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4,,,„„n hl , ,",� ' DEVELOPMENT SERVICES PLUMBING PERMIT f •
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"� .. • 13125 SW Hall Blvd., Tigard, , O R�;9 7223 (503) 639.4171 , ` PERM I T tt ° .' a' a- .. •. _ �= °L: C* � i 7 ��
i C E 2'.
„ , " ' ' PfRCEL,a 15:1 5BC- 0020
SITE (DD RESS.,, ' . 1076 5 OW C•PEEENBlU,RS RD , , , ' ' '• . ,
SUBDIVI . , , „ ' ,; _ ZOI' T ; C--:G ,
i ,C? 6
L
BLOCK— _ �, :. � n . LOT. n .(;TIO}�1° � I
�° - b.,_ .7UR.�SDI � T u • ,
li CLASS OF Worm. a :OTR4 . . GARBAGE-DISPOSALS.: . 0 1 *rC SPACES..:" 0 '
TYPE . �P'c TRS , 1 Y,,- OF l.lSC:� ...: COfa1 , WA51- iIf�lG - f�iACl?,' e =. - f'AC1SI; "1�llW !"t V,4�l�f 1 r� n
,
. OCCUPANCY �!GRP.. o u, - ' `'FLOOR •DROI�' S.'o .• . 0 ' ' T'R 'qn d .. . . , .b•'d .;,■•,. . ',. ', 1 ,.
„STORIES.. a • ,. c . - °fit,,• , , . WATER ��HEf9TERSa g , O'r' " GiTCF,i. BASINS.. ... n 0 ,
F.I•XTURE S -_ - _.- - -- -.- - , . LAUNDRY TRAYS. 4 . a =. ' 0 ,'SF RAIN DRAINS. - .. e 0 ` •
SIMSS... e e ... . 0 ' '' LURINAL.S.. ... e ..,.. 0.' GREASE TRAPS. ... 0,; "
LAVATORI a ... If 0 OTHER FIXTURES. n .. a ' 1 • . : ' . . . '
•
' TUB /.SHOWERS° . a o , 0 SEWER LINE (ft ),,.' .. a 0 „
WATER CLOSETS.. Cr . . WATER LINE (Ft') ; 'ID' 'i, - _. , '
' DISHWASHE:RS. e 0„ , - ' i P Nl DR( - tIN' (F e ►''• -
' Remark=,( Instill a commercial back flow Arevention or anti - pollution devi
ce
and' add indirect waste line. , ,
G]:ran a r� e . . - - - ' . . , . , , , . . - FEES ..- - - --- --- - - -' --- -
— ELEVEN tSO'UTHLAND)� t voe , ' am'oun't by dat e... ' ; ".recm't
107651 SW, CREENBURS RD • - PRMT $ • :34.00 GED' 0 /:1,9'/98 98"-306709
T I-GARD OR 97223 ' ” -- ' ' 5I=1.CT $; - -. 1. 717_1 ''C EG • r 6'/'1' /98 98- 306709
'Phone a ,� . , • , ,. •
' C'o0't r aLt,o r -- - - _ -- - - -- ; - - -- -
MICHAEL CO PLUMBING ..
• 0 G' BOX 2.3008 ' ,
T I1�A�2D OR `97281 _''__ - - -- _ - - -_- - - � _ - - " ��..
Whorl° #. 639-3189 $ 35.70 TOTAL • , , '
Reg #a.„ 000673 ' _
• - ' , — _.- - -_ —_. , REOU I RED „INSPECTIONS, _ -.--- . - -
• This pernit is Issued subject to the regulations' contained in, the ,.. ' „ RP / Bac kf. low Prey , - . ,
app! icable' laws.,, A11 cork will be done -an 'accordance,iith `' �'�ct i on „ �_r
Tigard Munici l Code,; State of, Ore: Specialty , Codes' and all 'Other Fi ia1"'i, _ •_
approved plans. This p sr=oit,w i'll expire - if work 'is not started' - , ' ' ' ' - _
ithia 180 da � s of issuance, or if work' is suspended for bore - _' _ _ !� .
than 190 days.. A 1TENTTION °Oregon law - requires you to fall(. -mules • ' , ' '
adopted. by the Oregon Utility P #otificat ion Anter, Those, rules are : ' ' -
set forth in OAR ,952-1E011010 througgh.`OAR•35?-Q it -!M80: You nay '_' - _ __ ,
obtain Copies of these"'.. °+files or direct ; C questions to CU by palling " —_
( 3) 246_.1387. _ _—
. .'' E" ';' I ' ''• 9'. . Is,slued' �Dy, , . _�,��°. Per e ilitt =ee�' S'1.L�Tiatlrir _ x' „
- 1- -1-° + + ++ ++fir +' - f-+ 4 - - r4"1 - 1-4-1- r- -r.41- - 1 . +4 - 4 ••'r f-i ••1 ++ 4•++ i ++ i- - - !••ri--I- 4-- I•+- r- -1- • +-r- +••F•9•• -r'-•+ •1- i- •++++
' Cal . l..'639 -4175' by 7s.00 p'.', t. •For an inspect ;,,on `needed the .next'' bus inesss, 'd • '
++ + +i -• '+ 4 -1-+ -++ + + +i--4•+++ Fi-i•'fi-F•r•-i•-t•i-i--i-44 ++4.4--1.4 :--i ++++^r•+ }:•k•_1- 'i-i-• ++ + ++ +++ -r-_1 -1- i- -r-+ +++ +4.47t-4
CIT/OF t GARD Plumbing Permit Application Plan Check# --
13125 SW HALL BLVD. Commercial and Residential Rec'd By 63
TIGARD, OR 97223 Date Rec'd /a - /q-- Li
(503) 639 -4171 Date to P.E.
Print or Type Date to DST -
Incomplete or illegible applications will not be accepted Permit # Arrtgr-a /75"
Related SWR #? - O/5 - O
Called le- Rte? 48
Name of Development/Project On back indicate Work Performed by fixture.
Job 9- / / FIXTURES (Individual) .s , QTY PRICE AMT
Address Street Address Suite Sink 9.00
/O7IskS 06Cre erivtuc eL Lavatory 9.00
Bldg # I City /State Zip Tub or Tub/Shower Comb. 9.00
Name Shower Only 9.00
Q y /e,_-, I Cam. / Water Closet 9.00
Owner Mailing Address Suite Dishwasher 9.00
Garbage Disposal 9.00
City/State Zip Phone Washing Machine 9.00
Name Floor Drain 2' 9.00
7 1 f 3' - 9.00
Occupant Mailing Address Suite 4• 9.00
/07( .S ...i 6 1 4 '.. 6,1 , e 1
City/State Zip S Phone Water Heater 0 conversion 0 like kind 9.00
v r:C i a 0.,- q/ 2.1.3 639 - `(O -C Laundry Room Tray 9.00
Na ff Urinal 9.00
iNi 1( Lc Q-( 4 (_ F' 1 v+ "" ) t - S Other Factures (Specify) 9.00
Contractor M�ilin�g� Address Suite M N fQl .cu i 9.00 G L?"
V a3eDie 9.00
Prior to permit City/State f Zip Phone C
issuance, a copy ` -' . 4 r a l CC) 7_ s, / ic - 31 1 Sewer - 1st 100' 30.00
of all licenses are Oregon Const. Cont. Board Uc.# Exp. Date , Sewer - each additional 100' 25.00
required if (D I (- 7 7 9 - / 5 - 9 I(' Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date
database 9 4. - 3 33 Pe 9-3 0 - g' Water Service - each additional 200' 25.00
Name Storm & Rain Drain - 1st 100' 30.00
Architect Storm & Rain Drain - each additional 100' 25.00
Or Mailing Address Suite Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Engineer City/State Zip Phone Pollution Device 1
Residential Backflow Prevention Device' 15.00
Describe work New 0 Addition 0 Alteration 0 Repair 0 Any Trap or Waste Not Connected to a Fixture 9.00
to be done: Residential 0 Non - residential X Catch Basin 9.00
Additional description of work: ^
... `, .---.,.:(,,e c - � tj�`k Q R 1'' Insp. of Existing Plumbing 40.00
per/hr
r b e `' i C Specially Requested Inspections 40.00
per /hr
Existing use of Rain Drain, single family dwelling 30.00
building or property nemv. ' , 7-// Grease Traps 9.00
Proposed use of y QUANTITY TOTAL . �,� nb
building or property �77 Isometric or nser diagram is required if Quanity Total is > 9
'SUBTOTAL
I hereby acknowledge that I have read this application, that the information 5% SURCHARGE
given Is correct, that I am the owner or authorized agent of the owner, and . . '.: .
that,plaFs submi,ted are in compliance wi on State Laws.
gnature of ner /Agent c Date "PLAN REVIEW 25% OF SUBTOTAL - F .?: 4 t.a +.-
� Required only d fbdure qty. total is > 9 ,, t ;4
. � •: `. la,;.`... • /�jZ f.� / r / TOTAL . 13-740
ct Per n Name Phone _ V
'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
le D 4 t D nes' 35-31S-9 Prevention Device, which is $15 + 5% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I:ldstslptumbapp.doc 515198
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
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:
IACstslplumbepp doe 5/5198
Accumulative Sewer Tally
Tenant Name: - / This SWR# 9 CV CC)
Address: in 76 SW pew-•v % j c Povi) This PLM#:
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
Value Capped off value added # added #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1
Eye Wash 1
Floor /sink - 2 inch 2
- 3 inch 5
- 4 inch 6
- Car Wash Dm 6
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
- • • Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2
- Bradley 5
- Commercial 3
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6
Urinal 6
TOTALS /ia n
Total fixture values: //y divided by 16 = �. /3 EDU /X� .9^- -F v`! S
HISTORY 9,4 (o -z? 9L "
PLM# EDU# 7 SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
i:'.dstslswrtaly.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION 1 _t
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
;f1/ 12 Date q!
e Reg q' uuested �n - 5 0 - AM PM BLD
Location 0165 SW ki2 ) b P({ Suite MEC
Contact Person S`fiZ� i ^/1�2c;�1f� Phh - PLM 68' 78
Contractor LtL_ i
a Er a Lr 1 Ph ( SWR
BUILDING Tenant/Owner c7CA ETO �%L 4JE 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
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
( MBtNC
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
07/ PART FAIL
�' - ANICAL
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 ti
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 �j pec /1- '
�/f J Ext
Approach /Sidewalk Date /'/ 3 f i� Inspector
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.