Permit A
CITY OF TIGARD
PLUMBING PERMIT
Sri DEVELOPMENT SERVICES PERMIT #: PLM2005 -00509
�� ,. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 2 1 S12DD
1
PARCEL: 2DD -01600
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: JURISDICTION: TIG
Project Description: Plumbing TI.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: B FLOOR DRAINS; 2 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: 5 OTHER FIXTURES: •
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [PLUMB] Permit Fee 10/20/200f $275.40
[TAX] 8% State Surcharl 10/20/200E. $22.03
Phone : 503 624 - 6300 Total $297.43
Contractor:
D P PLUMBING /DARREN T PLACEK
15825 NE SPRINGBROOK RD REQUIRED ITEMS AND REPORTS
NEWBERG, OR 97132
Phone : 537 - 9492 •
Reg #: LIC 110612
PLM 36 -70PB
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 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By � S; Permittee Signature t 7
Call 503-639-4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Building Fixtures � IV t_. (�
Plumbing Permit An tit�fi
City of Tigard 200 R e eB� 9 So 0 . 5 - Permit No.: �,�y _5
13125 SW Hall Blvd., Tigard, OR 97223 SEP 30 Plan Review `"� ��
Phone: 503.639.4171 Fax: 503.598.1960 G:..: , f D Other Permit N s s"
24- Hour Inspection Line: 503.639.4175 T r A ' 1 ' ° I
Internet: www.ci.tigard:or.us I T Y I L ^ -- Date Ready/By: lute: El See Page 2 for
D IVIS • Notified/Method Supplemental Information
TB FEE* SCHEDULE
New construction ❑ Demolition For special information use checklist •
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 249.20
❑ 1- and 2- family dwelling ® Commercial /industrial • SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 154/75 61i/ St° Auo )� Catch basin or area drain 16.60
City /State/ZIP: J t 'L Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: /� I Project name: 19 f r■'SSM"i ('ty , Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross to job site: Manholes 16.60
•
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) - Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer . Page 2 92 _So
_ / iff1 M . , i✓ W.11, , Backwater valve 16.60
Clothes washer 16.60
eA V
(T /- (J�b es are Volta( _ _t__ ( /u 1 Air /7t �, Dishwasher 16.60
❑ PROPERTY OWNER I ❑ ' TENANT � Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
• City / State/ZIP: Floor drain/floor sink/hub 1 16.60 55, ?b
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ 440 Page 2 92, .Sa
•
Address: Primer I 16.60 / 6 0
City /State/ZIP: Roof drain (commercial) 16.60
Phone: J' (S asir� ( ' 16.60 ���,
( ) Fax: )
Tub /shower/shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: D p plumb, )J DD --II Water heater ° C 16.60 ,
Address: LS` A. Alf rr • broelt t':..�• Other: _
City /State/ZIP: N I, b � a (�Z Subtot -
'NS/� Q Minimum permit fee: $72.50
Phone: ( ) - 7 _ Jet 9 RZ Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: t i o Lve
Plumbing Lic. no.: 3 6 _?0?8 Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature TOTAL / TOTAL PERMIT FEE
Print name: I Date: / / j 01 Q,J' This permit application expires if a permit is not obtained within
rr (( 180 days after it has been accepted as complete.
• *Fee methodology set by Tri -County Building Industry Service Board.
• i:\ Building \Pemiits\PLMF- PennitApp.doc 06/05 440-4616T(10/02/COM/WEB)
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
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof to and
Commercial Back Flow Prevention Device 46.40
including
148. i0g for the first $
$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: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria
accurately report fixtures could result in increased sewer fees *. Please check all that apply. •
Quantity by (Fixture) Work Performed ❑ Any new commercial building.
Fixture Type: Replace ❑ Any new exterior plumbing site utilities.
Previous Capped Added Existing ❑ A commercial building with installation, alteration or addition
Baptistry/Font of nine (9) or more new or relocated plumbing fixtures.
Bath -rub /Shower ❑ Medical gas and vacuum systems for health care facilities
- Jacuzzi/Whirlpool providing services to human beings.
Car Wash - Each Stall ❑ Plumbing installations, alterations or additions to food service
- Drive Thnil facilities where new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being installed for the food service area.
Dishwasher - Commercial ❑ Any new residential building containing three (3) or more
- Domestic dwelling units.
Drinking Fountain
❑ Any NFPA 13 - D multipurpose fire sprinkler system.
Eye Wash
Floor Drain /sink - 2" ?, Submit 2 sets of plans with any of the above. •
•
•
-3"
-4 „
Car Wash Drain Isometric or Riser Diagram
Garbage - Domestic ❑ Isometric or riser diagram is required for new buildings
Disposal -Commercial three (3) or more stories in height.
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station) Comments regarding fixture work:
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial 3
- Service
Swimming Pool Filter
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor er P
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
is�Building�Pennits \PLM- PermitApp.doc 07/06/05
CITY OF TIGARD
BUILDING DIVISION _ PERMIT #: PLM2005 -00508
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/1005
Phone: (503) 639- 4171m - RµgyS
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/16/2005 TIME: 7:06AM PAGE: 27
SITE ADDRESS: '15495 SW SEQUOIA PKWY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: DENTAL PROFESSIONALS
DESCRIPTION: Plumbing TI. Med gas & dental vac not included on this permit.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503-624 -6300
CONTRACTOR: U P PLUMBING /DARREN T PLACEK PHONE #: 637
Inspection Request Scheduled For: Date: 12/16/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 023620 -05 503- 888 -0214 N
Corrections /Comments /Instructions:
0-V
-1 / 17-17
; I- -ASS El PARTIAL APPROVAL El CANCEL El NO ACCESS
■ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector Date: ` 4 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION #: PLM2005 -00508
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2006
Phone: (503) 639 -4171 Ali I nspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/8/2005 TIME: 7:00AM PAGE: 49
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: DENTAL PROFESSIONALS
DESCRIPTION: Plumbing TI. Med gas & dental vac not included on this permit.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 603- 624 -6300
CONTRACTOR: D P PLUMBING /DARREN T PLACEK PHONE #: 537 -9492
Inspection Request Scheduled For: Date: 11/8/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 020606.01 603. 888-0214 N
Corrections /Comments /Instructions:
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED .
l laj
Inspector: Date: l Phone #: (503) 718 -
CITY OF TIGARD • - - •
BUILDING DIVISION PERMIT #: PLM2005-00509
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2005
Phone: (503) 639 -4171 wso�sgl;$ A\
Inspection Requests (24 Hrs.): (503) 639 -4175 p:_..
INSPECTION WORKSHEET FOR DATE: 10/27/2005 TIME: 7:16AM PAGE: 110
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: DENTAL PROFESSIONALS
DESCRIPTION: Plumbing TI. Med gas & dental vac not included on this permit.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503- 624 -6300
CONTRACTOR: D P PLUMBING /DARREN T PLACEK PHONE #: 537 -9492
Inspection Request Scheduled For: Date: 10/27/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 019450-01 503-888 -0214 Y
Corrections /Comments /Instructions: .
Or") U) rc u P l p - I t (A.,,c, 4- t�- wr o/
0 (.04 — w, I, M,ti e a../ OA el.. T S -1_4 — -k v.o 107,..4...7-1
4 ✓ Rt,. J e,,,./. .
❑ PASS Ni PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /---1...- ;1, `f Date: /0/27 to__( Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION _ PERMIT #: PLM2005.00509
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/20/2005
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/21/2005 TIME: 7:08AM PAGE: 101
SITE ADDRESS: 15495 SW SEQUOIA PKWY 120 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE:
PROJECT NAME: DENTAL PROFESSIONALS
DESCRIPTION: Plumbing TI.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: 503.624 -6300
CONTRACTOR: D P PLUMBING /DARREN T PLACEK PHONE #: 537 -9492
Inspection Request Scheduled For: Date: 10/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 018942 -01 503.888 -0214 Y
Corrections /Comments/ Instructions:
6 L litst. j j V I - f C .sI.L d C C U
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / op Phone #: (503) 718-
•