Permit (94) CITY TIGARD PLUMBING PERMIT
L DEVELOPMENT SERVICES PERMIT #: PLM2000 -00292
�,� � DATE ISSUED: 8/8/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S 115AB -01900
SITE ADDRESS: 16200 SW PACIFIC HWY E
SUBDIVISION: 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: FLOOR DRAINS: • 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 5 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Tenant improvement. Capped one floor drain, and added one new one. Added 5 new sinks, increasing the
fixture count from 469 to 484, for an increase of one (1) DU (see sewer permit).
FEES
Owner:
Type By Date Amount Receipt
BIT HOLDINGS LTD PARTNERSHIP PRMT DLH 8/8/00 $80.50 0004239
BY FORUM PROPERTIES INC 5PCT DLH 8/8/00 $6.44 0004239
FIVE CENTERPOINTE DR STE 290
LAKE OSWEGO, OR 97035 Total $86.94
Phone 1:
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED INSPECTIONS •
Phone 1: 503 - 642 -7323 Rough -in Insp
Underfloor /Underslab
Reg #: LIC 00000241 Top -out Insp
PLM 26 -162PB Final Inspection
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature: ' /L-E6
all ( 503) 639 -4175 by 7 :00 P.M. for an inspection needed the next business day
. CITY OF. TIGARD Plumbing Permit Application Plan Check*
13125 SW HALL BLVD. Commercial and Residential Rec'd By .2 �,/
TIGARD, OR 97223 I Date Rec'd A/ y /a-
(503) 639 -4171 / j Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit* / -60,2 9;
Related SWR #.207I7J -00.233
Called 6 /i e_ d' /ti/o
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job r - , `g Sink y 11.50 wy �
Address Str- /..dress 6 ,_ v� it Lavatory / 11.50
7 6 , 0v . c,>�G4 c ,. s' Tub or Tub /Shower Comb. 11.50
Bldg # City /State if Zip Shower Only 11.50
Name � i% Water Closet 11.50
fir4 f , Urinal , 11.50
Owner M Address Suite Dishwasher 11.50
• Garbage Disposal 11.50
City /State Zip Phone Laundry Tray 11.50 • Name • Washing Machine /Laundry Tray I 11.50 f/, SV
/2 M a. 4 ' Floor Drain/Floor Sink 2" i 11.50 g
Occupant Mailing Address Suite 3" 11.50
. 0.9* 4" 11.50
City /State Zip Phone _
Water Heater 0 conversion like kind 11.50
Name Gas piping requires a separate echanical permit. I I.�
A AC-4;' nl Jam { ■ VA F G • MFG Home New Water Service 32.00
Contractor Mailing Address (" `s Suite MFG Home New San/Storm Sewer 32.00
Coq ogOD .S(a) Me!(o el Hose Bibs 11.50
Prior to permit City/State Zip Phone Roof Drains 11.50
issuance, a copy Seatieif fcv, Ol_ ci D(a Vo`i'Z - 4323 11.50
Drinking Fountain
of all licenses are Oregon Const. Cont. Board Lic.# Exp. ate
Other Fixtures (Specify) 15.00
required if 2i4 I �y Q 2o f of
expired in COT Plumbing Lic. # Exp. Date
database Z(,- 1!02r6 _ (o13oIoi
Name
Architect Sewer - 1st 100' 38.00
Or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City/State Zip Phone Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New OIC Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial
Additional description of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device' 19.00
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No 0 Inspections per/hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL
that plans submitted are in compliance with Oregon State Laws. gtf,)610
Slgna ref weer /Age Dee/ 8% SURCHARGE
e......-1 ,� ! o o y Y
Con Person Name Phone
**PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if fixture qty. total Is > 9 in 2 BATH HOUSE $250.00_ , TOTAL y
3 BATH HOUSE $285.00 ;, -..
;;(This fee (deludes all plumbinkflxtures In the (wellIng and the first , 'Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
j00 feet of sanite, t ' sewer storm sewer and water service) :• , Device, which Is $25.+ 8% surcharge
"Ail New Commercial Buildings require plans with isometric or riser diagram and
plan review.
lldstsVormslplumapp.doc 11/18/99
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
Sink 1''
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray ='/ C° 1,�,/r /
Washing Machine
Floor Drain /Floor Sink 2" f /
3"
4"
Water Heater r/
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
•
1:ldstsVorms\plumapp.doc 11/18199
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
'24;Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/� BUP
1 7/4/ Date Requested Z 5 - --66 AM PM BLD
Location / 2 2.e4 �-k) ( y t MEC
Contact Person /TVl / Ph 73z3 PLM c aO
Contractor Ph SWR
BUILDING Tenant/Owner ELC
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
K. /
Firewall
Fire Sprinkler
Fire Alarm G7 ( fin r
Susp'd Ceiling • i
Roof
Misc:
Final
PASS PART FAIL
AergEOND
Post & Beam •
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
P •f-� PART FAIL •
MECHANICAL
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
Fire Supply Line [ ] Please call for RE: [ ] Unable to inspect - no access
ADA
Other p1 Ir Approach/Sidewalk Date s 7 0 Inspector 76 iv Ext
Final
PASS PART FAIL DO 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 .5-- AM PM BLD
Location / .0 .S 6 1/ Orr C / • c Suite ME
Contact Person Ph ‘e/ Z,-- ?,3 Z3 L 2e1/' -G 00 2.
Contractor Ph SWR
BUILDING Tenant/Owner ELC
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 l /c
Drywall Nailing / S p 6 ' G. - 5 / 5 /7 dc;~ 6(_20//
Firewall l /
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
23= f431 /
am
Under Slab
Top Out II/ v �.t,
Water Service
Sanitary Sewer
Rain Drains
F
PAS PART FAIL
AN IC A L
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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date g - - Inspector Aso I / _? . Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.