Loading...
Permit CITY TIGARD PLUMBING PERMIT / * A0 10I 4 DEVELOPMENT SERVICES PERMIT #: PLM2001 -00308 4 13125 SW Hall DATE ISSUED: 7/20/01 Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 09495 SW LOCUST ST A PARCEL: 1 S126DC 04800 SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -P BLOCK: LOT: 004 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: B FLOOR DRAINS: TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Capping (2) lavatories and moving (2) sinks. FEES Owner: Type By Date Amount Receipt MBM MEDICAL PRMT CTR 7/20/01 $72.50 27200100000 9495 SW LOCUST 5PCT CTR 7/20/01 $5.80 27200100000 TIGARD, OR 97223 Total $78.30 Phone 1: 503 - 245 -2415 Contractor: MARXMEN PLUMBING INC 9665 SW 163RD AVE BEAVERTON, OR 97007 REQUIRED INSPECTIONS Phone 1: 579 -2200 Rough -in Insp Top -out Insp Reg #: LIC 00102432 PLM 00 32 Insp existing /capped fixtures 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 • k he Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through O 52- 0001 -0080. ay o You mbtain copies of these rules or direct questions to OUNC by callin.; (' 6 -1987. iii Iss B y / • : - -.� '� , / I/ ./� Permittee Signature: f 1 ' . 1 � Call (503) • • • -4175 by 7:00 P.M. for an inspection needed the next • us' e'ss day �� / - cpOD2 (S r , Plumbing Permit Application m Date received: 7 a6 /4/ Permit no.: L/��q� / — �5(� F ►• _ , City of Tigard Sewer permit no.: Building permit no.: Address: 13125 SW Hall Blvd, Tigard, OR 97223 . City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: Expire date: Fax: (503) 598 - 1960 Date issued: By: Receiptno.: L i d use approval: Case file no.: Payment type: .. . ` IC: AA- TYPE OF PERMIT ❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement ❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other: JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist) Job address: a L{q 5, Lk) , Loc, i.LS r S Description Qty. Fee(ea.) Total Bldg. no.: I .Suite no.: New 1- and 2- family dwellings only: (includes 100 ft. for each utility connection) Tax map /tax lot/account no.: SFR (1) bath Lot: Block: I Subdivision: SFR (2) bath Project name: '� � N to t'a tiLC �l SFR (3) bath City /county: I ZIP: Each additional bath/kitchen Description and location of work on Anises: Siteutilities: ` 2.Qi..V' l✓ ed (CAL 04Zt u i i`' Catch basin/area drain Est. date of completion/inspection: Drywells / leach line /trench drain PLUMBING CONTRACTOR Footing drain (no. lin. ft.) Manufactured home utilities Business name: 1.- tgirGA(,it vp Lui,,i,i46( JJ Manholes Address: ct, 665 S-. : t'1& 4i.'€- Rain drain connector City: etexue-R1511 I Statee9 ✓ I ZIP: 9/7037 Sanitary sewer (no. lin. ft.) Phone: 6Ch ^57C-L.l I Fax: r: •7q -. :]y) I E -mail: Storm sewer (no. lin. ft.) , P lumb. bus. reg. no: CCB no.: LO�.�t 3 �— g• .4 l 6 /jP�s' Water service (no. lin. ft.) City /metro lic. no.: / fiZ, Fixture or item: Contractor's representative signature: ? // ♦ ' „' Absorption valve Back flow preventer 1.t-(1 Print name: ir.. hy�281,J Date: --.10,13 ( Backwater valve CONTACT PERSON Basins/lavatory Name: 1301-<_ -e (AA.-t^ AL, , C:uvl --b r Clothes washer Address: Dishwasher State: . ZIP: Drinking fountain(s) City: I I Ejectors/sump Phone:5 3• Girir(3 ,b,6 Fax: E -mail: Expansion tank OWNER Fixture /sewer cap ': y d r1 K 2.. Floor drains/floor sinks/hub Name (print): Garbage disposal Mailing address: Hose bibb City: I State: I ZIP: Ice maker Phone: I Fax: I E -mail: Interceptor /grease trap Owner installation/residential maintenance only: The actual installation Primer(s) will be made by me or the maintenance and repair made by my regular Roof drain (commercial) employee on the property I own as per ORS Chapter 447. S s), basin(s),1ays(s)V R ¢, 2 Owner's signature: Date: Sump _ EIYSlL11, Tubs/shower /shower pan Urinal Name: Water closet Address: Water heater City: State: I ZIP: Other: Phone: I Fax: I E -mail: Total it Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $ 7.A • 5-6' Notice: This permit application Plan review (at ❑ Visa ❑MasterCard expires if a permit is not obtained ( ) $ Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Jam. is Expires TOTAL $ 7 r.30 Name of cardholder as shown on credit card accepted as complete. $ Cardholder signature Amount 440-4616 (6/00/COM) PLUMBING PERMIT FEES . ..q. , ,,,, ,.:,.;:,;-,.„-- „.,•,,-:',. : -., ,!,.; , ' ,,, , , '1 : '= Fupg,': t ,' '::1„,N0,)&11,fi":lidi2„:4,,Ei•IiIVO,W,Olirig0'!Ority:. ,,.,, 'F ' ' . ; J : ' : G'Z ‘FIXTUOSlifyitiiidialr? - "17 - •'•::::•' - ‘ , ' - r 47. * *. ''',CITY(y. ',.z:4(ea) T7 gAMOUNT - 4:(i461tigeiliii; -,:., •_'''.. aP,F310E,,4::::::3,Ci2AL„,', Sink 16.60 Affei:I'W'ellirki: ,, QTY - „,(4a), • ;AitiOUTIT Lavato frOrAeackutilitkiconnectithi). ,,-- - ., , ' , 7 , ,1..».-.: ry 16.60 One (1) bath $249.20 Tub or Tub/Shower Comb. 16.60 Two (2) bath ,$350.00 Shower Only 16.60 ; Three (3) bath $399.00 Water Closet 16.60 SUBTOTAL Urinal 16.60 8% STATE SURCHARGE _. Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL Garbage Disposal 16.60 TOTAL Laundry Tray 16.60 Washing Machine 16.60 Floor Drain/Floor Sink 2" 16.60 3" 16.60 PLEASE COMPLETE: 4" 16.60 Water Heater 0 conversion 0 like kind 16.60 , .,- ,: -. :' ,-, :• , -- .,-", • *Quantity byAllork:-.Perfaiiiied ,„•, - Gas piping requires a separate mechanical Fixture Type":• --,•: i; -.5NeW ' A 6:'' i lg" -•12..„ertioved/ permit. • ....- , ,,,'"" ," „. ,..., '''• ," ' - *".•'',.. : ' •,'Cipped MFG Home New Water Service 46.40 , Sink MFG Home New San/Storm Sewer 46.40 Lavatory . • Tub or Tub/Shower Hose Bibs 16.60 Combination Roof Drains 16.60 Shower Only Drinking Fountain 16.60 Water Closet Urinal Other Fixtures (Specify) 16.60 Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain/Sink: 2" Sewer - 1st 100' 55.00 3" Sewer - each additional 100' 46.40 4" Water Service - 1st 100' 55.00 Water Heater Water Service - each additional 200' 46.40 Other Fixtures (Specify) Storm & Rain Drain - 1st 100' 55.00 . Storm & Rain Drain - each additional 100' 46.40 Commercial Back Flow Prevention Device 46.40 Residential Backflow Prevention Device* 27.55 Catch Basin 16.60 Inspection of Existing Plumbing or Specially 72.50 Requested Inspections per/hr COMMENTS REGARDING ABOVE: Rain Drain, single family dwelling 65.25 .. Grease Traps 16.60 QUANTITY TOTAL Isometric or riser diagram is required if Quantity Total is >9 *SUBTOTAL : ; , :'''' ''"A.--f: 8% STATE SURCHARGE **PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is >9 A ' "t:=,; r :.. : TOTAL - ,, r' "- $ * Minimum permit fee is $72 50 + 8% state surcharge, except Residential Backflow Prevention Device, which is $36.25 + 8% state surcharge. "All New Commercial Buildings require plans with isometric or riser diagram and ■ plan review. iAdstsVorms\plm-fees.doc 10/10/00 . Accumulative Sewer Tally \ / Tena;it Name:: �QMA 'bLC6y r/16,5 • This SWR# �`1( Address: 9 (19 5 6,-o. 1-00_u 5r /r. This PLM #: j `i. -1 -i26o / - oc , O 8 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 Drain/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 A ` 1' - Bradley 5 , - Commercial 3 , - Service 3 . Swimming Pool Filter 1 o Washer - Clothes 6 , Water Extractor 6 Water Closet - Toilet 6 . Urinal 6 , TOTALS a V a / 6 Total fixture values: ai 4 s- 5 ' divided by 16 = �' 5 � EDU �' 5 t ` C -Q- .0 0 Lh_c_,L 4 r-= . 3 ?D L. 5 -- ��v I e- -c,L -D e, , o / -� = f � fi C��: c (' 6 HISTORY ,; , 1 3 £- PLM# iga9 - aoLi oIp EDU# 1 q SWR# 1999 -1007 ti PLM# EDU# SWR# PLM# 9 -7-00Li zo EDU# 15 SWR #97 - co 39 / PLM# EDU# SWR# PLM# 9t, - ooava- EDU# I 5 SWR# ck, -6044,v- PLM# EDU# SWR# PLM# EDU# SWR #' PLM# EDU# SWR# i:klstslswrtaly.doc CITY OF TIGARD BUILDING INSPECTION DIVISION 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 MST BUP Date Requested — /D AM PM BLD Location I/ q Suite MEC Contact Person Ph c cj Z Z© 0 PLM A®? / - 0 630 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 Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL PLUMBING Post & Beam Under Slab Top Out Water Service - Sanitary Sewer Rain Drains PART FAIL a'' HANICALNm ' 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 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 - no access ADA Approach /Sidewalk /O// /0 / I nspector } /� Other Date QtA ^�,- Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. •