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12231 SW GARUEN PL BL.D. 1
CITYOF T I GA R D - BUILDING PERMIT
PERMIT#: BUP2001-00208
DEVELOPMENT SEWCES DATE ISSUED: 6/8/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
SITE ADDRESS: 12232 SW GARDEN PL BLD 'I PARCEL: 2S101BB-01500
SUBDIVISION: CROW PARK 217 ZONING: C-G
BLOCK: LOT: 003 JURISDICTION: TIG
REISSUE: _FLOOR AREAS _ EXTERIOR WALL CONSTRUCTION
CLASS OF WORK: ALT FIRST: sf N: S: E: W•
TYPE OF USE: CUM SECOND: sf _ PROJECT OPENINGS? _
TYPE OF CONST: sf N: S: E: W:
OCCUPANCY GRP: B TOTAL AREA: 0.00 sf ROOF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT': ft GARAGE: sf OCCU SEP. RATED:
B,3MT?: MEZZ?: REQD SETBACKS _ REQU_IRED
FLOOR LOAD: nsf LEFT: ft RGIiT: ft FIR SPKL: �SMOK DET:
DWELLING UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: $ 15,135.00
Remorks: Commercial T.I.
Owner: Contractor:
RREEF REAL ESTATE INV. MGR. C SCHiEWE + ASSOCIATES
720 SW WASHINGTON 1024 NE DAVIS
SUITE 710 PORTLAND, OR 97232
P90Tne:
ND, OR 97205 Phone: 234-6617
lo
Reg #: LIC 54105
FEES REQUIRED INSPECTIONS _
Type By Date Amount Receipt Mechanical Permit Require
PRMT CTR 6/8101 $196.90 27200100000 Electrical Permit Required
Sprinkler Permit Required
5PCT CTR 6/8/01 $15.75 27200100000 Framing Insp
PLCK GTR 6/8/01 $127.99 27200100000 I Gyp Board Insp
FIRE CTR 6/8/01 $78.76 27200100000 Final Inspection
Total _ $419.40 �I
This permit is issued subject to the regulations contained in the Tigard Municipal Cod? State of OR Specialty Codes
and all other applicable law 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 w irk is suspended for more than 180 days. ATTENTION. Oregon law
requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-1987 You may obtain a copy of these rules or direct questions to OUNC by
calling (503) 246-669 or 1-800-332-2344
Pennittee
Signature:
Issued By:� ,
Call 639-4175 by 7 p m. for an inspection the next business day
Building Permit Application s
City Of Tigard Datemceivcd'% (, /i Permit no.:�jtlP,,;tp/�i.oulo� b
Project/hppl.no.: Expire data
City ojTigard Address: 13125 SW Hall Blvd,Tigard, R 972
Phone: (503) 6394171J,1 Date issued: B . rL Receipt no.:
Fax: (503)598-1960 J t Case file no.: Payment type:
Land use approval: 1&2 family:simple Complex:
TYPE OF PERM111
U I &2 family dwelling or accessory U Commercial/industrial U Multi-family U N" construction U Demolition
U Addition/alteration/replacement ®Tenant improvement U Fire sprinkler/alarm C:Mier:
Job address: iz?,3z ..lr-� C�Ci//UE /'L r , • , w I Bldg.no.: 1 Suite no.:
Lot: I Block: Subdivision: I Tax map/tax lot/account no.:
r
Project name: 7,7 1, fete ,4u e.Y,4/E.--. --- - — - -----
Description and location of work on premises/special conditions: G CA IT 141M r
6WNI]l FOR SPECIAL]INFORMATION, USE CHECKLIST
R.M. k'kE F 2fiQC R1I N E /r / solar,
Mailing address: 7 , �. �, . .i "�,,,yuf['� ^7 .r, /c� 1&2 family dwelling:
City:_ State: .„ ZIP: += - Valuation of work........................................ $_
Phone: TFax. E-mail: _i,e No.of bedrooms/baths................................. _
Owner's representative: U 4 Total number of floors
Phone: i — Fax: . -F E-mail: -®- - - - - New dwelling area(sq.ft.) .......................... _
Garage/carport area(sq.ft.).........................
Name: ! ' ,I e/t.y �,, / Coveted porch area(sq.ft.) .........................
Mailing address: k',[I^44 Y E' b Deck area(sq.ft.) ........................................
City: . State: / ZIP: ?r Other structure area(sq, ft.).........................
Ph�nc: Fax: E-mail: Commercial/industrial multi-fandly: I S�
Valuation of work........................................
Existing bldg.area(sq.ft.) ..........................
4ddress: , New bldg.area(sq.ft.)................................
Slate: ;< ZIP: — Number of stories........................................
Phone: ;'. Fax -mail: !—~ Type of construction.................................... ------
E s _
CCB no.: - — Occupancy groun(s): Existing: L'
New:
City/metm lie no.: Notice:All contractors and subcontractors arc requited to be
t licensed with the Oregon Construction Contractors Board under
Name: provisions of ORS 701 and may be required to be licensed in the
Address: 7 jurisdiction where work is being performed.If the applicant is
City: — State: ZIP: exempt from licensing,the following reason applies:
Contact person: Earl no.: ---- ----- --
Phone: I at E-trial l.• 7k;elr/! u— -—
101 N1111111111111111
Name: Contact person: Fees due upon application ........................... $
Address: _ Date received:
City: State: ZIP: Amount received ......................................... $
Phone: I E-mail: Please refer to fee schedule.
I hereby certify I have read and examined this application and the Not all Juridickos ttsxe(a credit cards,please call Jurisdiction for more information.
attached checklist, All provisions o I ws and ordinances governing this U Visa ❑Mastercard
work will be comp wire cified herein or not. Credit card number:
Authorized siggat Date: � —-- Name of cardholder as shown on credit caExpires
d --
Print name $
aarwtaer airlrsaturc �c - mount
Notice:This permit a ii ation expires if a permit is not obtained within 190 days niter it has been accepted dt complete. 4404611(6MACOM)
SITE WORK PERMfT CHECK LIST
Commercial and Multi-Family: Complete ENTIRE form.
Residential: Complete SHADED areas only.
Excavation Volume: c�s
Grading Volume:
Soils report required for >5,000 cu. yds.)___ cu. ds.
Fill Volume:
(Fill exceeding 12" in depth shall be compacted to
90% of maximum density).___ cu. yds.
Retaining structure? (Check one) La Rock
❑ CMU
❑ Concrete
❑ Other
Ll
Total new impervious area including all buildings,
sidewalks, and paving: sq. ft.
Site Utilities Plumbing Work:
Complote ',he 'TAN" Plumbing Permit Application for site utilities plumbing work.
P1ann Required: See "Site Work Permit Application - Plan Submittal
Requirements" attached. The following must accom any this application: _
Site Plan with Vicinity Map Parking (including ADA) and
showing ADA compliance Licgl�ting Plan
Grading Plan_and details _ _ Landscaping Plan
Erosion Control Plan and details R_etaininq Structures
Site Utility Plan and details Soils Report (if required)
(showing connection to approved
system)
_ -- -
iAdsts\formsWtechecklist.doc 12/21/00
BUILDING PERMIT
CITYOF T I GA R D -_ PERMIT M BUP2001-00259
DEVELOPMENT SERVICES DATE ISSUED: 7/13/01
13125 SW Hall Blvd.,Tigard, OR 97223 (503) 639-4171 PARCEL: 2S101BB-01500
SITE ADDRESS: 12232 SW GARDEN PL BLD 1
SUBDIVISION: CROW PARK 217 ZONING: C-G
BLOCK: LOT: 003 JURISDICTION: TIG
REISSUE: _ FLOOR AREAS EXTERIOR WALL CONSTRUCTION
CLASS OF VVJORK: 'A I r FIRST: sf N: S: E: W:
TYPE OF USE: COM SECOND: sf _ PROJECT OPENINGS? _
TYPE OF CONST: sf N` S: E: W:
OCCUPANCY GRP: R1 TOTAL AREA: 000 sf RO(-sF CONST: FIRE RET?
OCCUPANCY LOAD: BASEMENT: sf AREA SEP. RATED:
STOR: HT: It GARAGE: sf OCCU SEP. RATED:
BSMT?: MEZZ?: _ READ SETBACKS _ _ REQUIRED
FLOOR LOAD: psf LE_FT: -� ft RGHT: ~ft FIR SPKL: SMOK DET:
DWELLING, UNITS: FRNT: ft REAR: ft FIR ALRM : HNDICP ACC:
BEDRMS: BATHS: IMP SURFACE: PRO CORR: PARKING:
VALUE: �,�-767,00
Remarks: Sprinklers: add (1)and relocate (2).
Owner: Contractor:
RRE.EF REAL ESTATE INV. MGR. AFP SYSTEMS INC
72.0 SW WASHINGTON 19435 SW 129TH
SUITE 710 TUALATIN, OR 97062
P�Pone:TLAND. OR 97206
Phone: 503-692-9283
Reg#: LIC 67534
FEES !�— REQUIRED INSPECTIONS
Type By Date Amount Receipt Sprinkler Rough-In
--
PRMT CTR 7/13/01 $62.50 27200100000 Sprinkler finalFinal Inspection
5PC1- CTR 7/13/01 $5.00 27200100000
Total $07.50
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes
and all other applicable law All work will be done in accordance ✓vith 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 the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952-001-0010 through OAR 952- 0,,-1987 You nay obtain a copy of these rules or direct questions to OUNC by
calling (503) 246- 9 or 1-8 0.3 2-2344.
Pe rm Itt^e
Signature: '
Issued By: ----
Call 639-4175 by 7 p.m. for an inspection the next businsss day
Building Permits Application
J "Dateremceiv"ed: l �� "Pennito.: (.
City of Tigard ��� f t�ojecUappl.no.: Expire date:
Citvr/Tigard Address: 13125 SW Hall Blvd,Tigard,OR 97223
Phone: (503) 639-0171 Date issued: By �k, I Receipt no.:
Fax: (503)598-1960 Case file no.: Payment type:
Land use approval: I&2 family:simple Complex:
;Job
1 &2 Tamil dwelling or accessory +A on mer-' ndustrial U !Multi-tan U1 U New construction U Demolition
Additio altera io eplacement )Tenant improvement ire s nnkle alarm U Other:
address: i iZ j l Bldg.no.: 1um not: Block: Subdivision: —� 7—Tax—map/tax lot/account nu.:
Project name: _ I
Description and location of work on premises/special conditions: '1._ - ' L1 a t Q C .Z -
sINFORMATION,
Name: EC-F ,tcr,�L St pT>r S E �k�fZS (1 loodplain,septic capa011y,War,etc'
u�t rr-1 lr,
Mailin address:l'Z SA_Qa5U4jr, " �� I &2 family dwelling:
City: TIT State:6(1 ZIP: 9-IZ6S Valuation of work........................................
Phone: IFemail: No.of bedrooms/baths.................................
Owner's representative: Total number of floors.................................
Phone: 7 Fax: E-mail:
New dwelling area(sq, ft.) ..........................
Garage/carport area(sq.ft.)......................... ---- - -
Name: -I- IJL Covered porch area(sq. ft.) .........................
Mailing address: ti Tt-t Deck area(sq.ft.) ........................................
City: T L State:r�,2 ZIP: Z Other structure area(sq.ft.).........................
Phone:Co 2.97 Fax: (r E-mail• Commercial/industrial/multi-fnmlly:
tV:auation of work........................................ $
Business name: YS i _f-.I IaC Existing bldg.area(sq.ft.) ..........................
New bldg.area(sq. ft)
Address: I ��5 S I
City"` Stnte:�ZIP:9` NOZ Number of stories........................................ _
Phone:(o Fax:(C .II E-mail: Type of construction.................................... —
Occupancy group(s): Existing:
CCB no.: oi `IS3q -- New: -
City/metro lie.no.: Notice:All contractors and subcontractors are required to he
MUM Kill Wi licensed with the Oregon Construction Contractors Board under
Name: (� 1 t til L.,��t�l� pU provisions of ORS 701 and may be required to he licensed in the
Address: w ttic 3 jurisdiction where work is being performed.If the applicant is
Cit : Lwe State:U2 I 7.1 P:9'1x35 exempt from licensing,the following reason applies:
Contact person: Plan no.: -- --- -
Phone: .C�5 Fax;
Aia
Name: Contact person: _ Fees due upon application ........................... $
Address: Date received:
City: State: ZIP: Amount received ......................................... $ _
Phone; Fax: I E-mail: Please refer to fee schedule.
1 hereby certify I have read and examined this application and the Not all jurisdictions accept credit cards,please call Jurisdiction for more information.
attached checklist. All ovisions flaws and ordinances governing this l]Visa ❑MaatctCard
work will he complied th,whet pecified herein or not. credit card number:
C:Xivires
Authorized �,}nature: _ Date: 1Z��1 Name of catcawldrr as Chown un credit card
Print name: t�R t Q%,1 tNL5AW — $ —
Cardholder signature Amount
Notice:This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. 440 4611(M)WOMt
Fire Protection Permit Check List
A. ❑ New ❑ Addition Alteration ❑ Repair
B.) Modification to sprinkler heads only:
Describe work to 1. 1-10 heads: No ;pian review required.
be done: 2. 11+ heads: Pla�i review required.
Number of sprinkler heads:
3
Additional description of work: ��7 $ 2 2t✓ P ��„�,��Erz�
Type of S stem (Complete A or B as applicable):
_
A. Sprinkler Wet U _ Dry ❑
Standpipes __-— --- –
Additional Hazard
Information Density
Design Area
K. Factor _
Sprinkler Project Valuation: $
B. Fire Alarm_ _--
Submittal shall Batte Calculations Yes ❑
Include: Individual Component Yes ❑
_Cut Sheets__
Fire Alarm Project Valuation: $
Project Valuation Subtotal (A & 13): $
Permit fee based on valuation (see chart): $ _
8% State Surcharge: $
FLS Plan Review 40% of Permit: $
TOTAL: $
1Adstslformslf PSchecklist.doc 10/04/00
` , �� �I���D ELECTRICALELECTRICALPERMIT
CITY
I Tx _
\\ PERMIT#: ELC2001-00329
DEVELOPMENT SERVICES DATE ISSUED: 06!22/2001
13125 SW Hail Blvd., Tici rd, OR 97223 (503) 639-4171
PARCEL: 2S1011313-01500
SITE ADDRESS: 12232 SW GARDEN PL BLD.1
SUBDIVISION: CROW PARK 217 ZONING: C-G
BLOCK: LOT : 003 JURISDICTION. TIG
Prosect Description: Installation of(2) service/feeders 200amp and 18 branch circuits.
_ RESIDENTIAL UNIT_ TEMP SRVC/FEEDERS MISCELLANEOUS _
1000 SF OR LESS: —� 0 200 amp:- PUMP/IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 600 amp: SIGNALWANEL:
MANF HMI SVCI FDR: 601+amps - 1000 volts: MINOR LABEL (10):
_ SERVICE/FEEDER __ BRANCH CIRCUITS _ ADD'L INSPECTIONS
0 - 200 amp: 2 W/SERVICE OR FEEDER: 18 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amn: EA. ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC/FDR >=225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
RRFEF REAL ESTATE INV. MGR. CAPITOL ELECTRIC CO INC;
720 SW WASHINGTON 12810 NE AIRPORT WAY
SUITE 710 UNIT 1
PORTLAND,OR 97205 PORTLAND, OR 97230
Phone: 503-295-5555 Phone: 255-9488
Req#: LIC 048748
SUP 31325
E L E 26-4960
FEES _ Required Inspections—
Type By Date Amount Receipt Elect'I Service
PRf.IT CTR 06/22/2001 $280.30 2720010000( Elect'I Final
EPCT CTR 06/22/2001 $22.42 2720010000(
Total $302.72
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 wok 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 952-001-0010 through OAR 952-001-0080. You may obtain copies of these rules ordirect questions to OUNC at(503)
246M99 or 1$00-332-2344.
Permit Signature: Issued By:J,/
r —.
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: VATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: 4el, 2,,r-7 DATE:
LICENSE NO:
Call 639-4175 by 7:00pm for an Inspection the next business day
i
Electrical [permit Application
Date receive jw a I Permit no.jgeL .-(b
Project/appl.ito.: Expire dude:
City of I tigdrd Date issued: 11Receipl no.:
CIN Of TIGARD Address: 13125 SW HALL BLVD,T11GARD,014 Case file no.: flavmcni type:
Phone: (503)6394171 Fat(503)598-1960 ove"D
Land use Approval: RSC
❑ 1 &2 I'mmily tlewlling or accessory p Commercial/int tstrial Cu�1�1 MEtC�I Multi-I'untily C1 Tenant improvement
Ncwconstrurlinn ❑ Add ❑ (Other: ❑ Partial
—_lXIl!llI!f111§11INN"
Joh addresq: 12232 SW GARDEN PC.. ut Tigard lildk.. No.: Suite nn '('ax tilap/tax lot/account no.:
Lot: _ I',lock:N/A Subdivision: — _
Project name: _ACRYMED IDescription and location of work on premises: Remodel of existing tenant
Estimated date of completion/inspection: 8/1/01
.lob no: 21-848 I v• yin,.
Husiness Name. Cipitol Electric Co.,Inc. De%cri Ilion Ut, I a.t i wai no insp
Address: 12810 NE Airport Way New residential-single or rn dli di:anily per
City: Portland State: OR '1.111: 97230.1029 dwellinitroil. Includes attached Karuke.
Phone: 503-255-9488 Fax 255-9488 E-mail: darrell ce dx coo Service Included:
CCB no.: 48748 111ec.bus,lic.no: 26.496C 1000 sq,11,or less $ 14515
Cityhnetro lic.no.: NIA 0zEach Additional 500 sq tl or puriion thereof 11 1140
Lz �.�:+ % I-,- _ 8119/01 Limited enctfts icsidcntial _ is an
igi more of supervising electrician ttecitine(6 Date I imited energy,non-residential 15 nn
Sup elect.name(print) Darrell McNeal License no 3132-S I ach manufactured home or modular dwelling
Service and/or feeder + 90 nn
Name(print): Spleker Properties Servirm or ferders-Insinllntion,
Moiling address: 4949 SW Meadows Rd Alteration or relocation:
City: Lake Oswego stale Or /11t 200 Amps or less 2 S 80.30 1600 2.
Phone: 503.697-8700 L;u, E-mail: 201 amps to 400 mops S lot,95 2
Owner Installation: The installation is being made on property i own 401 amps to 600 maps $ 160.60 2
which is not intended for sale,lease,rent,or exchange according to 601 Amps to 1000 Amps 1, 24060 2
ORS 447.455.479.670,701. Over 1000 amps or volts % 454 65 2
Utrner'.t signorure. Dale: kcconnect onlN 1 6695 I
'Temporary services or feeders-
Natne: Installation,alterations.or relocation:
Address 200 amps or less
C'itt Stale: ZIP: 201 Amps to 400 amps S ut0,3o
Pholte: I a I -mail: 401 tunes to 600 amps S 133.75 _
ummmmsirru Branch cireuitr-new,alteration,
0 Service nver 225 Amps-cummercinl p llealth-care facility or extension per panel:
ti n i,c .%ei 1216 Amps-rating of I&2 [3 IlalAidons location A Fee for brunch circuits with purchase of
Imnily dwellings ❑naildhtg over 10.000 square a four or service or feeder fee.each branch cn••uit 13 s 6651 1197o 2
I]System neer(100 vols nominal more residential units ht one structure f3. Fee for branch cocuils is ithout purchase
d nuilding over three stories ❑Fecdets,400 ntnps or more of service of Iecdci Ice,first branch cm mi k. 4o g5 1
(3 lkcuPant load over 99 Pelson, ❑Manufactures structures or RV Park Each additional hranch dread � 6s
CJ 139reswiighting Plnn O rnhct Mise.(Service or feeder not Included):
$tllalnit sets or plans yvlth any of Ane Above. F.ach pump or irrigation circle
The abosr rare not Applicable to temporary construction service. Inch sign of outline lighting n
Signal circuit(s)or n limited energy panel.
alteration,or extension' n:t 2
'Description
Fach additional inspectionover th allowable in Any of the al-N r
Per inspection �—I v ` <d
Investigation fee
Other
U Visit 0 MasterCard hermit Ice................ 5 280.30
i redit card nontlet / / Notice-this permit applIL8tion I'Inn review ( I S
expires if a permit is not obtained Slate Surcharge 1-97. ) 22.42
Name of ctndholda n,,town nn credit told withing 180 days after it has born
x TOTALL.............. ... 5 302.72
U,o' t as accepted complete.
Cardholdat sI afore p
CITYOF TIGARD PLUMBING PERMIT _
DEVELOPMENT SERVICES PERMIT#: PI_M2001-00281
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 7/2/01
SITE ADDRESS: 12232 SW GARDEN PL BLD.1 PARCEL: 2S101BB-01500
SUBDIVISION: CROW PARK 217 ZONING: C G
_
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: 2
STORIES: EATERS: CATCH BASINS:TRAPS.
WATER H
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 14
TUB/SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of two 2"floor drains and relocation of two sinks. Other fixtures include capping of 12 sinks and 2
"drench" showers.
Owner: _ _FEES
REEF REAL. r STATE INV MGR, Type By Date Amount Receipt
720 SW WASHINGTON PRMT CTR 7/2/01 $66.40 27200100000
SUITE 710 5PCT CTR 7/2/01 $5.31 27200100000
PORTLAND, OR 97205 PRMT CTR 7/2/01 $58.41 27200100000
Phone 1: 503-295-5555 SPCT CTR 7/2/01 $4.09 272001000o
Contractor: _ Total $134.21
ROWLAND PLUMBING
4524 N LOMBARD
PORTLAND, OR 97203-4799
REQUIRED INSPECTIONS
Phone 1: 285-2.586 Rough-in Insp +--
Reg #: LIC 5628 Underfloor/Underslab
PLM 26-68PB Top-out Insp
Final Inspeclinn
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 aprroved 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 952.0001-0080
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246-1987.
Issued By:
Perinittee Signature: j
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
i
Plumbing Permit Application
Datereceived: r Z 0/ Permitno.:� 20/-40'
City of Tigard no.: Building Address: 13125 SW Ball Blvd,'Tigard,OR 97223 Sewer permit g permit no.:
City u(Tigard Phone: (503) 639-4171 Project/appi.no.: Expire date:
Fax: (503) 598-1960 Date issued: By: Receipt na:
Land use approval: Case file no.: Payment type:
U 1 &2 family dwelling or accessory ..ommercial/Industrial U Multi-family U Tenant improvement
U New construction Addition/alteration/replacement U Food service. U Other:
It SITE INFORMAT,10Niinformation
Job address: ( 3 E�_ }C j= Ucscri tion Qty. hec(ca.) 'Total
Bldg.no.: Suite no.: New 1-and 2-family dwellings only:
Tax map/tax lot/account no.: (includes 100 A.foreachudlilyconneclimi)
SFR(1)bath
Lot: Block: Subdivision: SFR(2)bath- --_--- -- -
_Project name: M _ SFR(3)bath
City/county: GIP: Each additional bat'dkitchen
Description and location of work on premises:— Siteut8itles:
Catch basin/area drain
Est.date of completion/inspection: Drywells/leach liticArench drain
Footing drain(no.lilt.ft.)
_ O� D m a/� Manoletured home utilities
Business name: Manholes
Addret:s: Z[} ),L.p Ott SA lq D Rain drain connector
City: State:ORI ZIP:C020-j-5 p'sj Sanitary sewer(no. lin. ft.)
Phone.5D3-2 - Fax:45-p E-mail: Storm sewer(no. lin.ft.)
CCB no.: S(oZ_ r,",',1Plumb.bus.reg.no:Z(o`(o Water service(no.lin.ft.)
Cit metro c.no.: 3a o -z--
Fixture or Item:
Con ctor's representative signature: ? Absorption valve
— Back flow preventer
Print name: t'1"[4 1Il 2 Fq Date: Backwater valve
Basins/lavatory
Name: F - Clothes was
Address: - Dishwasher
Drinking fountain(s) _
City: State: ZIP: Ejectors/sump
Phone: T;t E-mail: Expansion tank
Fixture/sewer cap
Name(print): Fluor drains/floor sinks/hub
Mailing address: Garbage disposal
Nose bibb
City: State: ZIP: Ice maker
Phone: Fax: E-mail: Interceptor/grease trap _
owner installation/residential maintenance only: The actual installation Primer(s) _
wi!I be made by me or the maintenance and repair made by my regular Roof drain(commercial)
employee on the property I own as per ORS Chapter 447. Sink(s),hasin(s),lays(s)
Owner's signature: Date: Sump
Tubs/shower/shower pan
Urinal
Name: Water closet
Address: - _ Water heater _
City: State: ZIP: Other:
Phone: Fax: E-mail _ Total
Not all jurisdiction&accepi credit cards,please call jurisdiction for mrue inl'ot mniian. Notice:This permit application Minimum fee................$ —_—.—
U visa U MasterCard expires if a permit is not obtained Plan review(at _ %) $ _
Credit card number _ / within Inti days ager it has been State surcharge(8%)....$
Expires TOTAL .......................$
Name or cardholder as shown on credit card accepted as complete.
S _
Cardholder signature Amount 41()-1616(~'OM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2-family dwellings only:
FIXTURES_ (individual) QTY ea AMOUNT (Includes all plumbing fixtures in PRICE TOTAL
Sink 16.60 _33') the dwelling and the first100 ft. QTY (ea) AMOUNT
16 60 for each utility connection)
Lavatory One 1 bath _ _ $249.20 _
Tub or Tub/Shower Comb. _ 16.60 Two 2 bath $350.00
Shower Only 16.60 Thre13 bath_ f $399.00
Water Closet 1660 — — -
_ � SUBTOTAL
Urinal 16.60 8%STATE SURCHARGE
Dishwasher 16.60 PLAN REVIEW 25%OF SUBTOTAL
Garbage Disposal Y 16.60 TOTAL
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain/Floor Sink 2" 1650 '20 3" 16.60 ;PLEASE COMPLETE:
4^ 16.60
Water Heater O conversion O like kind 1660 CluantIty b f Work Performed
Gas piping requires a separate mech,:nical Fixture Type: New Moved Replaced Removed/
permit. _ Capped
MFG Home New Water Service 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory
Hose Bibs 16 60 Tub or Tub/Shower
Combination _
Roof Drains 16.60 Shower Only1
Drinking Fountain 16.60 Water Closet
Urinal _
C ,< cWres(Specify) Dishwasher _
e `y'. O Garbage Disposal
Laundry Room Tra
Washing Machine
1 i Floor Drain/Sink: 2"
Sewer-1 st 100' 55.00 3"
Sewer-each additional 100' 46.40 4" _
Water Service-1st 100' 55.00 Water Heater
Water Ssrvlce-each additional 200' 46.40 Other Fixtures
(Specify)
Storm 6 Rain Drain-1st 100' 55.00
Storm 8 Rain Drain-each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device' 27.55 —"- — —
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 72.50 _
Requested Inspections erRtr COMMENTS REGARDING ABOVE:
Rain Drain,sing�a family dwelling 65.25 _
Grease Traps _ 16.60 - ----"—
QUANTITY TOTAL
Isometric or riser diagram Is required 11 —
Ouantity Total is >9 _
'SUBTOTAL -
8%STATE SURCHARGE �O — -- --
"`PLAN REVIEW 25%OF SUBTOTAL
_ Roquired only it fixture qty total Is>9 _
TOTAL
*Minimum permit fee is$72 50•8%state surcharge,except Residential Backflow
Prevention Device,which is 138 25•8%slate surcharge
"All NewCommercisl Buildings require plans with Isometric or riser diagram and
plan review
I:\dsts\forms\plm-fees.doc 10110/00
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BLIP _
Date Requested -AM---PM _ BLD
Location e-L a--3� �� S 4e �_� MEC —
Contact PersonPh.; , PLM
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR _
Footing Access:
Foundation FPS
Ftg Drain SGN -
Crawl Drain Inspection Notes: --
Slab
Post&Beam ---- - SIT _
Ext Sheath/Shear
Int Sheath/Shear -
Framing �' 4 O✓�'c�"� J4'e� jA ,"---e04 �eT C 4f1✓w�rlam-} 01•
Insulation //
Drywall Nailing Q��_ a c e�S � a `jt✓e /�jReI.1 'r���t -__ -
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
--------- --
Roof
Misc: --__----
Final
PASS PART FAIL
PLUMBING
Post& Beam -- ---- - -- --- - -
Under Slab
Top Out - - ------ - - - -------
Water Service
Sanitary Sewer - - - -- ---- - -----
Rain Drains
na j
S PART FAIL
Wiff-HANICAL
Post&Beam
Rough In
Gas Line
Smoke Dampers
Final -- - - -
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG/Slab _--
Low Voltage
Fire Alarm �—
Final
PASS PART FAIL
SITE
Backfill/Grading --- - ---- ---
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin Please call for reinspection RE:
Fire Supply Line [ ] P __ [ ]Unable to inspect-no access
ADA
Approach/Sidewalk '
Other Date — Inspector %� y=e • _Ext
Final
PASS PART FAIL 00 NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 �-- - —�—
BUP
Date Requested ) — 1 AM PM SLD
Location ,� �- �� �.- �1 �� _ Suite MEC
Contact Person �� � ,uy Ph �S l� — �3gi .:Z PLM
Contractor _ Ph SWI2
BUILDING F! Tenant/Owner e C ELC: r�oGr va 3 Z
Retaining Wall _ ELR
Footing Access
Foundation FPS
Ftg Drain �— SGN -
Crawl Drain Inspection Notes -
Slab ___.. -- SIT
Post& Beam -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall � ------- -_---- ----------
Fire Sprinkler
Fire Alarm _
Susp'd Ceiling - -- - - -- --- -- - --
Roof
Misc: --
Final
PASS PART FAIL ----- 42 --
PLUMBING
Post&Beam _-
Under Slab
Top Out — -
Water Service _
Sanitary Sewer
Rain Drains
Final ----
PASS PART FAIL I
MECHANICAL
Post&Beam - -- - - ---
Rough In
Gas Line
3moke Dampers
Final -- ---- --- ---- ------
PASS PART FAIL
ELECTRICAL --- _ ----_...__---------.__,____—_--
Nouoh In
UG/Slab
Low Voltage I ' t i
Fire Alain
PASS AFT FAIL
Backfill/Grading - — - -- --
Sanitary Sewer
Sloan Drain ( 1 Reinspection fee of$ _ required before next inspection Pay at City Hall, 13125 SW Hell Blvd
Catch Basin ( ( Please call for reinspection RE: _- .� _ ( I Unable to inspect-no access
Fire Supply Line
ADA
Approach/Sitlewalk - �-
Other _ Date 40Inspector,. _ c Ext
Final
PASS PART FAIL 00 NOT REMOVE this Inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24-Hour Inspection Line: 639-4175 Business Line: 63'9-4171 —
BUP
Date Requested— AM PM BLD —
Location -� � � �-- ��� 114,0—Suite MEC
Contact Person t X t%�c'.C� Ph .i PLM _
Contractor � r .7)e-'?- 1V-94 Ph SWR
BUILDING Tenant/Owner —_ �' E L C
Retaining Wall ELR _
Footing Access: FPS
Foundation —
Ftg Drain SGN
Crawl Drain Inspection Notes. -i-
Slab -------.----- _ ----- SIT
Post& Beam —
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation —--- -_ ^ ------- ^
Drywall Nailing -- -- - --
Firewall
Fire Sprinkler - -- - --- -- ----- ------------
Fire Alarm < -'
Susp'd CeilingRoof
Misc:_ -- --- ..__.�_- _T ---- ---
Final •---- _--- -
PASS PART FAIL --
PLUMBING — --- - -- - —
most&Beam _Under Slab
fop Out
Water Service
Sanitary Sewer
Rain Drains
Final
PASS PART FAIL
MECHANICAL
Dost&Beam -- - ---. - -- --- ----- �— _— ----
Rough In
Gas Line - _._._. -- ------ --- --
Smoke Dampers
Final ----- _ ------ - -------------—---- --------
PASS PART FAIL
ELECTRICAL �----- -�-----�----
Service
Rough In _ ------------------__-- _--_
UG/Slab — --- ---- --- -------- ---
l_ow VoltagL-
Fire Alarm _-._..__-.- ------------------.------__-._�__ __ --
PASS ART FAIL. --- - -- - — - -- -----�.-_.�---
Backfill/Grading ---
Sanitary Sewer
Storm Drain [ ]Reinspection fee of$_ _required before next inspection Pay at C,ty Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line ( J Please call for reinspection RE: j Unable to inspect- no access
ADA 1 _
Approach/Sidewalk Date
Other ! 'z _Inspector Ext
Final
PASS PART FAIL 00 NOT REMOVE this inspection record from the job site.