Permit `e*C ITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2000 -00440
Al"411.- 611 ,uwill�" 13125 DEVE DEVELOPMENT SERVICES ) 639 -4171 DATE ISSUED: 12/26/00 'IV -.
SITE ADDRESS: 15230 SW SEQUOIA PKWY 130 PARCEL: 2S112DA -00300
SUBDIVISION: 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: 2 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS: 1
LAVATORIES: 2 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI for new tenant. Other fixtures are drinking fountain and ice maker.
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT CTR 12/26/00 $212.40 27200000000
15350 SW SEQUOIA PKWY #300 -WMI PLCK CTR 12/26/00 $53.10 27200000000
PORTLAND, OR 97224 5PCT CTR 12/26/00 $17.00 27200000000
Phone 1: Total $282.50
Contractor: •
AMERICAN PLUMBING SERVICES INC
5905 N INTERSTATE AVE
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone 1: 289-6498 Sewer Inspection
Top -out Insp -
Reg #: LIC 108025 RP /Backflow Preventer
PLM 20 8025
Final Inspection
1 7?
I)
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) 24.6 -1987.
Issued By: Permittee Signature:
/ it/ �
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the nex business day
BUP - Building Permit ELC - Electrical Permit — Q' ,
JI Inection De scription Date Passed By I In spection Description Da teY"a ` s sed . By
mooting /Setback Underground cover
' Foundation walls Wall cover
Footing drain Ceiling cover
Waterproof bsmt walls Electrical rough -in
Slab Electrical service
Crawl drain Electrical final
Underfloor insulation
Post/beam structural -
Shear walls /anchors ELR - Restricted Energy Permit
Roof nailing I Inspection Description Date Passed By
_ Firewall Low voltage
Tilt -up panel Electrical final
Masonry/Reinforcement
Framing
MFG- Structure set -up MEC - Mechanical Permit
Insulation
4 Inspection Description Date Passed By
Drywall nailing
• Post/beam mechanical
Suspended ceiling Gas line
Engineered soils Mechanical rough -in
Welding Lab Final Fire damper
Concrete Lab Final Duct work
Bolting Lab Final Smoke detector
Fireproofing Lab Final - Mechanical final
Structural observation
Final inspection
PLM - Plumbing Permit
4 Inspection Description Date Passed By
BUP - Fire Protection System Permit Plumbing underslab
4 Inspection Description Date Passed By Crawl drain
Sprinkler underfloor /slab Post/beam plumbing -_
Sprinkler rough -in Plumbing top -out / - at / / V"
Sprinkler final RP /backflow preventer
Fire alarm final Rain drain
Storm drain
Water service
SIT - Site Permit Sanitary sewer
4 Inspection Description Date Passed By Culvert/catch basin
Footings Pump /fill septic tank
Foundation walls Plumbing final
Sprinkler supply lines
Sprinkler underfloor /slab
Catch basin/Manhole SWR - Sewer Permit
Engineered soils. - 4 Inspection Description Date Passed By
Engineering acceptance Sanitary sewer
Final inspection Final inspection
INSPECTION RECORD - BUP PLM SWR ELC ELR MEC SIT PERMITS
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested /0 -2 e Q U AM PM BLD
Location /moo{ c.) j e C / V Suite /c 0 te MEC
Contact Person Ph ..2cvo -olowo
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation G �� FPS
/�
Ftg Drain ?- SGN
Crawl Drain Inspection Notes:
Slab - SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Fire wall S E s�(Q l_
Fire Sprinkler r'7
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
P T FAIL
LUMBING
Post &Beam
Under Slab
.o• Out - •
Water Service
Sanitary Sewer
Rain Drains
F.�.
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 2
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 ''\\ / _
Other Date / i�"�U Inspector ( a Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
/2-----0'ee et1v Sent /2// er 0
_ ,A zoor, -vo LH L
A14 Plumbing Permit Application p
Datereceived: ID_ Sf rro Permit .. 2 Z - Da Vito
+� 1 ,r City of Tigard
.� � - 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 Ai -7 M X196 " Date issued: By: I Receiptno.:
Land use approval: Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory Alit ommercial/industrial 0 Multi- family Tenant improvement
0 New construction 0 Addition/alteration /replacement 0 Food service 0 Other:
, JOB SITE INFORMATION FEE SCHEDULE (for special inforn ation use checklist)
Job address: / 5 2 30 5 ce Seguoi a Par k Description Qty. Fee(ea.) Total
Bldg. no.: / y Suite no.: 130 a 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: ; /o,,, Re/0 SFR (3) bath
City /county: T, e k I ZIP: 17 ZZ K - 7/ Z ff Each additional bath/kitchen
Description and location of work on premises: TI add Site utilities:
paetat40„ wa(( ?Lomb 4 Kest {of {a5f -rood. gj Catch basin/area drain
Est. date of completion/inspection: g0 Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: '9 1 , Zi q-,J / 0LU6 , 3 /A./6 Manholes
Address: S'90 S ti /A/ — EZS 6/--7E /50-:/e Rain drain connector
City: /JD2 -,vj, I S tate: I ZIP: 97a i 7 Sanitary sewer (no. lin. ft.)
Phone: 2,,P 9 —G V 9e, I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: /a 015 I Plumb. bus. reg. no: c z 6 —Sc - 7 P6 Water service (no. lin. ft.)
City /metro lic. no.: rh�,o a.j /3c /O / Fixture or item:
4 ! Absorption valve
Contractor's representative signature: i ii Back flow preventer
Print name: ; R j 'el M Soh ii5 % n/ Date: - ad 60 Backwater valve
CONTACT, PERSON Basins/lavatory
Name: 3-0e. ow Clothes washe
Dishwasher
Address: 5515 Ai Go„ e,,,oQ
City: I State: 412 I ZIP: 17Z( 7 Ejectors/sump
fountain(s) I
Y poi Ejectors/sump
Phone f , - /. 8487 Fax: z.'O - owe E -mail: Expansion tank
OWNER . Fixture/sewer cap
Name (print): Floor drains/floor sinks/hub 'L
address: Garbage disposal
Mailing Hose bibb
City: I State: I ZIP: Ice maker I
Phone: I Fax: I E -mail: Interceptor /grease trap I
Owner installation/residential maintenance only: The actual installation Primer(s) _;;
will be made by me or the maintenance and repair made by my regular jakof drain (com rctal)
employee on the property I own as per ORS Chapter 447. / inItts), basin(s),4jjl O
Owner's signature: Date: p
ENGINEER Tubs/shower /shower pan
, Urinal
Name:
;G :d 0 ( ., °n Water closet
Address: I5 I S 3 5 w Grialke tp•,4 • It F Water heater .1--
City: g,, ,, . I State: OR I ZIP: 47 p0(, Other: •
Phone: I Fax: I E -mail: Total i I
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ o� 'ID This permit application Plan review (at _ %) $ 5 3 , ( O
CI visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / State surcharge (8 %) $ 17 'Cr Ex
Expires
within 180 days after it has been
p accepted as complete. TOTAL $ .A 2 -5O
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440-4616 (6/00/COM)
I.
. i
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/,/ A. 16.60 03 the the dwelling and the first100 ft. QTY (ea) AMOUNT
ry �, 16.60 for each utility connection)
Lavato 2 33 2� 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 A.00 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. / /!o• 4161 Capped
MFG Home New Water Service 46.40 Sink ° L
MFG Home New San/Storm Sewer 46.40 Lavatory 1 --
Tub or Tub /Shower •
Hose Bibs 16.60 Combination
Roof prains 16.60 Shower Only
Drinking Fountain k 16.60 /(,� Water Closet
1/./ P Urinal
Other Fixtures (Specify) 16.60 Dishwasher
/ 6E t-W €L / /4,100 Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2" 2
Sewer - 1st 100' 55.00 3"
Sewer - each additional 100' 46.40 4"
Water Service - 1st 100' 55.00 Water Heater •1
Water Service - each additional 200' 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' 55.00 ' c f
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device% / 46.40 41, ,(1 /a. HR 4
Residential Backflow Prevention Device' 27.55 I FFbf 1 P /
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 r-) o t° V/< .�
Grease Traps / 16.60 /(.(pd per / p o P 0 /` e4-7 s P. r
QUANTITY TOTAL
Isometric or riser diagram is required if
Quantity Total is > 9
*SUBTOTAL o �� ,c-It)
8% STATE SURCHARGE l7 DU
h
**PLAN REVIEW 25% OF SUBTOTAL '
Required only if fixture qty. total is > 9 -� '
TOTAL Sag ,
* 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.
i:\dsts \fonns\plm- fees.doc 10/10/00
nn // 4 Accumulative Sewer Tally
Tenant Name: /o�'e, /o rJ /4 This SWR# //\)//C)"
Address: /5Z 64....) 5EQuoi A- PKt i /30 This PLM #: PL - 1 a)00 - 00WO
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 , . / /
r
Oil Sep (Gas Station) 6 .
Rec. Vehicle Dump Station 16 _
•
Shower - Gang (Per Head) 1 _
- Stall 2
Sink - Bar/Lavatory 2 • 02 9 .
- Bradley 5 •
//__ .
- Commercial 3 - 9- (.0
- Service • 3
Swimming Pool Filter 1 _
Washer - Clothes 6
Water Extractor 6 .
Water Closet - Toilet 6
Urinal 6
TOTALS / /1.0 /5.
. . EDU g g ^' /D �b t.� 5 ° � -�
Total fixture values: )5 % divided by 16 = .
9 = / s E . >,4 : • T �u a act
M a�uc,o Zee •:4 / E .. a7 ~ a
HISTORY -, E s •.
PLM #koo -00 I EDU# -? SWR# aciaa co//4' PLM# EDU# SWR#
PLM# 99 - ovo69 -. EDU# S SWR#99= ce06'8" PLM# EDU# SWR#
PLM# iikroey'aae 99 EDU# // SWR# PLM# EDU# . SWR#
PLM# EDU# SWR# PLM# EDU# SWR# .
i:ldsts%swrtay.doc