Permit • g 7
CITY ' OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00341
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/3/2007
PARCEL: 2S 112DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 220 ZONING: I -P
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: 002 JURISDICTION: TIG
PROJECT: SPEC SPACE
Project Description: DEMO SINK only.
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
15350 SW SEQUOIA PKWY #300 -WMI Description Date Amount
PORTLAND, OR 97224 [PLUMB] Permit Fee 8/3/2007 $72.50
[TAX] 8% State Surcha 8/3/2007 $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: Cr Permittee Signature: __
T r
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
Building Fixtures , RECEIVED FOR OFFICE USE ONLY
t g gp Z3 4 200/ ReceBy: )o1 !' l O' - fs� /J�lI
C/ of Tigard DateBy: [! Permit No.
11
• 13125 SW Hall Blvd., Tigard, 2 Plan Revi w
C Phone: 503.639.4171 Fax pr � Date/By: Other Permit Nor
'
Inspection Line: 503.639. Date Read lurr ® See Page 2 for
T I L. n It D Internet: www.tigard- or.go�C ' �'�/ B Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
El New construction lig 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 js. 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: /53s'0 S k.0 5eoud Qy-, wkr ) Catch basin or area drain 16.60
City /State/ZIP: fork\.. 49._ 9 1 21.4 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 020 I Project name: Footing drain (no. linear ft.: ) Page 2
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
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
be■.o l ‘0%toKNroov..- c ..., ( Pd:...} o-- u.s_o_ ,...4,,r Backwater valve 16.60
Nr_.. e....r Clothes washer 16.60
Dishwasher 16.60
•
6 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: 9 - ,- , - t - � s Expansion tank 16.60
Address: IS 3 hY $W SILL a ? I_t_o c . O Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( 7:r3 ) G2,4 - Gior. Fax: (Sb3 ) 4, 2. 9- - 775 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: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial 16.60
Phone: ( ) I Fax :: ( ) in asin/lavatory ,t\U I 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: pakaqc,.,, Q v........3,:-. L. L G Water heater I 16.60
Address: 27'425 % S. .e -aN.re cC\r- e,-e.y- e..\) Other:
Subtotal
City /State /ZIP: t -& \'.„' o-. ciloct
Minimum permit fee: $72.50
Phone: ( 5 ) t,32 - (65`1 Fax: (Sr d ) 1 /-(1‘,S3 Residential backflow minimum permit fee: $36.25 /a.
CCB Lic.: f( 7 s Plumbing Lic. no.: 3 - 449 f g Plan review (25 °/, of permit fee)
(� State surcharge (8% of permit fee)
Authorized signature: ° �V ... ` TOTAL PERMIT FE
Print name: 3 a,._ 4.„,ssor. e- Date: s- , s-0-7 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\PLMF- PermitApp.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 - I 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 - Ist 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
Q ty. Fee (ea) Total additional $100.00 or fraction thereof, to and
Fixture or Item 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 inspections - per hour 72.50 and including $50,000.00.
Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
each additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Quantity by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: Replace engineer.
Previous Capped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918- 780 -0040.
Bath - Tub /Shower ❑ Medical gas and vacuum systems for health care facilities.
- Jacuzzi/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash -Each Stall ❑ Any complex structure as defined in OAR918- 780 -0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic
Drinking Fountain Isometric or Riser Diagram
Eye Wash ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
-3
-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
- Bradley *Note: If the fixture work under this permit results in an
- Commercial I 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:
is\ Building \Permits\PLM- PermitApp.doc 12/27/06
Accumulative Sewer Tally Parcel # t13112DA= 00 34.1:. V
;Tenant Narrre: SPEC SPACE.:: • !: - -• . • This SWR# •` NA CREDIT DUE
.Site Addiess: 15350 'SW'Sequoia #220 . • : This PLM# 2007 =00341 . - .
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off #s count # value #s values
Baptisery/Font 4 .. - ' 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacuzzi /Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor /Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 , 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 ., ..... 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 0 0 0 0
-3inch 5 ,, 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
Car Wash Drn 6 - 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0 .
- Commercial (to 5 HP) 32 ` • 0 0 . • : . 0 0 0
- Industrial (over 5 HP) 42 ,. 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 0 • ., 0 0 0
Oil Sep (Gas Station) 6 .. • 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 ,. 0 0 0 0
- Commercial 3 0 1 3 0 -1 -3
- Service 3 0 0 0 0 0 • Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 — 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 .: 0 0 0 0 0
Urinal 6 0 0 0 0 0
Previous EDU Count ::: - 0 0
Capped EDU Credit 0
TOTALS • 0 0 1 3 0 0 -1 -3
Current Fixture Value -3 divided by 16 = -0.2 Current EDU 1 EDU = $ 2,800
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -3 divided by 16 = -0.2 over (under) $ (560.00)
Enter EDU Change Here -0.2
Notes:
Authorized Name /Signature:'Barb •. .. .' Date: f : : 8/3/2007 7 - :. -. ;
Building Division
d ote: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must,be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\ Building \Forms \SewerTallySheet.xls 02/02/07
7 _..4 CITY OF TIGARD PLUMBING PERMIT
. _ COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00341
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/3/2007
PARCEL: 2S112DA -01400
SITE ADDRESS: 15350 SW SEQUOIA PKWY 220 ZONING: I -
SUBDIVISION: PACIFIC CORPORATE CENTER LOT: 002 JURISDICTION: TIG
PROJECT: SPEC SPACE
Project Description: DEMO SINK only.
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
15350 SW SEQUOIA PKWY #300 -WMI Description Date Amount
PORTLAND, OR 97224 [PLUMB] Permit Fee 8/3/2007 $72.50
[TAX] 8% State Surcha 8/3/2007 $5.80
Phone : Total $78.30
Contractor:
ADDISON PLUMBING
1407 HOMESTEAD PLACE
MOLALLA, OR 97038 REQUIRED ITEMS AND REPORTS
0
Contact # : PRI 503- 785 -1840 4 .
i
FAX 503 -829 -9701 O
Reg #: LIC 151754 t EXPIRED • p
va
PLM 3 -449PB . /6 ' �
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: Permittee Signature: _,,,,➢ • 4 ;1i I, . " _ ■ — ..4c
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.
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required tor. PLM2007 -00341 REQUIRED ON GREEN INSPECTION CARD.
✓ Code I Inspection Description I PASS Date I By Fr Inspection Description I PASS Date I By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
805 MFG- Structure grading /footing 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post/beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG- Structure set -up MEC - Mechanical Permit
280 Insulation 605 Post/beam mechanical
285 Drywall nailing 610 Gas line
287 Suspended ceiling X 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper 11
299 Final inspection I 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
X 699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinlder underfloor /slab PLM - Plumbing Permit
910 Sprinlder rough in 305 Plumbing underslab
915 Fire alarm rough -in 310 Crawl drain
920 Suppression trip test
995 Misc. inspection: 315 Post/beam plumbing
998 Alarm final 320 Plumbing rough -in
999 Sprinkler final 322 Shower pan
330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert /catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing 399 , Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection 599 Final inspection
1:\ Building \Fonru \InspCard- AOP- Blankdoc 02/02/07
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