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Permit 1 CITY TIGARD PLUMBING PERMIT I4 DEVELOPMENT SERVICES PERMIT #: PLM2005 -00623 „ -.1 4 '�' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 11/10/2005 PARCEL: 2S 110 DC -02300 SITE ADDRESS: 11545 SW DURHAM RD B -6 ZONING: C -G SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT: JURISDICTION: TIG Project Description: TI with vacuum & air system for dental office. Medical Gas Value: $1,800 CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS: 1 OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 4 URINALS: GREASE TRAPS: LAVATORIES: 3 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 • WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES DURHAM /99 ASSOCIATES LTD PTNSH Description Date Amount BY CRIIMI MAE SERVICES LP ATTN: LOAN SERVICING [PLUMB] Permit Fee 11/10/200E $301.50 ROCKVILLE, MD 20852 [PLMPLN] Plan Review 11/10/200E $75.38 Phone : [TAX] 8% State Surcharl 11/10/200` $24.12 Total $401.00 Contractor: D P PLUMBING /DARREN T PLACEK 15825 NE SPRINGBROOK RD REQUIRED ITEMS AND REPORTS NEWBERG, OR 97132 Phone : 537 - 9492 Reg #: LIC 110612 PLM 36 -70PB 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 start- • in 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requ -s you to fo rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 0001 -0010 throu, h O A R 952 - 0001 -0100. You may obtain copies of these rules or irect questions to OUNC by cal i ng 50 - 246 -6699 • 140 ed 332 -2344. /_ Iss By'- / e a� Permittee Signature:) ( vn 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. //s 5 sw ou,oha,- a � . Building Fi ures Paa05 453 Plumbing Permit Application. , . - :, - _ . FOR OFFICE USE ONLY City of Tigard i u ic L t il V E® R eceived permit No.. 13125 SW Hall Blvd., Tigard, OR 97223 Date/By. y 6S (.1-1 .,i A* l '. 2005 Plan Review Phone: 503.639.4171 Fax: 503.598.1960N / /yr�,rm r . ;' tit /0)6(1-W Permit No.: 1,, 24- Hour Inspection Line: 503.639.4175 l � " Date/ ��I �U Jv�T+� r � Date Ready/By: / ® See Page 2 for Internet: www.ci.tigard.or.us (ITY r1F 71(: � N n otified/M d:11M /, 5- - � (a, Supplementa In 11 ( izEm QRmnsio" , ' . V/r't �/ ft i�C % ((( FEE* SCHEDULE ❑ New construction ❑ Demolit / JC For special information use checklist Description I Qty. I Ea. I Total - TA ❑ Other: New 1 dwellings (includes 100 ft. for each utility connection) 'CATEGORY OF CONSTRUCTION - SFR (1) bath 249.20 El 1- and 2- family dwelling OA 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: 1/'/S" 5 w 1) 111 1 - ti.o... /" A-6 Catch basin or area drain 16.60 City /State /ZIP: i e J> QL.- 4' 7 may • Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: b L, I Project name: b2 IAN ,,, X 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: Lot no.: Water service (no. linear ft.: ) Page 2 Tax map /parcel no.: aj• l 0-De -0a...300 Fixture or item Absorption valve 16.60 DESCRIPTION •OF WORK Backflow preventer / Page 2 4& r , t(] f I Backwater valve 16.60 Clothes washer / 16.60 16 . Dishwasher 16.60 Drinking fountain 16.60 PROPERTY OWNER I ❑ TENANT - Ejectors/sump 16.60 Name` , I q 1 P, 1� ,, 0,/ i T r ! 1 ST Expansion tank 16.60 Address: 1 � i T� '� Fixture /sewer cap 16.60 City /State /ZIP: Floor drain /floor sink/hub / 16.60 Ii-, 626 • Phone: ( ) Fax: ( ) Garbage disposal 16.60 Hose bib 16.60 ❑ APPLICANT Igii CONTACT PERSON Ice maker 16.60 Business name: L) p p &)J,,,! t.H Interceptor /grease trap 16.60 Contact name: _9 gy p. -1 Medical gas (value: $ 'f ° Page 2 72,50 Address: Primer 16.60 City /State /ZIP: Roof drain (commercial) 16.60 Phone: Sink/basin/lavatory 7 16.60 deo, ( ) Fax::( ) Tub /shower /shower pan 16.60 E -mail: Urinal 16.60 CONTRACTOR _ Water closet 1 16.60 1 6240 • Business name: - b P 4 2,,„,, y , Q f 1 ,4) ( , Water heater I 16.60 (Q Address: /581,5 N i, Q 1,,, , Q, k, b Other: City /State /ZIP: �ati4) c2-. 4 713 Subtotal ` � . � l 2 Minimum permit fee: $72.50 Q Phone: (�..L.C_5l 7J, - 9,4 ei Fax: ( ) Residential backflow minimum permit fee: $36.25 Q030 !• CCB Lie.: /1 6 & ( `)-- Plumbing Lic. no.: 15.6 '70P15 Plan review (25% of permit fee) 75, 3 tr State surcharge (8% of permit fee) A / 9 Authorized signal L °�� �� "`•'« TOTAL PERMIT FEE "7/ /)/r )c Print name: /J 2 y � u Date: / o S This permit application expires if a permit is not obtained within r, /� 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. i:\ Building \Pennits\PLMF- PermitApp.doc 06/05 440-4616T(10 /02JCOM/WEB) 6 - -x >> Plumbing Permit Application - City of Tigard Page 2 - Supplemental Information • • Fee Schedule: 0 Residential Fire Suppression Systems: •.Sit Utilities • , -,Qty., ' Fee (ea)' Total = ' Square, Foota • e: ge: Permit Fee: „ " ,' Footing drain - 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 $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 , . Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee:. , $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 Back flow 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: Plan Review for Complex. Structures Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing please indicate work performed by fixture. Failure to system 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 of nine (9) or more new or relocated plumbing fixtures. Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whiripool providing services to human beings. Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service - Drive Thru facilities where new plumbing fixtures, including interceptors, Cuspidor/Water Aspirator are being installed for the food service area. Dishwasher - Commercial El Any new residential building containing three (3) or more - Domestic dwelling units. Drinking Fountain ❑ Any NFPA 13 - multipurpose fire sprinkler system. Eye Wash 1 Floor Drain /sink - 2" 1 Submit 2 sets of plans with any of the above. -3" 4" , ` Car Wash Drain Isometric or Riser Diagram . Garbage - Domestic ❑ Isometric or riser diagram is required for new 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 Station Shower -Gang ■ -Stall Sink - Bar/Lavatory 3 • , ' - - - Bradley - Commercial 0 ' - Service y r Swimming Pool Filter -, . Washer - Clothes / *Note: If the fixture work under this permit results in an Water Extractor Water Closet - Toilet / . 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 \Permits\PLM- PermitApp.doc 07/06/05 ~'^ � CITY OF ��w n m n=�m TIGARD BUILDING DIVISION PERMIT #: PUN20O5,00623 13125 Hall Bkd.. Tigard, ORQ7223 DATE ISSUED: 11/10/2.005 Phone: (SD8) O39~4171 Inspection Requea�C24Hmj: (503) 639-4175 1 . : .14 «�-.. INSPECTION WORKSHEET FOR DATE: 1110/2086 TIME: 7:00AM PAGE: 62 SITE ADDRESS: 11545 SW DURHAM RD 8-6 CLASS OF WORK: . SUBDIVISION: \ML.LOWBROOK BUSINESS PARK LOT #: TYPE OF USE: PROJECT NAME: DR.VNLLC0X DESCRIPTION: TI with vacuum & air sy-tem ¶0' dental office. Medical Gas Value: $1.800 OWNER: QURNA1v1/99 ASSOCIATES LTD PTNSH. PHONE #: CONTRACTOR: DPPLUM[NWG/QARRENTPLACIDK PHONE #: 537-9492 Inspection Request Scheduled For: Date: 1/10/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 024661'01 505'888-0214 Y Corrections/Comments/Instructions: *S \ � �� � 1,6 �^ . ci „, € . ' r". / , • . . • Ti PARTIAL APPROVAL 111 CANCEL Ell NO ACCESS n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: 01 Oatg� / � /v Phonm #� (SO3\ 718' (/(P ` ' . CITY OF TIGARD 1 . ,__ BUILDING DIVISION PERMIT #: PLM200S-006?3 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/10/2006 Phone: (503) 639-4171 llit Inspection Requests (24 Hrs.): (503) 639-4175 A. - - - _ --. INSPECTION WORKSHEET FOR DATE: 1/6/2006 TIME: 7: amtvi PAGE: 20 SITE ADDRESS: 11645 SW DURHAM RD B - 6 CLASS OF WORK: SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT #: TYPE OF USE: PROJECT NAME: DR. WILLCOX DESCRIPTION: "Ii with vacuum & air system for dental office. Medical Gas Value: $1,800 OWNER: DURHAM/99 ASSOCIATES LTD PTNSH, PHONE #: CONTRACTOR: 0 P PLUME3ING/DARREN T PLACEK PHONE #: 637-3492 Inspection Request Scheduled For: Date: 116/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 024507-03 803.888-0214 N Corrections/Comments/Instructions: ..- . . dr, NW W _dliN / _ ...0....--- A i / ill tio' • 3 ( ', 5 I _filliM ''PoF.,'' A• . - ..,411 % illir — r r fl PASS fl PARTIAL APPROVAL El CANCEL El NO ACCESS 4 1■FAIL l] CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED Inspector: ii irl4" Date: I. ( g0 Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION - PERMIT #: PLM2005"00873 13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 11/10/2005 Phone: (50.3) 639-4171 Requests (24 Hrs.): (503) 639 -4175 :_.. INSPECTION WORKSHEET FOR DATE: 11/16/2005 TIME: 7 :03AM PAGE: 103 SITE ADDRESS: 11545 SW DURHAM RD Tr CLASS OF WORK: SUBDIVISION: W ILLOWNBROOK BUSINESS PARK LOT #: , TYPE OF USE: PROJECT NAME: (DR. W�ILLG' X J DESCRIPTION: I I with vacuum & air system for dental office. Medical Gas Value: $1,800 OWNER: DURHAM /99 ASSOCIATES LTD PTNSH, PHONE #: CONTRACTOR: D P PLUMBING /DARKEN T PLACEK PHONE #: 537 -9492 Inspection Request Scheduled For: Date: 11/16/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 021320 -01 503 -888 -0214 N • Corrections /Comments /Instructions: - PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS I FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: " _�� Date: r 7 Phone #: (503) 718- 1- CITY OF TIGARD BUILDING DIVISION ak. PERMIT #: PLM2006 -00823 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/10/2005 Phone: (503) 639= 4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 11/14/2005 TIME: 7 :12AM PAGE: 168 SITE ADDRESS: 11545 SW DURHAM RD B-6 CLASS OF WORK: SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT #: TYPE OF USE: PROJECT NAME: DR. W1LLCOX DESCRIPTION: TI with vacuum & air system for dental office. Medical Gas Value: $1,800 OWNER: DURHAM /99 ASSOCIATES LTD PTNSH, PHONE #: CONTRACTOR: D P PLUMBING /DARREN T PLACEK PHONE #: 537 -9492 Inspection Request Scheduled For: Date: 11/14/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 021042 -02 603.888 -0214 Y Corrections /Comments /Instructions: • OAri -At / I I PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS n FAIL In LL FOR INSPECTION n ADDITIONAL FEES ASSESSED I� � Inspector: )9472 Date: 1, I Phone #: (503) 718 CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2005-00623 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/10/2005 Phone: (503) 639-4171 / Nit Inspection Requests (24 Hrs.): (503) 639-4175 ■=10.• INSPECTION WORKSHEET FOR DATE: 11/14/2006 TIME: 7:12AM PAGE: 159 SITE ADDRESS: 11645 SW DURHAM RD B-6 CLASS OF WORK: SUBDIVISION: WILLOWBROOK BUSINESS PARK LOT #: TYPE OF USE: PROJECT NAME: DR. WILLCOX DESCRIPTION: TI with vacuum & air system for dental office. Medical Gas Value: $1,800 OWNER: DURHAM/99 ASSOCIATES LTD PTNSH, PHONE #: CONTRACTOR: D P PLUMBING/DARREN T PLACEK PHONE #: 537-9492 Inspection Request Scheduled For: Date: 11/14/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 315 Post/beam plumbing 021042-01 503-888-0214 Corrections/Comments/Instructions: fl PASS n PARTIAL APPROVAL El CANCEL NO ACCESS n FAIL 7 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED Inspector: Date: Phone #: (503) 718-