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Permit CITY OF TIGARD „ ' - DEVELOPMENT SERVICES PLUMBING PERMIT � : � �� . 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE I ISSUED: 08/12/98 8 -0238 PARCEL: 2S102CB -02300 SITE ADDRESS...: 13200 SW PACIFIC HWY SUBDIVISION • FREWINGS ORCHARD TRACTS ZONING: C —G BLOCK • LOT •008 JURISDICTION: TIG CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0 TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0 OCCUPANCY GRP..:B FLOOR DRAINS • 0 TRAPS • 1 STORIES • 0 WATER HEATERS • 0 CATCH BASINS • 0 FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0 SINKS • 0 URINALS • 0 GREASE TRAPS • 0 LAVATORIES • 20 OTHER FIXTURES • 2 TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0 WATER CLOSETS.: 3 WATER LINE (ft)...: 0 DISHWASHERS • 0 RAIN DRAIN (ft)...: 1 Remarks: Mullikan Medical Center TI 0 Owner: FEES MULLIKAN MEDICAL PARTNERS type amount by date recpt 13200 SW PACIFIC HWY PRMT $ 268.00 DEB 08/12/98 98- 308205 TIGARD OR 97223 SPCT $ 13.40 DEB 08/12/98 98- 308205 PLCK $ 67.00 DEB 08/12/98 98- 308205 Phone #: Contract or J & J MECHANICAL CONTRACTORS 9015 SE ST HELENS ST CLACKAMAS OR 97015 Phone #: 655 -2696 $ 348.40 TOTAL Reg #..: 001079 REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Underfloor /Under Tigard Municipal Code, State of Ore. Specialty Codes and all other Top —out Insp applicable laws. All work will be done in accordance with Storm Drain 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 more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 ' ',' 1-0@10 through OAR 952- 0001 -0080. You say obtain copies of these rules or direct questions to OUNC by calling (503)246 -1987. ( 11146 z ir Issue By: Permittee Signature:. 4 +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + +++ Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ - 1--2-e-- f l • CIV OrtleARD Plumbing Application Reed By, ' A, , 7e Recd - ' I "-;• / 92. 1,.3125 SW HALL BLVD. Commercial and Residential Date Rec 7- Date to P.E. 07 '2 9" e" TtoARD, OR 97223 Date to DST (503) 6394171 Permit #( qPg oa3 8 Print or Type Related SWR*qi" 0) TS Incomplete or illegible applicarns will not be accepted caned/If/I-A/c PA/90P 4Ybe-- Name of Devlopment/project 7'''''';',i";"417 ',:. New Single FamIlfResidentes On - !.* - , , - ..- Job iti oz.ci Keit, ' c 4 ( .,p HOUSE Address Street Address 4 Suite '• S..;ki;; '3 EIATH.HOUSE$ I 1 D. eac, ..S c e - PSG • - Fee - InoludeifilliiitiinbiriifixiiiiiinlbeliWefliFeend the.)101100 feiyri W ii - ni- Bldg # Cit,/State Zip water service sanitary sewer and storm sewer., See feiti:belOw;;; :..... _TV444.,/ ejt_ -, ',-; - ,';'' , '' ..-_,' • - - • : -.. .2 ,,,-.,-.': -,.., ;,-it.:.1--,-! , - f v. 7' ''' Name FIXTURES (individual) QTY PRICE AMT 1111 zi l i keit) Mete. P4fern €42 Sink 9.00 • Owner Mailing Address Suite Lavatory .,..R a . 9.00 I - City/State Zip Phone Tub or Tub/Shower Comb. 9.00 Shower Only 9.00 Name Water Closet _a 9.00 al - , A ei l 1 1 keel., teppez .. cem -tem_ Dishwater 9.00 Occupant Mailing Address Suite Garbage Disposal 9.00 13a-oc -Sce.:. Age.. 44.., le Washing Machine 9.00 City4State Zip f Phone Floor ()rain 2 • 9.00 3" 9 Name 9.00 - 3 - f-T tivt./er....44 . C...06....1 , 4" 9.00 Contractor Mailing Address Suite Water Heater 9.00 14) s Se 8,4. ok. Laundry Room Tray 9.00 City/State Zip Phone Urinal 9.00 e-14ck40 f 9eqS a SS - Q61 ‘ Oregon Const. Cont. Board Licit Exp. Date 9 4? of - Other Fixtures (Specify) ew c_ , 9.00 k 8 - Attach Copy of 10711y 8 , vvteo ..s.k.m.,_ i 9.00 1 - . Current Plumbing Lic. # Exp. Date 9.00 License ge - Sbe e .6 a -11-10 Sewer - 1st 100" 9.00 COT Business Tax or Metro # Exp. Date _31 6 q-c -/ k Sewer-each additional 100' 30.00 Name Water Service - 1st 100' 25.00 r • S. F Water Service - each additional 200' 30.00 Fte.. a .s.-7-4. A t 4 Architect Mailing Addess Suite 1 / Storm & Rain Drain - 1st 100' ( 25.00 or Storm & Rain Drain - each additional 100' 30.00 1.1 k 0 Lozsi 56)6 4 - Engineer City/State. Zip Phone Mobile Home Space 25.00 ru4st4v 1 tie Niaeis Commercial Back Flow Prevention Device or Anti- 25.00 Describe work New 0 Addition 0 Alteration Pollution Device Repair 0 Residential Backflow Prevention Device' 15.00 to be done: Residential 0 Non-residential Additional description of work Any Trap or Waste Not Connected to a Fixture 1 I 9.00 el - a a (a t 4 c_,.7 1.. .4 %./ , i4 i At. 64 to4 itterKootm Catch Basin ' Atm 9.00 Insp. of Existing Plumbing 40.00 per hr Existing building u or property eL se of , ,s r . Specially Requested Inspections 40.00 Vile caLcAL (A. 4 G per hr Rain Drain, single family dwelling 30.00 , , ' . Proposed use of building or property viAe e.L. c. Grease Traps 9.00 , .. Are you capping any fixtures? Ye," No o QUANTITY TOTAL --) Q • ,•?,:-.:,-,.:, ..',. -.1 - ,74: - Isometric or riser diagram is required if Ouanity Total is > 9 kr E) .4- I hereby acknowledge that I have read this application . that the information * .. ,...,:....--: . given is correct, that I am the owner or authorized agent of the owner, and SUBTOTAL ..7 , --- ''„ - 8 that plans submitted are in compliance with Oregon State Laws. . ‘ SignNe Vwner/Agen Date 5% SURCHARGE _4_,J 7 - 1 7 - 9' cr PLAN REVIEW 25% OF SUBTOTAL ', --4:.' • , --.; - . SUBTOTAL - 7 : ' • 6 - I Required only if fixture qty. total is > 9 Contact Person Name Phone TOTAL '..- ., . : . ::" s75-3)6f6 -., " ::: *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow iAdsts1p1mapp.doc Prevention Device, which is $15 + 5% surcharge L___ • • PLEASE COMPLETE: :Fixture Type Quantit by Work Perfocrr�ed.:> • New M oved : Replaced Removed /Capped Sink .— 4 Lavatory 6 i 3 Tub or Tub /Shower Combination Shower Only Water Closet l Dishwasher Garbage Disposal Washing Machine Floor Drain /Floor Sink 2" 3" 4" Water Heater Lau-netry-Reem-T-Fay owe Urinal Other Fixtures (Specify) & v a. c' ca T'o.Z iwr 4 v 21 /.s fit &. ('S r Lrd COMMENTS REGARDING ABOVE:,, -)1/tAdA1), _s Ct?) Visk IA . &q44.1-- 1 -1- , M 'rsl_ . v t L al (i i( -U)a1& I:WstsSplumapp.doc 717/98 CITY OF TIGARD Plumbing Permit Application Plan Check # , • • 13123 SW HALL BLVD. Commercial and Residential Rec'd By ' TIGARD, OR 97223 Date Rec'd (603) 639 -4171 Date to P.E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit# Rel. ed SWR # C. led Name of Development/Project FIXTURES (in • iv . ual) • QTY PRICE AMT ' Job Sink 9.00 Address Street A.. ress ite Lavatory 9.00 Tub or Tub /Sh ewer C. b. 9.00 Bldg # City /State Zip n Shower Only 9.00 Name ` Water Closet 9.00 Dishwasher 9.00 Owner Mailing Address uite Garbage Di posal 9.00 ashing :chine 9.00 City/State Zi. Phone • loor Drai Flo 2" 9.00 Name 3" 9.00 . 9.00 Occupant Mailing Address ,I Suite ; T ater 0 conversi• n 0 like kind 9.00 , .. g re. uires a sear. to mechanical permit. City/State . 'hone unti' Room Tray 9.00 Urinal 9.00 Name Other Fixtures (Specify) 9.00 Contractor Mailing Address Suite 9.00 9.00 Prior to permit City/State Zip -hone Sewer - 1st 100' 30.00 issuance, a copy Sewer - each additional 100' 25.00 of all licenses are Oregon Const. Cant. Board Lic. ; xp. D. e required if Water Service - 1st 100' 30.00 expired in COT Plumbing Lic. # . .. Date Water Service - each additional 200 25.00 database .rm & Rain Drain - 1st 100' 30.00 Name Sto • & Rain Drain - each additional 1 r0' 25.00 Architect ! Mobile ' .me Space 25.00 or Mailing Address Suite Commerci. :ack Flow Prevention Devi : or Anti- 25.00 • Pollution Dev . Engineer City /State Zip Phone ' Residential Ba • 'ow Prevention Device' 15.00 (Irrigation timing ices require a separate Describe work to be done: restricted energy pe • it.) New 0 Repair 0 Replace with like Ind: Yes 0 No 0 Any Trap or Waste No onnected to a Fixture 9.00 Residential 0 Commercial 0 Catch Basin 9.00 Additional description of work: Insp. of Existing Plumbing 40.00 per/hr • Specially Requested Inspections 40.00 per /hr Rain Drain, single family dwelling 30.00 Are you capping, moving or replacing any fixtures? Yes 0 No 0 Grease Tra 9.00 If yes, see back of form to indicate work performed by QUANTITY TOTAL fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric or riser diagram is required if Quantity Total is > 9 WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL .1 hereby acknowledge that I have read this application, that the information given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE that plans submitted are in compliance with Oregon State Laws. Signature of Owner /Agent Date "PLAN REVIEW 25% OF SUBTOTAL Required only if fixture qty. total is > 9 TOTAL Contact Person Name Phone *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow Prevention Device, which is $15 + 5% surcharge **All New Commercial Buildings require plans with isometric or riser diagram and plan review I:',dstslplumapp.doc 7/2/98 • Page No. 1 CASE HISTORY FOR CASE NO.: PLM98 -0238 MULLIKAN MEDICAL CENTER 13200 SW PACIFIC HWY 03/04/99 Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd Code Sent Done Done Date By - --- --- -- - - - - -- - -- PLMC003 Application received / / / / 07/17/98 PASS BON 07/21/98 JSD PLMC005 Permit Created / / / / 07/21/98 PASS JSD 07/21/98 JSD PLMC007 Plans routed to Plans Examiner / / / / 07/22/98 PASS JSD 07/22/98 JSD PLMC008 Plans Approved /Routed to DST / / / / 08/05/98 no du for sump pump PASS MS 08/05/98 MRS ewc -- drinking fountain abry • PLMC015 DST Post Review Complete / / / / 08/06/98 DONE DLH 08/06/98 DLH PLMC040 (F) Ready to issue / / / / 08/06/98 Need copy of current plumbing license PASS DLH 08/06/98 DLH and pay sewer fees for SWR98 -0183 before issuing permit. Received copy of current plumbing license on 08/06/98. dlh • PLMCO50 (F) Issue permit / / / / 08/12/98 DONE DEB 08/12/98 DST " PLMC720 Underfloor /Underslab 08/05/98 / / 08/13/98 PASS TLP 08/18/98 TLP '''PLMC720 Underfloor / Underslab / / / / 08/26/98 3" drain for service sinl PASS MS 08/26/98 MRS PLMC725 Top -out Insp 08/05/98 / / 09/08/98 PASS TLP 09/09/98 J *H • PLMC725 Top -out Insp / / / / 10/12/98 added sink to examing room PASS TLP 10/12/98 TLP PLMC725 Top -out Insp / / / / 11/12/98 Floorsink - developing room water line. PASS TLP 11/12/98 J *H PLMC725 Top -out Insp / / / / 11/18/98 PASS LB 11/18/98 J *H PLMC730 Storm Drain Insp 08/05/98 / / / / 08/05/98 MRS PLMC740 Misc. Inspection /• / / / 09/08/98 Elevator shaft drain appproved PASS TLP 09/09/98 J *H PLMC799 Final Inspection / / / / 10/26/98 corrections done. PASS TLP 10/26/98 J *H PLMC800 Case Finaled / / / / 10/26/98 PASS TLP 10/26/98 J *H PLMC800 Case Finaled / / / / 01/20/99 second phase completed PASS TLP 01/20/99 TLP • • • • • • • •