Permit (187) 7A5
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C ITY O TIGARD PLUMBING PERMIT
�I DEVELOPMENT SERVICES PERMIT#: PLM2002-00504
a- ��J II 13125 SW Hall Blvd., Tigard, OR 9722 (503) 639 -4171 DATE ISSUED: 3/14/03
SITE ADDRESS: 16200 SW PACIFIC HWI
Y PARCEL: 2S115BA -00101
SUBDIVISION: TIGARD TOWNE SQUA E ZONING: C -G
BLOCK: LOT: 001 r - JURISDICTION: TIG
CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS: TRAPS:
STORIES: 1 WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 200 ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: 200 ft
Remarks: Phase 1, Lease A, site utilities. 4/25/03, added 200' of sanitary sewer service.
FEES
Owner:
Description Date Amount
BIT HOLDINGS LTD PARTNERSHIP [PLUMB] Permit Fee 3/14/03 $189.60
BY FORUM PROPERTIES INC
FIVE CENTERPOINTE DR STE 290 [PLMPLN] Plan Review 3/14/03 $47.40
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 3/14/03 $15.17
[PLUMB] Permit Fee 4/25/03 $101.40
Phone : [PLMPLN] Plan Review 4/25/03 $25.35
Contractor: [TAX] 8% State Tax 4/25/03 $10.14
MT HOOD LAND DEVELOPMENT INC Total $389.06
PO BOX 1432
SANDY, OR 97055 REQUIRED INSPECTIONS
Phone : 503 - 826 - 1412 Water Line Insp
Storm Drain Insp
Reg #: LIC 88843 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
_ / �
/ j /
�� __ Permiftee Signature / � "''l '
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next • usiness day
A w1 CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2002 -00504
lli; DEVELOPMENT SERVICES DATE ISSUED: 3/14/03
13125 SW Hall Blvd., Tigard, OR 97223 (50 639 -4171
SITE ADDRESS: 16200 SW PACIFIC HY� �I v PARCEL: 2SI 15BA -00101
W
SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G
BLOCK: LOT: 001 • JURISDICTION: TIG
CLASS OF WORK: GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: 1 WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: 200 ft
Remarks: Phase 1, Lease A, site utilities
FEES
Owner:
Description Date Amount
BIT HOLDINGS LTD PARTNERSHIP
BY FORUM PROPERTIES INC [PLUMB] Permit Fee 3/14/03 $189.60
FIVE CENTERPOINTE DR STE 290 [PLMPLN] Plan Review 3/14/03 $47.40
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 3/14/03 $15.17
Phone : Total $252.17
Contractor:
MT HOOD LAND DEVELOPMENT INC
PO BOX 1432
SANDY, OR 97055 REQUIRED INSPECTIONS
Phone : 503 Water Line Insp
Storm Drain Insp
Reg #: LIC 88843 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
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bu mess day
Site Utilities
Plum Permit Application Plumbing FOR OFFICE USE ONLY
Received ? A
Date/By: 1 a FIR
Permit No.: ' a , `� -oeJre V
Planning Approval Sewer
City of Tigalr, VEp Plan Planning Permit
13125 SW Hall Bl{� Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 - 639 -4171 'r... 92)60 Post - Review Land Use
�� /r �nru r di ��� � Date/By:
ontac Case No.:
®
Internet: www.Ci.tigard...us �� C•I I Contact Juris.: See Page 2 for
24 -hour Inspection Raint :13163 $B5 Name/Method: Supplemental information.
BUILDING DIVISION
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
❑ New construction ❑ Demolition . Description I Qty. I Fee(ea.) I Total
❑ Addition/alteration/replacement ❑ Other: New 1- & 2- family dwellings
CATEGORY OF CONSTRUCTION (includes 10 ft. for each utility connection)
SFR (1) bath 249.20
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00
['Accessory Building ❑ Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: A (.="2..420 S kv iPAc. Ft c. Hwy Site Utilities
Suite #: I Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: F6 .r Tcao. a.p"fio' wt4.Sc,� Footing Meath (no. linear drain 16.60
Footin drain (no. linear ft.) Page 2
Cross street/Directions to job site: _Manufactured home utilities 110.00 _
Manholes 16.60
Rain drain connector Z 16.60 3 3 20
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer (no. linear ft.) Page 2
Tax map /parcel #: Water service (no. linear ft.) Page 2
Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
I KSpI Karr ?t ex rub L.i KIN Fi4301 Backflow preventer Page 2
_X is r i 1y., Sfie..tricti;k Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
-] PROPERTY OWNER 1 ❑ TENANT Ejectors/sump 16.60
Name: S (tt y1F,PtT ftofiverrea LL, Expansion tank 16.60
Address: 1 121 SAX 541-ellvrct S-tl'TE 40:2 Fixture/sewer cap 16.60
City/State /Zip: P X7 p Qe e7 2.S Garbage drain/floor disposal sink/hub 16.60
� ) Garbage disposal 16.60
Phone: 242^ 2i0 C79 Fax: 2.74- Q) 5 Hose bib 16.60
❑ APPLICANT ❑ CONTACT PERSON Ice maker 16.60
Name: Interceptor /grease trap 16.60
Address: Medical gas - value: $ Page 2
Ci City/State/Zip: Primer 16.60
tY P Roof drain (commercial) 16.60
Phone: I Fax: Sink/basin/lavatory 16.60
I E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
Business Name: lylt . / At,.-.r/ O..riv -- l. Water closet 16.60
Water heater 16.60
Address: P 0. l3 Q-)/ Ai-31- Other:
City/State /Zip: _vi j OE_ 9 70 0 C Other: 5t c. 15c,, ,4o
Phone: 503 -6 a&-/ y/ Z Fax.o3 ,9 A 6 - p-/a3 Plumbing Permit Fees*
Subtotal $ j R 9 . cao
CCB Lic. #: kigyri.3 Plumb. Lic. #: Minimum Permit Fee $72.50 $
Authorized La - Sr _p 3 Residential Backflow Minimum Fee $36.25 •
Signature: �� Date: 3 /G -4-3 Plan Review (25% of Permit Fee) $
FR R N /C I NA/ S' OA, State Surcharge (8% of Permit Fee) $
(Please print name) TOTAL PERMIT FEE $
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\Dsts\Permit Forms \PlmPermitApp.doc 01/03
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
L = 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 .55.6Q Medical Gas Systems:
Water Service - each additional 100' 46.40 Valuation: Permit Fee:
Storm & Rain Drain - 1st 100' 55.00 Ej; . $1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' I • 46.40 ( , $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
additional $100.00 or fraction thereof, to and
Fixture or Item Qty. Fee (ea) Total 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
each additional $100.00 or fraction thereof, to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 _ $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: �: J each additional $100.00 or fraction thereof.
15M to
Fixture Work:
Are you capping, moving or replacing existing fixtures ?. If
"yes ", please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees *.
Quantity by (Fixture) Work Performed Comments regarding fixture work:
Fixture Type: Replace •
New Moved Existing Capped
Baptistry/Font
Bath - Tub /Shower
- Jacuzzi/Whirlpool
Car Wash -Each Stall
-Drive Thru
Cuspidor/Water Aspirator
Dishwasher - Commercial
- Domestic
Drinking Fountain •
Eye Wash
Floor Drain/sink - 2"
_3" -
4 „ -
Car Wash Drain *Note: If the fixture work under this permit results in an
Garbage - Domestic
Disposal Commercial increase of sewer EDUs, a sewer permit will be issued and
- Industrial fees assessed for the sewer increase must be paid before the
Ice MachiRefrig. Drains plumbing permit can be issued.
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar /Lavatory
- Bradley
- Commercial
- Service
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet •
Urinal
Other Fixtures:
i:\Dsts\Permit Forms\PlmPermitAppPg2.doc 01/03
CITY OF TIGARD • 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Lid ' (503) 639 -4171 MST
BUP
Received Date Reques ed 6- AM P BUP
Location /4' 3.06 Suite MEC
Contact Person Gr-1/ Ph ( ) a - 0 - • PLM (7 d `il
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final •
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Ot r:
' ASS 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: 0 Unable to inspect — no access
Fire Supply Line
ADA Z 3 Ins ector Ext
Approach/Sidewalk Date p
Other:
Final DO NOT REMOVE this Inspection record from the job site.
PASS PART FAIL