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Permit
-� TIGARD CITY OF I �� PLUMBING PERMIT tri DEVELOPMENT SERVICES PERMIT #: PLM2003 -00035 I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/3/03 SITE ADDRESS: 14945 SW SEQUOIA PKWY 150 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: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft • DISHWASHERS: RAIN DRAIN: ft Remarks: D FEES Owner: Description Date Amount PACIFIC REALTY ASSOCIATES 15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 2/3/03 $72.50 PORTLAND, OR 97224 [TAX] 8% State Tax 2/3/03 $5.80 Total $78.30 Phone : Contractor: DEAN WARREN PLUMBING 3111 SE 13TH PORTLAND, OR 97202 REQUIRED INSPECTIONS Phone : 236 - 4152 Top -out Insp Insp existing /capped fixtures 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 B � Permittee Signature: - Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day 4 ' " Plumbing Permit Application � ,. Date received: ,Q , D3 Permit no.: ti-/9 3S City of Tigard ` Ai' ` g Sewer permit no.: Building permit no.: CiryofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 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: T'Y'PE OF PERMIT ❑ 1 & 2 family dwelling or accessory v Commercial/industrial ❑ Multi- family l'enant improvement ❑ New construction )4 Addition/alteration/replacement ❑ Food service ❑ Other: J011 SITE INFORMATION FEE SCIIEDULE (for special information use checklist) Job address: J41 9 y s S w S€ ,,,,,, l A . P k w V Description Qty. Fee (ea.) Total Bldg. no.: Suite no.: /s© New 1- and 2- family dwellings only: Tax ma /tax lot/account no.: (includes 100 ft. for each utility connection) p SFR (1) bath Lot: Block: I Subdivision: SFR (2) bath Project name: P t At, r/W PR 7)� SFR (3) bath City /county: T/ .A I ZIP: q 7 a a L+ Each additional bath/kitchen Descripti it and location of work on premises: -D ie. a Site utilities: R 0_ ea.:r RR �, ,1 -.5INIC_ Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain PLUl lBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: bEAy,/ /A ),44,4,1,„ pi46 Manholes Address: Z Li. S g tl 3 s- - Rain drain connector City: Po,e ri„a I Sta 14I ZIP:q -7A a Sanitary sewer (no. lin. ft.) Phone:a 34,— A ' Fax' 3b" 1 77 E-mail: Storm sewer (no. lin. ft.) CCB no.: Q 1 ? A I Plumb. bus. reg. no: a � g3 pe Water service (no. lin. ft.) 1 City/metro lic. no.: / Fixture or item: 1 9 9 /�� Absorption valve Contractor's representative signature: . ,6 "2 - Back flow preventer Print name: y , _ w Date: .0 D . Backwater valve • CONTACT PERSON Basins/lavatory Name: ° A -141.- _ .) A,Q,10 Clothes washer Dishwasher Address: Drinking fountain(s) City: I State: I ZIP: Ejectors/sump Phone: Fax: E -mail: Expansion tank OWNER Fixture/sewer cap ,_ Name (print): 6 A Floor drains/floor sinks/hub t,( S'� y'�eiT� 31,0 Garbage disposal Mailing address: / 5 TA StW St 451440 L4 P�ew Hose bibb City: �1�,4. I state a t I ZrP :9'7n. Li Ice maker Phone;b j .- & Fax: j -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) ? er / Owner's signature: Date: Sump Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: I State: I ZIP: Other: Phone: I Fax: I E -mail: ' Total 3 Minimum fee $ '7 a S� Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ T O r ' Credit card number: / / State surcharge (8%) .... $ Jr.!- Expires within 180 days after it has been TOTAL $ 7 8 33 _i Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440 -4616 (6r00/(.'OM) PLUMBING PERMIT FEES: Ar - � . PRICE TOTAL New 1 and 2- family dwellings only: • FIXTURES (Individual) QTY (ea) AMO& (includes all plumbing fixtures In PRICE - TOTAL Sink ./ 16.60 / 6 i the dwelling and the flrst100 ft. QTY (ea) AMOUN, Lavatory for each utility connection) 16 /b �O 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 4,0 I 16.60 16 .i SUBTOTAL Urinal 16.60 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 3" 16.60 PLEASE COMPLETE: 3" 16.60 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 Quantity bj Work Performed Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed/ permit. Capped MFG Home New Water Service 46.40 Sink / MFG Home New San/Storm Sewer 46.40 Lavatory I • Tub or Tub /Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 . Water Closet it 16.60 Urinal Other Fixtures (Specify) Dishwasher Garbage Disposal , Laundry Room Tray Washing Machine , Floor Drain /Sink: 2" Sewer -1st 100' 55.00 3" Sewer - each additional 100' 46.40 • 4" 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 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 Quantity Total is > 9 *SUBTOTAL 7 8% STATE SURCHARGE S i "PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL $ --7 p 3� *Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow O Prevention Device, which is $38.25 + 8% state surcharge. "All New Commercial Buildings require plans with Isometric or riser diagram and plan review. iAdsts\forms\plm- fees.doc 10/10/00 Accumulative Sewer Tally Tenant Name: Prudential NW Properties This SWR# N/A Site AddreSl;: 14945 SW Sequoia Pkwy #150 This PLM# 2003 -00035 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 0 0 0 0 - 3 inch 5 0 0 0 0 0 - 4 inch 6 0 0 0 0 0 - Car Wash Drr 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 1 2 - 0 -1 -2 • - Bradley 5 • 0 0 : 0 0 0 - Commercial 3 1 0 _ 0 0 0 0 - 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 1 6 0 -1 -6 Urinal 6 0 0 0 0 0 Previous EDU Count 7.7 123.2 123.2 Capped EDU Credit 0 TOTALS 0 123.2 2 8 0 0 -2 115.2 Current Fixture Value 115.2 divided by 16 = 7.2 Current EDU 1 EDU = $2,300.00 Previous Fixture Value 123.2 divided by 16 = 7.7 Previous EDU Change -8 divided by 16 = -0.5 over (under) $ (1,150.00) Enter EDU Change Her -0.5 Op T HISTORY (Arm- - ma • 5 etkrz r, - 1r AL. C ittb irS = • 8 Notes: PLM# 2002 -00052 EDU# 7.7 SWR# N/A PLM# Per Sheryl EDU# 8 SWR# ....---RI.V# EDU# SWR# ame: j� p e 0m44 Date: ;/ 31 L " ' is re uired Signature of person that calculated this tally sheet and date pedromed q CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST BUP Received Date Requested 3 13 AM PM BUP Location �� 1,4_44 et Suite /- MEC +� Contact Person e u— / � Ph ( ) .z 3 ( `7' tsO PLM 66 Cp Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing ELC Foundation 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 - - - C� 2 ,,/e* Other: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In ( Water Service Sanitary Sewer /�! / 1 ; / Rain Drains ,� . • , Catch Basin / Manhole Storm Drain Shower Pan Other: //J )1 6 4 = PARTO HANICA & 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: 0 Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date 3/0/ Inspector Ext Other: Final DO NOT REMOVE this inspection record from the job site. PASS PART FAIL