Permit ~ ' CITY O
DEVELOPMENT SERVICES PLUMBING PERMIT
11. 13125@W Hall BAvd., Tigard, QR97223 (03)039-4171 PERMIT #. . . . . . . : PLM96-0359
DATE ISSUED: 11/27/96
PARCEL: 2S110AA-00300
SITE ADDRESS...: 14145 SW 105TH AVE
SUBDIV�SI8N.^. . :' ` - ZONING: R-12
• BLOCK..........: LOT.............:
CLASS OF WORK..:ADD GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:COM / • WASHING MACH,—.: 1 BACKFLOW PREVNTRS.. : 0
OCCUPANCY GRP..:I1.2 FLOOR DRAINS ^ 0 TRAPS,...........: 0
STORIES—. ^ 0 • WATER HEATERS• • : 0 CATCH BASINS . ^ 0
FIXTURES LAUNDRY TRAYS.....: 0 SF RAIN DRAINS.....: 0
SINKS. .'�....'� .'. 2^ • .' ' 'jURINALS. .'.���.��. .^��' ' • 0` • GREASE TRAPS ~ 0
.
LAVATORIES ^ 1 OTHER FIXTURES ^ 1
TUB/SHOWERS.'. 1 -` '` ' SEWER' LINE, (ft)~ -. : . 0
WATER CLOSETS'.: 1 WATER LINE (ft)...: 0
DISHWASHERS.. . . : 0 . RAIN DRAIN (ft).. . : 0 � .
Remarks: Installing 2 sinks, 1 lay, 1 shower, 1 toilet, 1 washing machine, and a
mop. sink -'
, . ' 'FEES, ` '
TIGARD MEDICAL & REHAB type amount by date recpt
SUNRISE HEALTHCARE. ^ . . PRMT^ $ , 63.00. JSD 11/27/96 96-287031
14145 SW 105TH AVE 5PCT $ 3.15 JSD 11/27/96 96-287031
TIGARD OR 97224 .
Phone #: •
Contractor:
J & S PLUMBING
6101 NE ST JOHN RD._
'
VANCOUVER WA. 98661 -
Phone #: 360-693-4648 $ 66.15 TOTAL
Reg #—:. 009068.-
, . .' REQUIRED INSPECTIONS
This permit is issued subject tntho regulations contained in the Top-out I
Tigard Municipal Codp, State of Ore.. Specialty and all. other . ' Final, Inspection
applicable laws. All^work iwaccordance with . • .
approved .plans. : expire , if - work is not otarted. . ••
within .18N days , of [or if work. is,sospended^fonAmone ~ • ' ' "
than 180 days:. � . • '� � ` ` • � ' ` '/' � • . ' '
' `�
. .`
Permitt �N������y°� `� �` `� „/.
Issued ��EI�
� •
• Call. for inspection - 639-4175
":3ITY OF TIGARD Plumbing Application Recd By 5 -Mi .v V'd
13125 SW HALL BLVD. Commercial and Residential Date Recd 11 - Z I
IGARD, OR 97223 Date to P.E.
• Date to DST
(503) 639 -4171 Permit a r fr b -635
Print or Type Related SWR x %(v - We
Incomplete or illegible applications will not be accepted Called /f - LS - /l ,
i
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
'
•
Job 1 c)cl�tc,\ in t ca, i ki- q.8 Sink a 9.00 + (�
Address 5t eel Address /'� Suite Lavato
L� Li5 S IA I OS I 9.00
Tub or Tub /Shower Comb. 9.00
Bldg 5 City /State Zip Shower Only 9.00 CI
I■ q edz A OK Water Closet I 9.00 q
I Name 2\ Dishwasher I` 9.00
1ef Mailing Address Suite Garbage Disposal 9.00
Washing Machine 9.00 GI
• City /State. Zip Phone .5 Floor Drain 2' 9.00
Name
w LI -6993 3 9.00
. 4 9.00
Occupant Mating Address Suite Water Heater 9.00
•
Laundry Room Tray 9.00
City/State Zip Phone Urinal 9.00
Name Other Fixtures (specify) P s J• 9.00
7 J'J Mbt 1'�� - -- 9.00
Contractor Mailing Addressss 3 1\ - Suite 9.00
(0SI 0 f1! E J 1 -, N� 9.00
CtyiState Zi Phone 361`.)
Ynr�(.0ve -eP 1JA v/46��1 6 53 '116,14 A 9.00
9.00
Oregon CConst. / Cont. Board Lies p. Date
Afrdcl■ Copy of b0 1 0( ,9 ' '/ d -9
7 9.00
Current Plumbing Lic- s p. Date_ Sewer - 1st 100- 30.00 ' • Licensee -3 -+39 0 '4- /4
Sewer -each additional 100' 25.00
COT Business Tax _orr Metros p. Datee Water Service - tst 100'
d0� 25Sto iE -_ / 30.00 •
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st 100' 30.00
Or Mailing Address Site Storm & Rain Drain - each additional 100' 25.00 I
Mobile Home Space 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
( Jesa+Ds work New O Addition Alteration 0 Repair O Residential Backflow Prevention Device' 15.00
to be done: " Residential 0 Non- residential 0 Any Trap or Waste Not Connected to a Fixture l 9.00
additional pesaiptcon of work Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per /hr
.4sang use of
Spectaily Requested Inspections 40.00
oerihr
^9property Rain Crain. single family dwelling 30.00
Proposed use of Grease Traps 9.00
budding or property II
QUANTITY TOTAL
, Are you capping . moving or replacing any fixtures? Yes o No ❑ Isometric x riser diagram s reguirea f Cuanrty otal is > 9
(If yes see back of tom) 'SUBTOTAL (1(6 p0
I hereby acknowledge that I have read this application, that the information
' given s correct, that I am the owner or authorized agent of the owner. and 5% SURCHARGE i
that plans Submitted are in compliance with Oregon State Laws. - )
Signature of er /Agent Date PLAN REVIEW 25% OF SUBTOTAL
ReouRequired d fixture only cture oty. total is > 3 .,��
�I{l\ l f ] q 1 TOTAL i / (0(0,15
I Contact Persdn Name ' Phone hone )
I *Minimum permit tee is 525.- 5% surcharge. except ResidentiallBautflow�,
Prevention Device. which is 515 + 5% surcharge
i:\dsts\plmapp.doc 8/96
1t -
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty .
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
•
COMMENTS REGARDING ABOVE:
Tenant Name: I t d WO Accumulative Sewer Tally This SWR #:
Address: 1 L( Lk) )r)c`i"v" This PLM #: %- 0
Fixture Value Previous # Previous Credits Capped Fixtures Fixtures New New
Value Capped off value added # added total #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4 I 4 i L+
- Jacuz/Whpl 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commer 4
- Domest 2
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2 I Z / Z
- 3 inch 5
- 4 inch 6
- Car Wash Drain 6
.. Garbage Disposal 16
- Dom (to 3/4 HP)
- Comm (to 5 HP) 32
- Ind (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
K Oil Sep (Gas Station) 6
f Recreational Vehicle Dump Station 16
Shower - Gang (Per Head) 1
Stall 2
.Sink - Bar /Lavatory 2 I Z 1 Z
- Bradley 5 I
- Commercial 3 _ ` 2 Co Z to
- Service 3
Swimming Pool Filter 1
Washer, Clothes 6 _ I (-0 I
Water Extractor 6 •
r /-
Water Closet, Toilet 6 I (A 1 Li
Urinal 6
TOTALS
1 2 - 0 ' Zl.o
Total fixture values: 7 divided by 16 = 1-1(g10 2-S EDU __ Z-- "4. ckuc
HISTORY Pi qz, m(, was vo OA Z 2D
PLM #.3 ?j EDU# L}S SWR# 1it — GU2:1 PLM# EDU# SWR#
PLM# EDtU# `T5 SWR# , DE y PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
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l _ _ 0_ 4/IL _I �- - //
CITY OF / GARD BUILDING INSPECTION NOTICE -- i i
Inspection Line: 639 -4175 Business Phone: 639 -4 7
Footing Rain Drain Cover /Service FINAL: •
Foundation Water Line Ceiling - Plumb.
Post/Beam Mech. Shear /Sheath Framing -Mech.
PIbg.Und /FIr /Slab Glbg. Top 03 Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. dg.
San. Sewer Gas Line Appr /Sdwlk ifill
Other:
Date: /0 I ( co `
A.M. P.M. �/,Entry:
/ ,
Address: / � / l 6 . '
Tenant: Ste: MST:
BUP:
Con /Own: MEC:
PLM.
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
. e s ..... ,,...____
.., .....
(j41 c ys 7ii Z1
Inspector: - Date/Ge/
APPROVED I SAPPROVED /CALL FOR REINSP. / / CF CO
CITY OF TIGARD BUILDING INSPECTION NOTICE
Inspection Line: 639 -4175 Business Phone: 639 -4171
Footing Rain Drain Cover /Service FINAL:
Foundation Water Line Ceiling - Plumb.
- Post/Be m nnarh. Shear /Sheath Framing -Mech.
Und /Flr /Slab Plbg. Top Out Insulation - Elect.
Post/Beam Struct. Mech. Rough -in Gyp. Bd. -Bldg.
San. Sewer Gas Line Appr /Sdwlk Reins.
Other: ' �L4—
Date: `9 3 7(.2 A.M. P.M.. Entry:
Address:
Tenant: Ste: MST:
t // BUP:
Con /Own: c l5 ' ( - . 7 3 L �v MEC:
PLM:
ELC:
THE FOLLOWING CORRECTIONS ARE REQUIRED: ELR:
Inspector: ' Date: /Z /'
- ROVED DISAPPROVED/CALL FOR REINSP. CF CO