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Permit ~ CITY OF TIGARD PLUMBING PERMIT ���;� PERMIT #: PLM2003 -00066 DEVELOPMENT SERVICES DATE ISSUED: 2/28/03 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14945 SW SEQUOIA PKWY 110 PARCEL: 2S112AD -01000 SUBDIVISION: PACIFIC CORP. CENTER 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; 1 TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 2 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing fixtures. Move 1 floor drain, add 1 lay and 1 relocate, add 1 kitchen sink, add 1 water closet and relocate 1 water closet, add 1 water heater. FEES Owner: Description Date Amount PACIFIC REALTY ASSOCIATES 15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 2/28/03 $116.20 PORTLAND, OR 97224 [TAX] 8% State Tax 2/28/03 $9.30 Total $125.50 Phone : Contractor: DEAN WARREN PLUMBING 3111 SE 13TH PORTLAND, OR 97202 REQUIRED INSPECTIONS Rough -in Insp Phone : 236 - 4152 Top -out Insp Reg #: LIC 172 Final Inspection PLM 26 -83PB 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 • Issued By: f` �t _ i • L Permiftee Signature:, Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day Building Fixtures P.lumbin Jrmit Application . Received , FOR OFFICE USE ONLY // h� Plumbing.� _Wl Date/By : o( -6.310 Permit No. :1 ` a( - 09O66, Planning Approval ` Sewer City of Tigard Date/By: Permit No.: 13125 SW Hall Blvd. Plan Review Other Tigard, Oregon 97223 Date/By: Permit No.: Phone: 503- 639 -4171 Fax: 503 -598 -1960 6 � 'dl Post - Review Land Use BI' Internet: www.ci.tigard.or.us a :� II Date/By: Case No.: Contact Juris.: ® See Page 2 for uQ3 24 -hour Inspection Request: 503- 639 -4175 -' Name/Method: Supplemental Information. TYPE OF WORK FEE* SCHEDULE (for special information use checklist) ❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) J Total IA Addition/alteration /replacement ❑ Other: New 1- & 2- family dwellings CATEGORY OF CONSTRUCTION (includes 100 ft. for each utility connection) SFR (1) bath 249.20 ❑ 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 JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2 Job site address: 14q s -5-s,w, s( tjD P.K.W t Site Utilities Suite #: /16 Bld g. #: / Catch basin/area drain 16.60 Project Name: E� C� Drywell/leach line/trench drain 16.60 �i 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: Plug (-Me_ ( p I Lot #: Storm sewer (no. linear ft.) Page 2 Tax map/parcel #: I Water service (no. linear ft.) Page 2 Fixture or Item DESCRIPTION OF WORK Absorption valve 16.60 Backflow preventer Page 2 Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 -PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60 Name: Pot. A °(_ 'Retl i.,5 7 Expansion tank 16.60 Address: 1 S SA GEa1/4,e1i'1- ‘Nlq.0 f iit - Fixture /sewer cap 16.60 City /State /Zip: ?0 �„ �/� - q72 Floor disposal sink/hub l 16.60 Garbage ge dissposal 16.60 Phone: 6 Z 6 Y co Fax: 1p z �- 7 7 Hose bib 16.60 ❑ APPLICAN ❑ CONTACT PERSON Ice maker 16.60 Name: Interceptor /grease trap 16.60 Address: Medical gas - value: $ Page 2 City /State /Zip: Primer 16.60 Roof Roof drain (commercial) 16.60 Phone: I Fax: Sink/basin/lavatory 3 16.60 E -mail: Tub /shower /shower. pan 16.60 CONTRACTOR Urinal 16.60 Water closet 9 16.60 '- Business Name: Dg_ 4 W eLtrrF) fiv7 . , Water heater [ 16.60 Address: 3 1. L ( S .. F , ( 3 Other: n City /State /Zip: PBft� �. L t ci7d O 2 Other: ' `i• Subtotal $ [ I Lo .2D Phone: 2.3 6 ' ! 5'Z Fax: 2,3 6 / 7 7 3 Plumbing Permit Fe CCB Lic. #: 0 / 7 Z. Plumb. Lic. #: 2C B3 Minimum Permit Fee $72.50 $ Authorized / .. 3 Residential Backflow Minimum Fee $36.25 Signature: _ __� _ %. _ , • .te: -.47-o3 Plan Review (25% of Permit Fee) $ P At tL- Iv b State Surcharge (8% of Permit Fee) $ 9. 3o (Please print name) TOTAL PERMIT FEE $ /ca 5.5 l) 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. i :\Dsts\Perrnit Forms\PlmPermitApp.doc 01/03 Plumbing Permit Application - City of Tigard • Page 2 - Supplemental Information • • Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ea) Total Square Footage: 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 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 additional $100.00 or fraction thereof, to and Fixture or Item Qty. Fee (ea) Total 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 *. Quantity by (Fixture) Work Performed Comments regarding fixture work: Fixture Type: Replace New Moved Existing Capped 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" / -3" -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 -f'/ , - Bradley - Commercial - Service Swimming Pool Filter Washer - Clothes Water Extractor • Water Closet - Toilet 7 r Utinal Other Fixtures: Vbsif,p //t i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03 Accumulative Sewer Tally Tenant Name: Spec Space This SWR# NA Address: 14945 SW Sequoia Pkwy. Ste. 110 This PLM# 2003 -00066 Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count off #s count # value #s values Baptisery/Font 4 0 0 0 0 0 Bath - Tub /Shower 4 0 0 0 0 0 - Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash - Each Stall 6 0 0 0 0 0 - Drive through 16 0 0 0 0 0 Cuspidor/Water Aspirator 1 0 0 0 0 0 Dishwasher - Commercial 4 0 0 0 0 0 - Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 0 0 0 0 0 Floor Drain/Sink - 2 inch 2 0 1 2 1 2 0 0 - 3 inch 5 0 0 0 0 0 - 4 inch 6 0 0 0 0 0 - Car Wash D 6 0 0 0 0 0 Garbage Disposal - Domestic (to 3/4 HP) 16 0 0 0 0 0 - Commercial (to 5 HP) 32 0 0 0 0 0 - Industrial (over 5 HP) 48 0 0 0 0 0 Ice Machine /Refrigerator Drain 1 0 0 0 0 0 Oil Sep (Gas Station) 6 0 0 0 0 0 Rec. Vehicle Dump station 16 0 0 0 0 0 Shower - Gang (per head) 1 0 0 0 0 0 - Stall 2 0 0 0 0 0 Sink - Bar /Lavatory 2 0 0 1 2 1 2 - Bradley 5 0 0 0 0 0 - Commercial 3 0 0 1 3 1 3 - Service 3 0 0 0 0 0 Swimming Pool Filter 1 0 0 0 0 0 Washer - Clothes 6 0 0 0 0 0 Water Extractor 6 0 0 0 0 0 Water Closet - Toilet 6 0 0 1 6 1 6 Urinal 6 0 0 0 0 0 Previous EDU Count 7.2 • 115.2 115.2 Capped EDU Credit 0 TOTALS 0 115.2 1 2 4 13 3 126.2 Current Fixture Value 126.2 divided by 16 = 7.9 Current EDU 1 EDU = $2,300.00 Previous Fixture Value 115.2 divided by 16 = 7.2 Previous EDU Change 11 divided by 16 = 0.7 over (under) $ 1,610.00 Enter EDU Change Here 0.7 HISTORY Gk 'r Aol, 7 ( *Lsp,_Em+ - t - 4 .1 CP rfl .8 Credit brought forward + .7 PLM# EDU# SWR# added, = current credit of .1 PLM# EDU# SWR# PLM# EDU# SWR# Name: . , __,!.__,,,, Ai% ,� Date: a - a. 7 — 6 Signature of person that calculated this tally sheet and date perfromed is required CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP' Received D Date Requested f f AM PM BUP Location / 4 q LI. i Suite �l O MEC Contact Person / Ph ( ) Z �� – 4 / t / Sag PLM — d v d 6 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation ELC Access: 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 i PASS PART FAIL PLUMBING • Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan O • - r: RT FAIL ICAL 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 0 Please call for reinspection RE: Unable to inspect — no access Fire Supply Line ADA � Approach/Sidewalk Date " 7/ ) Inspector / �1 Ext Other: Final DO NOT REMOVE this inspection record from the Job site. PASS PART FAIL