppression Systems: Qty >� F lea) Totai S"uare Footage., PermitFee: �� t .SrteUt►hties,.� = ° °' � _ e _, q_. _ ... _ . _ - _, F., ... _.;`��. Footing drain - 100' 55.00 0 to 2,000 $115.00 - 4110111 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' t 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 V a lua tiO'n ,. ., °`Permit Itee: • 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 additional $100.00 or fraction thereof, to and _ rY 0.$ °� :F.ee (ea) Total R'40,7450-110101'0700i •�, ,;,•.: r , ,� � • 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 each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 $50,001.00 and up _ $742.00 for the first $50,000.00 and $1.20 for Subtotal: 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 *. Comments regarding fixture work: �,�� �. � � � _ �Quatttrtyby(Frxturej Work Performed= g g Fixt ie TYpe r f -Replace s .:; 1 ..- iV :KAU ., ..;:Newt ,`z Moved . vE ishug .Gapped .E Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor /Water Aspirator Dishwasher - Commercial - Domestic Drinking Fountain Eye Wash Floor Drain/sink - 2" 4 • Car Wash Drain *Note: If the fixture work under this permit results in an Garbage - Domestic Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and - Industrial fees assessed for the sewer increase must be paid before the Ice Mach. /Refrig. Drains plumbing permit can be issued. Oil Separator (Gas Station) Rec. Vehicle Dump Station Shower -Gang -Stall Sink - Bar /Lavatory - Bradley - Commercial - Service Swinuning'Pool Filter Washer - Clothes . Water Extractor Water'Closet - Toilet • 'Urinal • • J` Other Fixtures: _ • i:\Dsts\Permit Forms\P1mPermitAppPg2.doc 01/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested AM PM BUP Location ao j�wL.�t- f- -1',t. Suite C 300 MEC Contact Person - Ph ( ) / )S0 PLM (9 Contractor Ph ( ) SWR • BUILDING Tenant/Owner ELC Footing Foundation Access: ELC 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 Susp'd 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: *ASS PART FAIL - _r 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 reins•ection RE: ❑ Unable to inspect - no access Fire Supply Line ADA - - Approach /Sidewalk Date - Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL