Permit C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2000 -00410
I11 DEVELOPMENT H BMENg SO R 9 2 639 -4171 DATE ISSUED: 11/30/00
SITE ADDRESS: 06825 SW SANDBURG ST PARCEL: 2S101DD -00400
SUBDIVISION: SALEM FREEWAY SUBDIVISION ZONING: C -P
BLOCK: LOT: 001 JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: 5 TRAPS:
STORIES: WATER HEATERS: 2 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: 2 GREASE TRAPS:
LAVATORIES: 8 OTHER FIXTURES: 11
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: 10 WATER LINE: 250 ft
DISHWASHERS: 1 RAIN DRAIN: 100 ft •
Remarks: This permit is for both site utilites and building plumbing. Other fixtures are: 4 roof drains, 1 drinking fountain, 1
sump, and 5 primers.
FEES
Owner:
Type By Date Amount Receipt
TOC MANAGEMENT SERVICES PRMT CTR 11/30/00 $938.40 27200000000
6825 SW SANDBURG STREET PLCK CTR 11/30/00 $234.60 27200000000
TIGARD, OR 97223 5PCT CTR 11/30/00 $75.08 27200000000
Phone 1: 620 -1710 Total $1,248.08
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 REQUIRED INSPECTIONS
Phone 1: 503 - 639 -5296 Sewer Inspection
2439 Water Service Insp
Reg #: LIC 24
PLM 24 9P6 Underfloor /Underslab
Top -out Insp
Storm Drain Insp
Rain Drain Insp
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 ob ' .pies of these rules or direct questions to OUNC by calling (503) 246 -1.87.
Issued By _ / � • � � je.4' ' Permittee Signatur= . , ���� /_
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
/ / -( -0 4 w /,e
Plumbing Permit Application
Datereceived: / / /.17) Permit no.: A.,-/,,?two - 00 `l /D
4 "` 0 "' - '" ) " Ci of Tigard and oopa
' 1 1 `J Sewer permit no.: a _ Building permit no.:
.44. Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl.no.: Expire date:
Fax: (503) 598 -1960 6 Li-Pa� - 0 3 G Date issued: By: Receipt no.:
Land use approval: ' 24 - DOD / Case file no.
-5-72 Payment type:
TYPE OF:-PERMIT "-
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi - family 0 Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job addressl 5 J Al5V. , Descri , tion Oa Fee(ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
Tax map /tax lot account no.: (includes 100 ft. for each utility connection)
SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: , // - / _ SFR (3) bath _
City /county: ZIP: Each additional bath/kitchen
Des ri,[2Lion and la tion of work on premises: `�� i� :. ite utilities:
,� ,, 7 7J ` . ch basin/area drain
Est. date of completion/inspection: Drywells/leach line trench drain
PLUMBING CONTRA'TOR Footing drain (no. lin. ft.)
� L �
' Manufactured Manholes home utilities
T � _ _ - � i. Manholes MI
Address: � <<Z�jZ�7 ��4' Rain drain connector _
�!7 -- State i` i Z k .,4 Sanitary sewer (no. lin. ft.) j
Phone• ,Z,f �/ • r - 7 ! -mail: 6 30 (p ( Storm sewer (no. lin. ft.) WA
: no.: __ Plumb. bus. reg. no:��� ater service (no. lin. ft.) M74
City /metro lic. no.: / /' / / , Fixture or item:
Contractor's representative sign. ture: Z �iI''j .� f�Ii Eck flow pre enter
I
' mil .„,, :' .. Backwater valve
CONTACT PERSON ; Basins/lavatory r��
i
� �^
Name: y /._ _`� _
,r Clothes washer Dishwasher ✓✓ M IM
Address: `,;, „/
Drinking fountain(s) v
City: State: ZIP: Ejectors/sump
II
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Name (print): �� e. Floor drains/floor sinks/hub ✓
Mailing address: Garbage disposal V V
Hose bibb
City: I State: I ZIP: Ice maker
Phone: Fax: 1 E -mail: Interceptor /grease trap , ,
Owner installation/residential maintenance only: The actual installation Primer(s) 14P ✓
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) 1/ t/
Owner's signature: Date: Sump d/
ENGINEER Tubs/shower /shower pan _
— Urinal ✓17 V
Water closet
Address: ” /'/ ! A 6 Water heater , t/1/ �/,
City: 4 . .11.13 %�`4 ZIP. �' Other:
Phone _i ax: E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at — %) $
0 Visa 0 MasterCard expires if a permit is not obtained
Credit card number: / ! State surcharge (8 %) .... $
Expires within 180 days after it has been
TOTAL $
Name of cardholder as shown on credit card
accepted as complete.
Cardholder signature Amount 440-4616 (6/00 /COM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink ,- i 16.60 lki the dwelling and the first100 ft. QTY (ea) AMOUNT
Lavatory 16.60 `32 for each utility connection
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 ✓ /19 16.60 Hp& , OU SUBTOTAL
Urinal J • Z,, 16.60 A 4,90 8% STATE SURCHARGE
Dishwasher ✓ / 16.60 '&40 PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal / 16.60 !b 04 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain /Floor Sink 2" V i 16 igP
3" 16.60 PLEASE COMPLETE:
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical JJ� Fixture Type: New Moved Replaced Removed/
,/ J
permit. Capped
MFG Home New Water Service 46.40 Sink /
MFG Home New San/Storm Sewer 46.40 , Lavatory 8
Tub or Tub /Shower
Hose Bibs 16 Combination
Roof Drains . I / 16.60 66,9D Shower Only
Drinking Fountain ✓ / 16.60 / G . G p Water Closet
y Urinal % 4.
Other Fixtures (Specify)
-.0 �/0 / / 16.60 /6 Dishwasher
Pkotiw..;,-..) ,., Q3oC Garbage Disposal /
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2"
Sewer - 1st 100' / 55.00 56," 3"
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' - 55.00 55 .& Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
(Specify
Storm & Rain Drain - 1st 100' / 55.00 k6 ,a
Storm & Rain Drain - each additional 100' g 2, 46.40 921. SO AO 0 ) 4 14.i? S
Commercial Back Flow Prevention Device 46.40 P140 /iii
Residential Backflow Prevention Device' 27.55 61�
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
Quantity Total is > 9
*SUBTOTAL ` ./6
8% STATE SURCHARGE �,
"PLAN REVIEW 25% OF SUBTOTAL AS9' GD
Required only if fixture qty. total is > 9
TOTAL $6) 7b �Dr ,
* 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.
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 4 I AM PM BLD
Location (OC&C; G 12 Suite MEC
Contact Person �`' / Ph PLM o?G 0/0 — 96
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling V \ I
Roof /,
Misc:
(\! 0
F'
FAIL
ost ';� / /
• er Slab i % ,
Top Out (�
el Pfe-/
■
Water Service
S• • -ry Sewer
■ . s
• • S • ART FAIL
ANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART. FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk D ate `%
Other ,(920 Inspector � ,� Ext
Final
PASS PART FAIL Eid NOT REMOVE this inspect. n record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date � AM PM BLD
�
Location �e‘ S� .ersi■tiai/ Suite MEC
Contact Person Ph PLM ld 't °',o4' /0
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall LR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspectio otes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing ✓,2 ?%A
Firewall f
Fire Sprinkler D' ■QS
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
C BI
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
&mi - ART FAIL
— 'ANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for rein pection RE: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk
Other D ate ` Ins p ector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION''
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST
/ BUP
Date Requested 3' 2 / AM PM BLD
Location 6r Z s 5ct/ d (' 7 /2.-e/ Suite MEC
Contact Person. Ph 63 $ PLM e /e/e/ V
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall Fire Sprinkler ��v I d �� �i �� !4. ,� S 7
Fire Alarm /
h » 6/t q / �
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
c
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
< PASS PART FAIL
ECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA 31-0//6/ Approach/Sidewalk
Other D nspecor It
O / Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
703) •
CITY OE- TIGARD BUILDING INSPECTION DIVISION ins
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP �►
Date Requested 3- 1 AM PM BLD
Location Jct./ .5t/6 Suite MEC
Contact Person Ph PLM 2■vo 4 C /f
Contractor • Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
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
Water Service
Sanitary Sewer
Rain Drains
Fina
ASS ART FAIL
AL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Date ( ' 7 ( Inspector ( a Ext
Final
1
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY Or TIOARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Line: 639-4 MST
BUP
Date Requested 2 ' AM RM BLD.
Location 6' (V) 5 4✓ See-el 6 Suite // MEC
Contact Person rj Ph 63i S L y y PLM - G u� D
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall e 6.
Fire Sprinkler
Fire Alarm
Ceiling /3a2 RU / a Ai 42 CAI id - c-
Roof O 4 _l ' 7 S 7 8Q // G'Q /� / �� ,
Misc: v
Final
PASS PART FAIL
UMBI CC /7 /2
P ost t Ream
Under Slab v�s�'7d f
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA r�
Approach/Sidewalk Date 272 t/ � Inspector / Ext
Other p
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
w s
CITY OF TIGARD BUILDING INSPECTION DIVISION MST •
r 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
/ Date Requested /2- - / AM PM BLD
, B L
Location ) 5-61, " C Suite MEC
Contact Person Ph &37—f?- G PLM 2.{.„00 - 00 I
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
` /,�_' ' ft
Firewall / IffIrteff
Fire Fire Sprinkler L
Fire Alarm
Susp'd Ceiling
Roof
Misc: � /_ LJ /. 1/A r �`�
Final
PAS PART FAIL - _ �� / �� / _ —
LUMBIN
Post & Beam
Under Slab
Top Out .Trat. --/
Water Service v �
/, l
Sanitary Sewer
Rain Drains
Fi
digf PART FAIL
CHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk I 1 �( ,inr) O ther Date l O' V� Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
I-