Permit C ITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00370
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/16/2007
PARCEL: 2S112DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 250 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: 002 JURISDICTION: TIG
PROJECT: COMMON SENSE
Project Description: TI - Cap (1) sink & (1) dishwasher, install (1) sink, (1) dishwasher, (1) shower stall, (1) lay, (1)
water closet & (1) water heater.
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: 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: 1 RAIN DRAIN: ft
Owner: . FEES
• PACIFIC REALTY ASSOCIATES Description Date Amount
15350 SW SEQUOIA PKWY #300 -WMI
PORTLAND, OR 97224 [PLUMB] Permit Fee . 8/16/2007 $99.60
[TAX] 8% State Surcha 8/16/2007 $9.97
Phone : Total $109.57
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 irect questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued y: 4. /// f / - Permittee Signature: ,.d2/
,
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.
Plumbing Permit Application
1 FOR OFFICE USE ONLI'
City of Tigard Receiv ; I /P Q V A , Permit No.: 2427^00570
III 13125 SW Hall Blvd., Tigard, OR 97223
C
Phone: 503.639.4171 Fax: 503.598.1960 an Review
DateBy: Other Permit No.: j �Q0497- 7 00,2,0 3
T I G A R D
Inspection Line: 503.639.4175 Date Ready/By: kris; Ei See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE • ❑ New construction ❑ Demolition For spedal information use checklist
Description Qty. I Ea. Total
ddition/alteration/replacement 0 New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ I- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00
❑ Accessory building /❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / ..... Catch basin or area drain 16.60
City/State /ZIP: tot'r� T j r O� Drywell, leach line, or trench drain 16.60
-
Suite/bldg. /apt. no ^ �� P roject name: Footing drain (no. linear ft.: ) Page 2
� -ii° J � P � r � Manufactured home utilities 110.00
Cross street/directions 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
.gs / l t m� 6 /VIO
Fixture or item
Tax map/parcel no.: Y/
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher j 16.60 /(0•6
PROPERTY OWNER I ❑ TENANT Drinking fountain I 16.60
Ejectors /sump 16.60
Name: ,11 t, 54--
Expansion tank 16.60
Address: !�' Fixture /sewer cap 16.60
City/State /ZIP: . Floor drain/floor sink/hub 16.60
Phone: ( ) F ax: ( ) Garbage disposal • 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: • t Medical gas (value: $ ) Page 2
,e.- Y> /t_ r A /v
Address: Primer 16.60
City/State/ZIP: Roof drain •• - 16.60
Phone: ( ) Fax:: ( ) P ink asi eLato ' A 16.60 3
Tub /shower /shower pan ' 16.60 /4 , 4 0
E -mail: Urinal 16.60
CONTRACTOR Water closet / 16.60 / h. Go
Business name: 0 1,4 4.4 ... 0 ,,,, t..; 7/ # ,.. 2 . 7 ,, Water heater 1 16.60 / G (
Address: Other:
27st ZS s Ecw +oro. -�G� e Subtotal
City/State /ZIP: yam"„ \„ ,,„.. o vz g 7def.L
Minimum permit fee: $72.50
Phone: (sal ) 6 32 - (6s Fax: (S73; )632 -iltog Residential backflow minimum permit fee: $36.25 7 7. wC
Plumbing Lic. no.: Plan review (25% of permi f
CCB Lie.: lSi7,t'� g 3~ 'iQ P(i c �
State surcharge (8% of permit fee) ! • `1 j
Authorized signature:( l V-t aaP -12. TOTAL PERMIT FEE /Q 9 . 57 l
Print name: J4 -s I Date: g - Ito-o1 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.
I:\ Building \Permits\PLM- PennitApp.doc 12 /27/06 440- 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 - 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 br fraction thereof, to
and including $50,000.00.
specially requested inspections - per hour 72.50
Subtotal: $50 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: •
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees * . Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
-Tub/Shower as defined in OAR918- 780 -0040.
Car Wash -Each Stall ❑ Medical gas and vacuum systems for health care facilities.
-Drive Stall ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash Isometric or Riser Diagram
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
- 3 that meet the qualifications above:
-4
Car Wash Drain
Garbage - Domestic Comments regarding fixture work:
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory *Note: If the fixture work under this ermit results in an
- Bradley p
- Commercial / increase of sewer EDUs, a sewer permit will be issued and
- Service fees assessed for the sewer increase must be paid before the
Swimming Pool Filter plumbing permit can be issued.
Washer - Clothes
- Water Extractor
Water Closet - Toilet
Urinal
Other Fixtures:
i:\ Building \Permits\PLM- PermitApp.doc 12/27/06
CITY OF TIGARD = -
BUILDING DIVISION PERMIT #: PLM2007-00370
13125 SW Hall Blvd., Tigard, OR 97223 y DATE ISSUED: 8/1612007
Phone: (503) 639 -4171 a '
Inspection Requests (24 Hrs.): (503) 639 -4175 ''I I�
INSPECTION WORKSHEET FOR DATE: 1//2612007 TIME: 7 :00AM PAGE: 9
SITE ADDRESS: 15350 SW SEQUOIA PKWY 250 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: Q02 TYPE OF USE:
PROJECT NAME: COMMON SENSE
DESCRIPTION: TI - Cap (1) sink & (1) dishwasher, install (1) sink, (1) dishwasher, (1) shower stall, (1) lay, (1) water
closet & (1) water heater.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 603- 785-1840
Inspection Request Scheduled For: Date: 11/2612007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 060218 -01 503-740 -8116 N
Corrections /Comments /Instructions:
Care c x.) aA 9 14J
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: p \ IY\ � _ Date: I 1 121(. 1(0 Phone #: (503) 718-
CITY OF TIGARD • -
BUILDING DIVISION PERMIT #: PLM2007 -00370
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/16/2007
Phone: (503) 639 -4171 � � 1.
Inspection Requests (24 Hrs.): (503) 639 -4175 'I I..
INSPECTION WORKSHEET FOR DATE: 8/17/2007 TIME: 7:01AM PAGE: 11
SITE ADDRESS: 15350 SW SEQUOIA PKWY 250 CLASS OF WORK:
SUBDIVISION: PACIFIC CORPORATE CENTER LOT #: 002 TYPE OF USE:
PROJECT NAME: COMMON SENSE
DESCRIPTION: TI - Cap (1) sink & (1) dishwasher, install (1) sink, (1) dishwasher, (1) shower stall, (1) lay, (1) water
closet & (1) water heater.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 503 - 785 -1840
Inspection Request Scheduled For: Date: 8/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 054247 -01 503- 740 -8116 N
Corrections/Comments/Instructions:
•
VI PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 / ^'. i I "....2_ Date: C O 1 7 i3 7 Phone #: (503) 718-