Permit ,r 1.,.
CITY TIGARD PLUMBING PERMIT
1I DEVELOPMENT SERVICES PERMIT #: PLM2001 -00167
n � J � I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/23/01
SITE ADDRESS: 07257 SW KABLE LN 300 PARCEL: 2S112DB-00300
SUBDIVISION: SOUTHERN PACIFIC TIGARD IND. ZONING: I -L
BLOCK: LOT: 005 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: 2 GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 7 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Tenant Improvement
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT CTR 4/23/01 $298.80 27200100000
15350 SW SEQUOIA PKWY #300 -WMI 5PCT CTR 4/23/01 $23.84 27200100000
PORTLAND, OR 97224
Total $322.64
Phone 1:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 236 -4152 Rough -in Insp
Top -out Insp
Reg #: LIC 172
PLM 26 -83PB 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 OAR 952- 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: /� Permittee Signature: c°4-
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
I
Y,
`?' A Plumbing Permit Application
Date received: 4123— D f Permit no. �
li
a / -40 /(
ilii a City of Tigard and
`•� 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) 598 - 1960 Date issued: By: Receipt no.:
Land use approval: Case file no.: Payment type: .
• TYPE OF PERMIT - '
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
Cl New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: 7257 S ) k t.4. /--/Wt-: Description Qty. Fee(ea.) Total
New 1- and 2-family dwellings only:
Bldg. no.: I Suite no.:
ii ft. for each utility connection)
Tax map /tax lot/account no.: bath
Lot: (Block: ISubdivision: bath
Project name: 7 N h o r (ixt6 -del bath
II
City /county: 7 Q,o 1 I ZIP: q 72,2_4‘ Each additional bath/kitchen
Description and location of work on premises: Site utilities:
Catch I.
Est. date of completion/inspection: drain
Footing •
PLUMBING CONTRACTOR
• Manufactured home utilities I=
Business name: 77E4- t/ , +j'r 'c, { Manholes = =
Address: 3/// .3S /3 �-tc drain connector I _ _ _
City: ,Pp -7•-y p I State: 4 ZIP:97ZG •
Phone: ,236.44. i 5' Fax:.2, d 7731E-mail: F
O
CCB no.: Oa/ 7 2 Plumb. bus. reg. no: •_ -$3
City /metro lic. no.: /9
Absorption valve
Contractor's representative signature:
Print name: '�. , '' Date: 23-01 CONTAT PERSON Name: _ Address: City: I State: I ZIP: Phone: Fax: E -mail:
OWNER Fixture/sewer cap
Name (print): a.e__i le.._ / P,9i6 Here_` -- Floor drains/floor disposal
III
Mailing address:
City: .Pcsa77- R I State.GD, jZIP: 9 7 / Ice maker
Phone: (003 - S q 2./ I Fax: 1E-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) (
Owner's signature: Date: Sump
ENGINEER Tubs /shower /shower pan
Urinal Z
Name:
Water closet 7
Address: Water heater /
City: I State: ZIP: Other:
Phone: Fax:- E -mail: • Total 1S
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application at — %
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at $
Credit card number: / / within 180 days afterit has been State surcharge (8 %) .... $
Expires TOTAL $
-
Name of cardholder as shown on credit card accepted as Complete.
$
Cardholder signature Amount 440 -4616, (6/OO /COM)
PLUMBING PERMIT FEES:
--/-,-.,,,,,.- ,PPRICE5Tf. ,Ni T 974 Lq: ' 6 l ;:dift12 if a iii 11j I i rid ig cif i V: ';:' . ''.. ..; .0
FIXTURES 7,s7::-1::.7,7 '."0 't.Z.'(ga)g., tAticitAlt. C'(includes Air pi ,, -,-,-,.-- -',,, - ',,oilict -, ,,,,,' - 7.!'kt(), - 7114
Sink 2_ 1660 --3 i tiii*Weitjnivanti.16e'fir4100,t. : :ar( . ,,:(0-0) -,,, -*wow-.
Joi.:e tlfiediiiii) %,„i „ . :2,:
Lavatory
114 16.60 46t 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 7 16.60 //h
SUBTOTAL -, -- :' ,3:
Urinal - 16.60 3 3,...0 8% STATE SURCHARGE "--,:' ..-:-,
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray 16.60 •
Washing Machine 16.60
Floor Drain/Floor Sink 2' I 16.60
f .--..--
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 ' . ..--4-, ,•,. ,,, ant ty byWq k Ferro d
Gas piping requires a separate mechanical
/ i‘,46j)L Eixit.ire,TYke:i4 . ':-2 i"'NeVii!`': - '.,'Relileded';, :,,Remiived/
permit. :., „. ,.:.: - - .,-,.,. ,,-, ;.:',. '-z,-.;,, - • :. 1... 'Capped.:
MFG Home New Water Service 46.40 Sink /
MFG Home New San/Storm Sewer 46.40 Lavatory 2, 2.
Tub or Tub/Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain / 16.60 /4,,,it- Water Closet ,
/
Urinal /
Other Fixtures (Specify) 16.60
Dishwasher
Garbage Disposal
Laundry Room-Tray
Washing Machine •
Floor Drain/Sink: 2" 1.
Sewer - 1st 100' 55.00 3" ,
Sewer - each additional 100' 46.40 •c
Water Service - 1st 100' 55.00 Water Heater /
Other Fixtures
Water Service - each additional 200' 46.40 (Specify)
Storm & Rain Drain - 1st 100' 55.00 13-
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 4_92'-:z:-',
Quantity Total is > 9 ,: :„. = _ , ' ;,. :',--•;,,''
*SUBTOTAL L-
8%
8% STATE SURCHARGE :•." ' '',',:i '''.'`7-A-
**PLAN REVIEW 25% OF SUBTOTAL ,:.;;.,',
- Required only if fixture qty. total is > 9 ;.„ :': : ?;;;:,,,,,,"fil3., - _
TOTAL
* 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:\dsts\forms\plm-fees.doc 10/10/00 .
� Accumulative Sewer Tally
Tenant Name: � /t7Z . to -� This SWR#
Address'] a 57 6 e. 161 - This PLM #: 11-"n a oQ e- C)O /677
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1 I 1)
Eye Wash 1
Floor Drain /sink - 2 inch 2 1
- 3 inch 5
- 4 inch 6
•
- Car Wash Drn 6
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) _ 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
. Rec. Vehicle Dump Station 16
' Shower - Gang (Per Head) 1 .
- Stall 2 '�j(
Sink - Bar /Lavatory 2 _ 1 - .
- Bradley 5
- Commercial 3 I , 3 !' 2
•
•
- Service 3
Swimming Pool Filter 1 ,
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6
Urinal 6
TOTALS ��
Total fixture values: 1 k divided by 16 = 7 EDU e - a (j/Li-- (-"I L / 0 6t
HISTORY g f 7,- `, 1, ; a---,A e''/2 5 r/ -C , - 401 1 ) I I
PLM# EDU# SWR# PLM# EDU# SWR#
_ PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# • SWR# PLM# EDU# SWR#
i:Wsts\swrtaly.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639- 1
BUP
Date Requested �� 2 AM PM BLD
Location 7 t 5 7 5 f t -v4, Suite �G MEC
Contact Person Ph Z cil PLM O -o/ 00/a 7
Contractor Ph SWR
BUILDING' Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
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
PASS PART FAIL
Post & Beam
Under Slab
Top Out 9 ...-
Water Service
Sanitary Sewer
Rain Drains
ASS PART FAIL
'IC L
Post & Beam
Rough In
Gas Line -
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL`> ...1'., a a
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm _
Final
PASS PART FAIL
Backfill /Grading
Sanitary Sewer •
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay atCity Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA l /
Otheoach /Sidewalk Date 7._ ® Inspector' / (�e �"� Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.