Permit CITY TIGARD PLUMBING PERMIT
1 DEVELOPMENT SERVICES PERMIT #: PLM2001 -00072
I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/13/01
SITE ADDRESS: 15055 SW SEQUOIA PKWY 170 PARCEL: 2S112DA -00800
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: 1
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: 1 SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of one commercial backflow prevention device, one commercial sink and one laundry tray.
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT CTR 3/13/01 $79.40 27200100000
15350 SW SEQUOIA PKWY #300 -WMI
5PCT CTR 3/13/01 $6.35 27200100000
PORTLAND, OR 97224
Total .$85.75
Phone 1:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 236 -4152 Rough -in Insp
#: L IC 172 Top -out Insp
Reg RP /Backflow Preventer •
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 m obtain co • s of these rules or direct questions to OUNC by calling -13) 246 -1987.
Issu By: £ Permittee Signature: , — "'II\ It
w
Call (503) • • -4175 by 7:00 P.M. for an inspection needed the next business day
4.
. • Plumbing Permit Application
Date received: g, 5/0/ Permit no.: `J- /pee,/ -0007
M b City of Tigard o 7
.� I city Sewer permit no.: V -do llilding 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: I 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
❑ New construction Addition/alteration /replacement ❑ Food service O Other:
JOB SITE INFORMATION // �� FEE SCHEDULE (for special information use checklist)
Job address: i 50 SS S LA) S lil .0i ,A J/ kw Y Description Qty. Fee (ea.) Total
New 1- and 2-
Bldg. no.: Suite no.: ' ? f 2-family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: ) 12 5_,(5 0 , n/ A A 4 5 SFR (3) bath
City /county: 6-,ql*2 0( I ZIP: C f 7 - LI Each additional bath/kitchen
Description and location of work n premises: Site utilities:
R t . w , 7 " 4- A/ k Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line trench drain
Footing drain (no. lin. ft.)
PLUMBING CONTRACTOR Manufactured home utilities
Business name: i FA,) WAY . t ,,J i f) e_ G- Manholes
Address: j 1 l 1 S E_ i 3 ` 4 _ Rain drain connector •
City: I.. TL A, ,--{1 I State: ()E I ZIP: CI — 7 - D.t Sanitary sewer (no. lin. ft.)
Phone: Z 3 (, —1—J / ,5, Fax:R3 4, Storm sewer (no. lin. ft.)
CCB no.: Q ) '7 a I Plumb. bus. reg. no: a ( 083 p..E3 Water service (no. lin. ft.)
Fixture or item:
City/metro lic. no.: f r1 S I I Absorption valve
Contractor's representative signature: = ` l ' . = Back flow preventer __i_
Print name: - L.-e_ ov.J E L. lt: w5 Date: 3 1 _ . Backwater valve
CONTACT PERSON Basins/lavatory
Name: _ (-2_ a i vim/ f f- LSE j$ Clothes washer
Address:
Dishwasher
City: (State: I ZIP: Drinking fountain(s) •
Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): Garbage disposal
Mailing address: Hose bibb
City: I State: I ZIP: Ice maker
Phone: I Fax: I E -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) a
Owner's signature: Date: Sump
ENGINEER Tubs/shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at _ %) $
O 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 (6i00/COM)
r
PLUMBING PERMIT FEES: \ i'
•
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures In PRICE TOTAL
Sink / _ the dwelling and the first100 ft. QTY (ea) AMOUNT ,
Lavatory 16.60 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 16.60 - 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 V
Floor Drain/Floor Sink 2" 16.60 PLEASE COMPLETE:
3" 16.60
4" 16.60
Water Heater 0 conversion 0 like kind 16.60 Quantity by Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removed!
permit. Capped
MFG Home New Water Service 46.40 Sink 1
MFG Home New San/Storm Sewer 46.40 Lavatory
Tub or Tub /Shower
Hose Bibs 16.60 Combination
Roof Drains 16.60 Shower Only
Drinking Fountain 16.60 Water Closet
Urinal
Other Fixtures (Specify) 16.60 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
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device / 46.40 t
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 --C)----
8% STATE SURCHARGE ( 3.5
**PLAN REVIEW 25% OF SUBTOTAL to ,...----- ---
Required only if fixture qty. total is > 9
TOTAL $ 75
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** Ail New Commercial Buildings require plans with isometric or riser diagram and
plan review.
is \dsts \forms\plm- fees.doc 10/10/00
3�LP
CITY OF TIGARD BUILDING INSPECTION DIVISION .
MST '
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
2 BUP
Date Requested ,/ - Z AM PM BLD
Location ($ b 5 54' ,517.4 ?c../ti, Suite / 70 MEC
Contact Person / Ph Z, l J Z PLM 20 L 7 Z_
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
PA RT FAIL
Post & Beam nn
Under Slab Kos j4 1 r.
Top Out
Water Service
Sanitary Sewer
F fin a,�rains
ma, I-
C:FAO 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 3/22/6-/
Other oach /Sidewalk Date Inspector /4 1 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.