Permit .. , •1`
ibil, CITY OF T I GA R D BUILDING PERMIT
PERMIT #: BUP2006 -00465
" 1 11 '
�� DEVELOPMENT SERVICES DATE ISSUED: 9/27/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103DD - 01201
SITE ADDRESS: 13900 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Demo 20,000 sq. ft. commercial building on sewer. UPON FINAL DEMO CREDITS FOR SDC'S MAY
APPLY.
REISSUE: FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: DEM FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf PROJECT OPENINGS?
TYPE OF CONST: sf N: S: E: W:
OCCUPANCY GRP: TOTAL AREA: 0 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: ft GARAGE: sf OCCU SEP. RATED:
BSMT ?: MEZZ ?: REQD SETBACKS REQUIRED
FLOOR LOAD: psf LEFT: ft RGHT: ft FIR SPKL: SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE:
Owner: Contractor:
LCG PENCE LLC
2747 PENCE LOOP SE
SALEM, OR 97302 -8109
Phone: Contact #: PRI 503 - 399 - 7223
FEES Reg #: LIC 153167
Description Date Amount REQUIRED ITEMS AND REPORTS
[BUILD] Permit Fee 9/27/2006 $62.50
[TAX] 8% State Surcha 9/27/2006 $5.00
[ERPRMT] Erosion Con 9/27/2006 $26.00
[ERPLN] Erosn Pln Rv C 9/27/2006 $8.45
(additional fees not listed here)
Total $110.40
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the rules adopted by the
Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy
of these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1 -800- 332 -2344.
Issued By:"
y: 7 T , � Permittee Signature: _/4. 1=
ilb
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.
PI Perm><t DD ication rolz Orrlct: Hsi.: oNiN
Received ^ � 7 D / � I A �_7 / �t� � 7 U . J�
Cit of Tigard �ateBy y ( � „pmt, Permit N .. v `�Ov
to 13125 SW Hall Blvd., Tigard, OR 9722 plea Review
• ■ Phone: 503.639.4171 Fax: 503.598.1960 Date/By. Other Permit No.:
T I G A It a Inspection Line: 503.639.4175 Date Ready/By: x Juz 1 s: RI See Page 2 for
Internet: www.tigard - or.gov Notified/Method " ) 1( Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction Demolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement [Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
• CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
❑ 1- and 2-family dwelling 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: 139 6 S W P t c„,i C ki W y Catch basin or area drain 16.60
City /State/ZIP: " (.... L, D t 01g-• Drywell, leach line, or trench drain 16.60
Footing drain (no. linear ft.: _) Page 2
Suite/bldg./apt. no.: Project name: 41 :I 00 19W % (-L. Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
WI G L0 A ny. exc., c' t� tm ` Rain drain connector 16.60 •
q - / . ;�-L; iJ 8 LC Sanitary sewer (no. linear ft.: _J Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: l Lot no.: Water service (no. linear ft.: Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Back flow preventer Page 2
_ . 1 . .... ► • - .,� CP-- 1 T i O Backwater valve 16.60
14 V ` . ` t �. Clothes washer 16.60
11" � C T_ Dishwasher 16.60
J�,1 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
` Ejectors/sump 16.60 .
Nam Ann OW ILL 1r1 D . OF ' 1c. CALL) ✓f g _ ) ILL . Expansion tank 16.60
Address: loe. C n- _ Fixture/sewer cap 16.60
c
City / State/ZIP: ?er .„p ,...10 0 1 Z 14 Floor drain/floor sink/hub 16.60
Phone: (S13) 3 S VI Od Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60 •
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax: : ( ) Sink/basin/lavatory 16.60
I Tub /shower/shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: LG ( Pe r.1 Le. Go r s ST Lt. C Water heater 16.60 .
Address: 2:74 re f-1 ca. ( uP Other:
City /State/ZIP: c.. 6 2 ci-� 3 b Z
Subtotal
- r Minimum permit fee: $72.50
Phone: (5) ?. , r . 2 . Fax: ( ) Residential backflow minimum permit fee: $36.25 _
CCB Lic.: 1s i t
Plumbing Lic. no.: _ Plan review (25% of permit fee)
t State surcharge (8% of permit fee)
Authorized signature: TOTAL PERMIT FEE
Print name: ?ND ` 5(,..4-10 ` Z I Date: ci 121 l I 6 c. This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:t Building \PmnitslPLMF- PamitApp.doc 04/06/06 410.4616T(IW02/COM/WEB)
//.' `YI'
Plumbing Permit Application - City of Tigard ,. _ 4 - ,
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) Total Square Footage: Permit Fee:
Footing drain - l 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
Valuation: Permit Fee:
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
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 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
Inspection of existing plumbing or each additional $100.00 or fraction thereof; to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof
. t , n 1' 1 t
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 Q .Any new commercial buildin .
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/Whirlpool providing services to human beings. .
Car Wash -Each Stall . Q • 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 ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain ❑ Any NFPA 13 - multipurpose fire sprinkler system..
Eye Wash
Floor Drain /sink - 2" 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 . .
- Bradley •
-Commercial
-Service . • • .
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor i of sewer EDUs, a sewer permit will be issued and
Water Closet - Toilet + Pe
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
•
i:\ Building \Pennite\PLIN- PmnitApp.doc 07/06/05
c
SDR2006 -00002
2S103DD -01201
13880
(existing)
(�
13920
SW MCD❑NALD STREET
NEW ADDRESS: 13920 SW PACIFIC HWY
RETIRE: 13900 SW PACIFIC HWY
• CITY OFYTIGARDART NOTE: Zip Code, is 97223
'i ENGINEERING DEPARTMENT
e '" . 13125 S.W. HALL BLVD.
TIGA TIGARD OREGON 87223
TAT x(503) 624 -0171
FAX:' (503) 624 -0752
• • CITY OF TIGARD
BUILDING DIVISION PERMIT #: BUP2006 -00465
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/27/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175 F_
INSPECTION WORKSHEET FOR DATE: 3121/2007 TIME: 7:02AM PAGE: 49
SITE ADDRESS: 13900 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: GOODWILL INDUSTRIES CENTER LOT #: TYPE OF USE:
PROJECT NAME: GOODWILL INDUSTRIES
DESCRIPTION: Demo 20,000 sq. ft. commercial building on sewer. UPON FINAL DEMO CREDITS FOR SDC'S
MAY APPLY.
OWNER: GOODWILL INDUSTRIES, PHONE #: 503
CONTRACTOR: LCG PENCE LLC PHONE #: 503 - 399 - 7223
Inspection Request Scheduled For: Date: 3/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
299 Final inspection 045140 -01 503-209-3586 N
Corrections /Comments /Instructions:
itilp r.
PASS /� PARTIAL APPROVAL El CANCEL 111 NO ACCESS
❑ FAIL / CALL FOR INSPECTION ❑ ADDITI NAL F ES ASSESSED
IOW
Inspector: _ Date: 3 z` 0 Phone #: (503) 718-
: !