Loading...
Permit CITY T I G A R D PLUMBING PERMIT PERMIT #: PLM2001 -00065 w A -� DEVELOPMENT H BMENg Tigard, ) 639 -4171 DATE ISSUED: 3/6/01 SITE ADDRESS: 15115 SW SEQUOIA PKWY 110 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: OCCUPANCY GRP: FLOOR DRAINS; 1 TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: TUB /SHOWERS: 1 SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Capping of plumbing fixtures for commercial TI. FEES Owner: Type By Date Amount Receipt PACIFIC REALTY ASSOCIATES PRMT CTR 3/6/01 $99.60 27200100000 15350 SW SEQUOIA PKWY #300 -WMI 5PCT CTR 3/6/01 $7.97 27200100000 PORTLAND, OR 97224 Total $107.57 Phone 1: Contractor: iig POWER PLUMBING CO P BOX 23144 TIGARD, OR 97281 REQUIRED INSPECTIONS Phone 1: 244 -1900 Final Inspection Reg #: LIC 52378 PLM 34 -150PB • 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 obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987. � � Issued By: Permittee Signature: ____ Call (503) 639 -4175 by 7:00 P.M. for an inspection needed thi next business day ,� r Plumbing Permit Application Datereceived: 3 /(o Q/ Permit no.:pi - 6006 ��� , � ; F City of Tigard :.i i� Sewer permit no.: Building 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:2Receipt no.: Land use approval: Case file no.: Payment type: TYPE OF PERMIT 0 1 & 2 family dwelling or accessory 0 Commercial/industrial 0 Multi- family .Tenant improvement 0 New construction ddition/alteration /replacement 0 Food service 0 Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: I S I I Jr- : W S EQ1uo l A Pk W y Description Qty. Fee(ea.) Total Bldg. no.: 7 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 n a m e : f j _ ,4 'Me t L 21. e . SFR (3) bath City /county: I ZIP: 7 22 y Each additional bath/kitchen Description and location of work on premises: / Wo of . Site utilities: /o,....e,,,,- 0Xtsuetsr Catch basin/area drain Est. date of completion/inspection: Drywells/leach line/trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: ]� vw.�% sR Manholes Address: p.o. ' .,F (q'-ii Rain drain connector • City: T \A il I State: ()RI ZIP: q1 a 0 Sanitary sewer (no. lin. ft.) Phone: 2,y.. -19 pp Fax:zy 446'.1$ I E- mail: Qc ewer (no. lin. ft.) CCB no.: $2.3'18 /2/0 3 I Plumb. bus. reg. no: 3y -1 5'0 pa, _ ater service (no. lin. ft.) City /metro lic. no.: 14(02- Fixture or item: Contractor's representative signature. -�V-10 Absorption valve Back flow preventer Print name: J i'r ©Nave% • Date:3 x-01 Backwater valve CONTACT PERSON Basins/lavatory Name: 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): r 9 oke T gr Floor drains/floor sinks/hub Mailing address: Garbage disposal 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) Owner's signature: Date: Sump ENGINEER Tubs/shower /shower pan Name: Urinal Water closet Address: Water heater City: State: ZIP: Other: R,.,,,,,,„,,„ k Cep So I b • r'= 99. Phone: Fax: E -mail: Total 9Q. 4 .O, Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ _ 94 Notice: This permit application Plan review at %) "—' O Visa 0 MasterCard expires if a permit is not obtained review ( at $ 9 Credit card number: / / within 180 days after it has been State surcharge (8 %) $ 7 Expires accepted as complete. TOTAL $ /07. '' Name of cardholder as shown on credit card $ Cardholder signature Amount 4404616. (6R)0/COM) l%/ I �i!'.�1 0'i' 7' 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 / 16.60 the dwelling and the first100 ft. QTY (ea) AMOUNT Lavato 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 Floor Drain/Floor Sink 2" / 16.60 3" 166.60 0 PLEASE COMPLETE: 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 • 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 ' 9 9• = 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 1 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 9 i. Quantity Total is > 9 *SUBTOTAL 9qr b� 8% STATE SURCHARGE 7.97 **PLAN REVIEW 25% OF SUBTOTAL / Required only if fixture qty. total is > 9 TOTAL $ 57 S7 ' ''. • * Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow Prevention Device, which Is $36.25 + 8% state surcharge. ** AII New Commercial Buildings require plans with Isometric or riser diagram and plan review. is \dsts \forms\plm- fees.doc 10/10/00 , , •-' Accumulative Sewer Tally Tenant Name: /) /L Win/ T This SWR# W Address: /S/ /S SA) _SE GZuoi /' y // o This PLM #: 02 DD / -DO 4 Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New Value Capped off value added # added #s total Count off #s count value values Baptistry/Font 4 Bath - Tub /Shower 4 - Jacuzzi/Whirlpool 4 Car Wash - Each Stall 6 - Drive Through 16 Cuspidor/Water Aspirator 1 Dishwasher - Commercial 4 - Domestic 2 Drinking Fountain 1 • Eye Wash 1 Floor Drain/sink - 2 inch 2 - 3 inch 5 - 4 inch 6 - Car Wash Dm 6 Garbage Disposal 16 - Domestic (to 3/4 HP) - Commercial (to 5 HP) 32 - Industrial (over 5 HP) 48 Ice Machine /Refrigerator Drains 1 Oil Sep (Gas Station) 6 Rec. Vehicle Dump Station 16 Shower - Gang (Per Head) 1 - Stall 2 / 2 Sink - Bar /Lavatory 2 y •- - Bradley 5 - Commercial 3 • - Service 3 / ,3 Swimming Pool Filter 1 Washer - Clothes 6 Water Extractor 6 • Water Closet - Toilet 6 / 4 Urinal 6 TOTALS 3 Total fixture values: 3 7? divided by 16 = 0 2 3, 3 EDU a 3 , t _ . tp 6 u. C'2 /7 HISTORY PLM# of - D/ y EDU# a 3 SWR# PLM# EDU# SWR# PLM# 9 -OP'? EDU# a 3 SWR# -6 3 y PLM# EDU# SWR# PLM# , p /ice EDU# SWR #n a3/ PLM# EDU# SWR# PLM# f -/� - 9(,„ EDU# a / SWR# - PLM# EDU# SWR# i:Wstslswrtaly.doc 230 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested � 5 AM PM BLD Location /5//5 5 S-� f 01 a A ' /C Suite % /t( MEC Contact Person Ph /901) PLM 2(jS U (rs Contractor Ph SWR BUILDING Tenant/Owner (('10)) ‘fso kr/ I ELC Retaining Wall =/,u :0 ELR Footing Access: Foundation HL ' 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 eam Under Slab Top Out Water Service Sanitary Sewer Rain Drains 111:1 PART 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 BackfilVGrading 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 nSpeC t or � � / to icnke Ext ' Other D a t e Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.