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Permit • C ITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00560 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 11/15/2006 PARCEL: 2S 112DD -01600 SITE ADDRESS: 15575 SW SEQUOIA PKWY 160 ZONING: I - SUBDIVISION: PACIFIC CORPORATE CENTER LOT: JURISDICTION: TIG Project Description: 1 lunchroom sink • CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: 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 Owner: FEES PACIFIC REALTY ASSOCIATES Description Date Amount 15350 SW SEQUOIA PKWY #300 -WMI PORTLAND, OR 97224 [PLUMB] Permit Fee 111 $72.50 [TAX] 8% State Surcha 11/15/200E $5.80 Phone : Total $78.30 Contractor: ADDISON PLUMBING 1407 HOMESTEAD PLACE MOLALLA, OR 97038 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 785 -1840 FAX 503- 829 -9701 Reg #: LIC 151754 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 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:w J1�..I�.o-. Permittee Signatur . — Q - akrt 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. ,.. ii, PiurnMne Permit REGGEIVED iiiimaiiiiitiiiiiiim City of Tigard Received 13125 SW H>�Blvd, Tigard, OR 9'722NOV 1 5 2006 Date/By. 1 1 I I I S 1 nt., Penult tJlk - c4,49) Phone: 503.639.4171 Fax: 503.598.1960 t „;.Y, Date/By. Other Permit N �/ �6e,2,7 Plan , �., __. 24- Hour Inspection Line: 503.639.4 QATY OF TIGARD f } 1 i ■ Date Ready/By See page 2 for Internet: www.tigard- or.gov BUILDING DIVISI • Notified/Method 3 uti Sapplemmtal Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demol it ion For special information use checklist. Description I Qty. I Ea. I Total ❑ Addition/alteration/replacement ❑ Other: New I- 2-family dwellings (includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 ❑ 1- and 2-family dwelling j20 Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building 114 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: ( 5-57 rj` Project nam 5e a o/ a Ikeda t / Catch basin or area dra 16.60 City/State/ZIP: �� QM r D J Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: C .2 i6 e: { .1, ad c�/sIM� Footing drain (no. linear R : ) Page 2 Cross street/directions to job site: I / Manufactured home utilities 1 10.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: f Lot no.: Water service (no. linear ft: ) Page 2 Tax map/parcel no.: Fixture or item Absorption valve 16.60 DESCRIPTION OF WORK Back flow preventer Page 2 Add b rl ai room cegAda, 2( 5 (').(k Backwater valve 16.60 Clothes washer 16.60 Dishwasher 16.60 kl PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60 Name: iqGTV.l,I y D� p �- Ejectoron tan k 16.60 16.60 ` Expansion tan Address: f' S 3 J D 6 t ei kick y 36 n Fixture/sewer cap 16.60 City/State/ZIP: r10 Y. -. t K Floor drain/floor sink/hub 16.60 Phone: [503) 6 a 4 `` ` �� ` `���"` ^^^^^����� o Fax: (05) 6 2 ( /-7 75- Garbage disposal 16.60 Hose bib 16.60 ❑ APPLICANT X CONTACT PERSON ,,( T r- q„Q ' 4 - Ice maker 16.60 Business name: 4 (�J.(� �g (� ''."''! Interceptor/grease trap 16.60 Contact name: S� r 9 Lo / d s Medical gas (value: $ ) Page 2 Address: l 55 - ot 5 (49 // _ y � 2 Foy ? Primer 16.60 City /State/ZIP: L Q„ Roof drain (commercial) 16.60 Phone: (503) oZ ®� �'� fr Fax:: (!Oj) �j aS f �� S ink in/lavatory ` 16.60 r s hower /shower pan 16.60 E-mail: 4 t 4/ 1 � aB/ 0244 Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: t $ Q lv v.,V. ".9 L l, c- Water heater 16.60 Address: letp7 Ho .S+ec*� Q1nce her: City/State/ZIP: Subtotal YtiOke,\ \a UIz- Q mg Minimum permit fee: $72.50 Phone: (so 3 ) 72v Ig go Fax: ( .523 ) $2i 746? Residential backflow minimum permit fee: $36.25 7,.,, CCB Lic.: t s 1 yam. Plumbing Lic. no.: .i'- 44 Plan review (25 % of permit fee) ((�yy�� State surcharge (8% of permit fee) 5 i 2 Authorized signature: ., y� email., TOTAL PERMIT FEE l 3o Print name: ,)a.� In�aore 1 f Date: /r- /y-06. ( This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. t:\ BuiIding\PemitaPLM- PennitApp.doe 12/30l0s 440- 4616T(I0/02/COM/WEB) 4, : I Plumbing Permit Application - City of Tigard _• Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities Qty. Fee (ca) Total Square Footage: Permit Fee: Footing drain - 1 ° 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 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 Inspection of existing plumbing or each additional $100.00 or fraction thereof to specially requested and including $50,000.00. pec y eq rested in spections - per hour 72.50 $50,001.00 "and up ' ' • $742.00 for the fist $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. • . Quaodty by (Fixture) Work Performed ❑ Any new commercial building r 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 - Tub/Shower ❑ Medical gas and vacuum systems for health care facilities - Jacuzzi/Whirlpool providing services tq human beings. . Car Wash - Each Stall ❑ Plumbing installations, alteiations or'dditions to food service - Drive Thru • 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 plan with any of the above. -3" -4" Car Wash Drain Isometri or Riser Diagram Garbage - Domestic ❑ - Isometric br riser diagratn 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 — f - Service Swimming Pool Filter Washer - Clothes *Note: If the fixture under this permit results in an Water Extractor ure wor uner Pe 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 Termiu\PLM- PermitApp.dot 07/06/05 CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM20()G 00560 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/15/2006 Phone: (503) 639 -4171 .. Inspection Requests (24 Hrs.): (503) 639 -4175 .. !4 '" ■ I �,. INSPECTION WORKSHEET FOR DATE: 11/22/2006 TIME: 7:03AM PAGE: 36 SITE ADDRESS: 15575 SW SEQUOIA PKWY 160 CLASS OF WORK: SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE: PROJECT NAME: PETROCARD DESCRIPTION: 1 lunchroom sink OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: CONTRACTOR: ADDISON PLUMBING PHONE #: 60378&1B40 Inspection Request Scheduled For: Date: 11/22/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final 040148 -01 503320 -8601 Y Corrections /Comments/ Instructions: pv cte ( v • [PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ut fl Date: 1 t, .2; . Phone #: (503) 718 - 41,-4 CITY OF TIGARD • BUILDING DIVISION ^ - PERMIT #: PLM200&00! C0 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/15/2006 Phone: (503) 639 -4171 .A '�I ,. Inspection Requests (24 Hrs.): (503) 639 -4175 _ -' .. IL INSPECTION WORKSHEET FOR DATE: 11/17/2006 TIME: 7 :01AM PAGE: 25 SITE ADDRESS: 15575 SW SEQUOIA PKWY 160 CLASS OF WORK: SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: TYPE OF USE: PROJECT NAME: PETROCARD DESCRIPTION: 1 lunchroom sink OWNER: PACIFIC REALTY ASSOCIA1ES, PHONE #: CONTRACTOR: ADDISON PLUMBING PHONE #: 503405-1840 Inspection Request Scheduled For: Date: 11/17/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough•in 039968 -01 503- 320 -8601 Y Corrections /Comments /Instructions: 1 0 M 1 N 1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ ' ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: : IV 6e Le Date: I 1 11 6 Phone #: (503) 718 V A46„. CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2006.00G +0 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/15/2006 Phone: (503) 639 -4171 .a . Inspection Requests (24 Hrs.): (503) 639 -4175 !�- �- INSPECTION WORKSHEET FOR DATE: 11/16/2006 TIME: 7 :00AM PAGE: 28 SITE ADDRESS: 16575 SW SEQUOIA PKWY 160 CLASS OF WORK: SUBDIVISION: PACIFIC CORPORATE CENTER LOT #' TYPE OF USE: PROJECT NAME: PETROCARD DESCRIPTION: 1 lunchroom sink OWNER: PACIFIC REALTY ASSOCIATES, PHONE #: CONTRACTOR: ADDISON PLUMBING PHONE #: 5037135 - 1840 Inspection Request Scheduled For: Date: 11/16/2006 Pour Time: Code # Inspection Description Confirm # Contact # Message 305 Plumbing underslab 039876 -01 503320.8601 Y Corrections /Comments /Instructions: 6 1.. ) 0 ,PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: v �� uy Date: IP 24' Phone #: (503) 718 -b •