Permit _---_- -__---_____-_ "=` '
PLUMBING PERMIT
PERMIT #.......: PLM96+D013
larm �� ���� TIGARD DATE ISSUED: 01/29/96 1 ~�~ ~
1 4, COMMUNITY DEVELOPMENT DEPARTMENT
• 1o1osSw Hall Blvd. Tigard, Oregon mr22oom9(50oo39-4n1 PARCEL: 2S110AA-00300
SITE ADDRESS...: 14145 SW 105TH AVE
1 SUBDIVISION....: ZONING: R-12
BLOCK..........: LOT.............:
___ ____ ___ ______ _ ______
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE....:COM WASHING MACH......: 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:B2 FLOOR DRAINS......: G TRAPS..............: 0
STORIES........: 5 WATER HEATERS ^ 0 CATCH BASINS.......: 0
FIXTURES--- --- LAUNDRY TRAYS.....: 0 SF RAIN DRAINS.....: 0
SINKS..........: 1 URINALS...........: 0 GREASE TRAPS.......: 0
LAVATORIES.....: 0 OTHER FIXTURES....: 0 , �
�
TUB/SHOWERS....: 0 SEWER LINE (ft)...: 0 ���
....
' _/}\ ` / k~ «
WATER CLOSETS..: 0 WATER LINE (ft)...: 0 � ��
DISHWASHERS....: 0 ' RAIN DRAIN (ft) ... . f'd
" : 0 �Remarks: INSTALL 15 x 15 BAR SINK
Owner: ------- ---- FEES - -
TIGARD MEDICAL REHAB type amount by date recpt
14145 SW 105TH AVE PRMT $ 25.00 JSD 01/17/96 96-274984
. 5PCT $ 1.25 JSD 01/17/96 96-274984
TIGARD OR 97224 ^
Phone #: .L"
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- -
T[
Conractor: - UU- -~
MP PLUMBING CO ^���
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MILWAUKIE PLUMBING CO /��� «
J� `~ -
PO BOX 393 , keJ
CLACKAMAS OR 97015 --------- ---��-
Phone #: 655-9161 $ 26.25 TOTAL
Reg #..: 083196
REQUIRED INSPECTIONS -------
This poroit is issued subject to the regulations contained in the Rough-in Insp _ _ __
Tigard Municipal Code, State of Ore. Specialty Codes and all other PLM/Underfloor ____ ___
applicable laws. All work will be done in accordance with Top-out Insp _____ ___
approved plans. This permit will expire if work is not started Final Inspection _____ ___
within 180 days of issuance, or if work is suspended for sore ___ _ _ _ ______
than 180 days.
r -- --�---'- ----
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__ __
Permittee S. �re: . _____� ____ __ ____
___��
41 11105 17
' *, ___- _____
Issued � ,�'` ` _ ____ __ . __
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Call for inspection - 639-4175
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O( _ 1 �9(P
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # fi(' _ 2/ ( C
13125 SW Hall Blvd. Permit # (t1 9(_i '?
Ti'gardt OR 97223 5 96_ crt
(503) 639 -4171 '
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Development New Single Family Residences Only
Address ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job !q/ 93-- 0 LAD 105 ❑ 3 BATH HOUSE $225.00
Address aty� a_te ZIP Fee includes all plumbing fixtures in the dwelling and the first 100 feet
�
">.t q 70- 3 q of water service, sanitary sewer and storm sewer. See fees below.
Name ( me of Business) FIXTURES . QTY PRICE AMT
Sink 151 is l 5 , :nit-- / 9.00 ci Do
Mai&,o Address PhOAe Lavatory 9.00
Owner Tub or Tub /Shower Comb. 9.00
City /State • LP Shower Only 9.00
Water Closet 9.00 .
Na (or name of business) Dishwasher 9.00
�� O�( Ca/ -er 1a- Garbage Disposal 9.00
Occupant Ma ng i / Ph one Washing Machine 9.00
Floor Drain 9.00
Day/State LP Water Heater 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
F1 P pL (aC n ' Co Other Fixtures (Specify) 9.00
Meng Address U I Phone 9.00
Contractor '0. 1Dk 93 9/ a �
a.> - . 9.00
Day /State zw 9.00
CA ,(S CI (-- 01-- c 20/-S Sewer 1st 100' 30.00
State Registration No. City Bus. Tax No Sewer - ea. Addit. 100' 25.00
(yvO- (1�'/ / ( -/ 7 Water Service 1st 100' 30.00
I hereby acknowledge that I ha jead 's - application, that the Water Service ea. Addit. 200' 25.00
information given is correct, that r the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct. (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
( � G
�i 7-b--r) / -- Lc : 9& Back Flow Prevention -
C� Device or Anti- Pollution Device 9.00
:,:,,,,.e town. or agent) Dale Any Trap or Waste Not
Connected to a Fixture 9.00
Describe work new addition 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential 0 non - residential 0 Insp. of Exist Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of Rain Drain, single family dwelling 30.00
building or property
. Residential backflow prevention
devices 15.00
Proposed use of
building or property
*(Except residential backflow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL ._Q5c'c'
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE f a.C-
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL
TOTAL o?("
Special Conditions
Date issued by
qa Inc t�
Tenant Name: Accumulative Sewer Tally This SWR#:
Address: / S� /O 5 This PLM #: c-- 6 - 07). /�
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
- 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
- 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
Oil Sep (Gas Station) 6
Recreational Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2 / e
Bradley 5 –
- Commercial 3
- Service 3
Swimming Pool Filter 1
Washer, Clothes 6
Water Extractor 6
Water Closet, Toilet 6
Urinal 6
TOTALS
Total fixture values: divided by 16 = c(- EDU ArO 6 CL qe.(
HISTORY _ V _ l
PLM# EDU # L..)2A i1 cy l lO EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
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