Permit r C OF TIGARD PLUMBING PERMIT
jik DEVELOPMENT SERVICES PERMIT #: PLM2003 -00381
A 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/1/03
SITE ADDRESS: 15230 SW SEQUOIA PKWY 190 PARCEL: 2SI12DA -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:
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: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Demo (1) break room sink, demo & relocate (2) water closets, (2) lays, (1) 2" floor drain and (1) water heater.
Other fixture is (1) primer.
FEES
Owner:
Description Date Amount
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WMI [PLUMB] Permit Fee 8/1/03 $116.20
PORTLAND, OR 97224 [TAX] 8% State Tax 8/1/03 $9.29
Total $125.49
Phone :
Contractor:
ADDISON PLUMBING
17506 SE RIVER RD.
MILWAUKIE, OR 97267 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Top -out Insp
Reg #: LIC 151754 Final Inspection
PLM 3 -449PB
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 , ;J -4 • a Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Building Fixtures •
Plumbin , P e ion Received FOR OFFICE USE ONLY
Plumbing
Date/By: A I ✓ Permit No.: P 00005 3 >/
City of Tigard Planning Approval
Date/By: y: Permit No.:
13125 SW Hall Blvd. AUG Z��� Plan Review Other Q
Tigard, Oregon 97223 CITY OF TIGARD Date/By: Permit No.: IaCt-pAZA65- • 004
5 1� 5'pstp6 Post - Review Land Use
Phone: 503 - 639 -4171 F
lal u. b9Si0V/ /x�a,Nir , I I t\ Date/By: Case No.:
Internet: www.ci.tigard.or.us a e .' Contact Ju • .. ® See Page 2 for
24 - hour Inspection Request: 503 639 - 4175 - ' Name/Method: !6 " Supplemental Information.
" _ TYPE OF"WORK- FEE* SCHEDULE (for special information use checldist) `;' , _•
❑ New construction ❑ Demolition Description I Qty. I Fee(ea.) I Total
® Addition/alteration/replacement El 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 E 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: ISz3o Sw s ` o, o-• P>--nt + Site Utilities .
Suite #: /q0 bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: Drywell/leach line /trench drain 16.60
Pro
J : W eST wpm u� P,RoDv - rs i /Nc• 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: Lot #: Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft.) Page 2
Tax map /parcel #: Fixture or Item .. , _ .
. " .. DESCRIPTION OF WORK Absorption valve 16.60
'D4 : I g„ - e . o „ S...K • Backflow preventer Page 2
1DPwwn t g.e toca.ire : a - w c z - L.AiJ f - pli ft Backwater valve 16.60
Clothes washer 16.60
(- �'' K Dishwasher 16.60
Drinking fountain . 16.60
El PROPERTY OWNER I ❑ TENANT Ejectors/sump 16.60
Name: 7o,c.'x.,.,,s k Py `( • Expansion tank 16.60
Address: er cap / 16.60
City /State /Zip: Floor drai floor sink/hub a f 16.60 IL,. t
-GGarbage disposal 16.60
Phone: Fax: Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Primer 1 16.60 /6,60
City /State /Zip: Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 2- 16.60 33.2.0
E -mail: Tub /shower /shower, pan 16.60
CONTRACTOR Urinal • 16.60
Business Name: 1A�,�so.,.. 3i.,.wb' l.1 Water heater et 2 16.60 (t.. o
""� Water hea / � 16.60 !6.(
Address: t/5 SE e.L' «- KD Other: •
t
Cit /Stae /Zi • Other: ?
City/State/Zip: W„�wawk.:e t o�2 4 - 7ZbZ ,
Phone: 563 - /S1 0 1 0 S o Fax:- 644/ Plumbing Permit Fees* ,
Subtotal $
CCB Lic. #: r517 54 Plumb. Lic. #: 3- 4 Q g 1 ° Li Minimum Permit Fee $72.50 $ `� 945 Authorized 1 I Residential Backflow Minimum Fee $36.25 A/(0'
Signature: q /�/ . 4-i d -tC.s- Date:9 - 03 • Plan Review (25% of Permit Fee) $
t • ,50-4 (WO o`� �-
1 State Surcharge (8% of Permit Fee) $ 9. Al
(Please print name) TOTAL PERMIT FEE $ 1 9t5. 4 7
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\Permit 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 - l 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' 55.00 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
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
• BUP
Received Date Requested Q---2 2_ AM PM BUP
Location z f21' uite I ? () MEC
III
Contact Person ).--r-Lt-I Ph ( a'
' ) '2 ( — c / . - 00vim ?
Contractor U 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
i
Other: -
Final
PA PART FAIL
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
• er:
I
/ " S PART FAIL
',, HANICAL
Post & Beam
Rough -In
Gas Line •
Smoke Dampers
Final
PASS PART FAIL
•
ELECTRICAL .
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final 0 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: El Unable to inspect — no access
Are Supply Line
ADA / , 2 1 Approach/Sidewalk - Date ■ / I Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site
PASS PART FAIL