Permit . „ii iik , CITY OF TIGARD PLUMBING PERMIT
I� DEVELOPMENT SERVICES PERMIT #: PLM1999 -00272
ALA
r � ' -I ' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 09/20/1999
SITE ADDRESS: 10505 SW TIGARD ST PARCEL: 1S134DD-00102
SUBDIVISION: ZONING: I -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 3 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: 100 ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Add 2 sinks, 1 lay, 1 dishwasher, 1 water closet, move 2 lays, 2 water closets and 1 shower. No change to the
EDU count of two (2), dummy sewer permit SWR1999- 00179.
FEES
Owner:
Type By Date Amount Receipt
DON SCHAEFER PLCK DST 09/20/199E $41.13 99- 318442
PO BOX 23697 PRMT DST 09/20/199E $164.50 99- 318442
TIGARD, OR 97281 5PCT DST 09/20/199E $11.52 99- 318442
Phone 1: Total $217.15
Contractor:
GRIDLINE PLUMBING + HEATING
4343 SE 37TH AVE
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 771 -8790 Rough -in Insp Insp
Reg # : LIC 00074105 Fop -out pec
g Final Inspection
PLM 26 -449PB
ORIGINAL
. ..
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 by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling ( 13) 246 -1987.
Issued B
// //
/�� , Permittee Si nature• 4-/
Y / g _.l
Call (503) 639 -4175 by 7:00 P.M. for an inspection nee. a next business day
CITY OF TIGARD - Plumbing Permit Application Plan Check •
13125 SW HALL BLVD. - Commercial and Residential Recd By �'7
TIGARD, OR 97223 Date Rec'd iSiMf
(503) 639 -4171 Date to P.E ' -- '''
Print or Type Date to DST ? ?i' 0 9 '
Incomplete or illegible applications will not be accepted Permit SW / ?9S 6v� ,
Related WR #/ 00)
Called 1-16 O{-
GEFr del /4.)s 8-RC'
N ame of Development/Project FIXTURES • ` QTY `PRICE AMT
S
Job ,/ 054 5 �C� T-,-,,,41,9.( Sink 11.50 e2_3C
Address Street Address Suite \ Lavatory 7 11.50 23 a
Tub or Tub /Shower Comb. 11.50 i/, jd
Bldg # City/State Zip Shower Only r 3 11.50
N e ec Water Closet/Urinal (Specify) - 7 e 11.50 3,/,_5V - Dishwasher /. t. 11.50 // - 0
L
Owner `ailing Address PD SoX Suite Garbage Disposal 11.50
2 / (_Q z-61 Washing Machine /Laundry Tray (Specify) 11.50
City /State Zip g7y4IPhone
� l � l/CV D , Floor Drain/Floor Sink 2" / 11.50 it 50
N 3" 11.50
//ST & '/ E'Q:T - 4" 11.50
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
City /State Zip Phone MFG Home New Water Service 28.00
NNNt�aaaa�rrrnnnn AUfrkt6 /�� MFG Home Ne w San /Storm Sewer 28.00
- _ d { n N % Hose Bibs 11.50
Contractor Mailin /S uite Rain Drains 11.50
y4.3¢ S4 3 s- Drinking Fountain 11.50
Prior to permit • /State ip , Phone Other Fixtures (Specify) 15.00
issuance, a copy of T' _ y 7 z 77/ . , , _
of all licenses are Oregon Con t. Cont. Board Licit Exp. Date
required if 7 �L / _ s- 00
expired in COT Plu mbin # Exp. Date
O }
database . - , / _ 1,��
Name // ( Sewer - 1st 100' 38.00
Architect Sewer - each additional 100' 32.00
or Mailing Address Suite Water Service - 1st 100' • 38.00
En ineer City /State Zip Phone Water Service - each additional 200' 32.00
g Storm & Rain Drain - 1st 100' 38.00
Describe work to be done: Storm & Rain Drain - each additional 100' 32.00
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device 32.00
Residential 0 Commercial 0 Residential Backflow Prevention Device* 19.00
Additional description of work:
Catch Basin 11.50
Insp. of Existing Plumbing 50.00
Are you capping, moving-or replacing any fixtures? per /hr
Yes No 0 Specially Requested Inspections 50.00
If yes, see back of form to indicate work performed by per /hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45 00
-
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9
that pl su itted are i pliance with Oregon State Laws *SUBTOTAL •
Sig ure Owner /A nt Date - MO
/ • Z./f.-..- .i?- /.tom`' /C`�y 7% SURCHARGE it onta t Person Name Phone
--J PUiie, ,#/ 77/ flyf) * *PLAN REVIEW 25% OF SUBTOTAL ' 03
1 BATHaHOUSE z : , .,` - • - ' • ` ,- - _ ks Required only if fixture qty total is > 9
:2,6%ATH'HOUSE`325000�,�� 5 �r y ,... �..._, .,,,,-;:',:;,.%--,., , TOTA /y
, --,. .;HOUS 52 1 :19L:;z. ;' „- f ;, , N ' . ,- _ ° - , • - -- ,, D�/ /,�
(Tis fee cl all plumbing 1,ictureOn the dvvelling and. the first -` , o
;100 Teel of 8aD SeW9F5tOrmJlewer and.watBr, service ) '; 'Minimum permit fee is $50 + 7% surcharge, except Residential Backflow Prevention
=• - == 1 Device, which is $25 + 7% surcharge
"All New Commercial Buildings require plans with isometric or nser diagram and
plan review
I \dsts\forms\plumapp doc 8/5/99
oupig -co As 3
PLEASE COMPLETE:
Fizture< Type . , Quantity. by Work Performed",
New - Moved Replaced Removed/Capped
Sink
4( 4'
Lavatory / 2
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I ldsts \fortns\plumapp doc 8/5/99
Accumulative Sewer Tally
Tenant Name: This SWR# /f99 - CO / X 9
Address: /0505 51-1 �/6,, This PLM #: f9¢4 -+94, F
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 / — 4
- JacuzzilWhirlpool 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4 / ' 4/
- Domestic 2
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2
- 3 inch 5
- 4 inch 6
- Car Wash Drn 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 _g- t aZ
- Bradley 5
- Commercial 3 - 07_ 6
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 2 'lc? 1 6
Urinal 6
TOTALS 3g -,,o /'
Total fixture values: 3 & divided by 16 = ) , �� EDU --------- a 5 P s 6 && 4z- /A)
HISTORY U�'e 7 (b (/��
PO }�Fttrin4G- ea -,U S r C
PLM# EDU# ,2 SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
is \dsts\swrtaly doc
11/10/1999 Activities for Case #: PLM1999 -00272
9:06:25 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 08/18/1999 BON RECD No Hold GEO 08/24/1999
PLMC005 Permit Created 08/24/1999 GEO DONE No Hold GEO 08/24/1999
PLMA007 Plans routed to Plans Examiner 08/25/1999 BON DONE No Hold BON 08/25/1999
PLMC120 Plumbing Undersl 09/10/1999 09/10/1999 09/28/1999 MS PASS No Hold RB 10/06/1999 Done with Plumbing Top -Out
above slab.
PLMC725 Top -out Insp 09/10/1999 09/10/1999 09/28/1999 MS FAIL No Hold AKJ 09/28/1999 not ready
PLMC799 Final Inspection 09/10/1999 09/10/1999 10/21/1999 KBS PASS No Hold JS 10/21/1999
PLMC008 Plans Approved /Routed to DST 09/10/1999 09/10/1999 09/10/1999 TLP DONE No Hold TLP 09/10/1999 .
PLMC015 DST Post Review Complete 09/15/1999 GEO DONE No Hold GEO 09/15/1999
PLMC040 (F) Ready to issue 09/15/1999 GEO DONE No Hold GEO 09/15/1999
PLMCO50 (F) Issue permit 09/20/1999 GEO DONE No Hold DST 09/20/1999
PLMC725 Top -out Insp 09/29/1999 09/29/1999 09/29/1999 MS PASS No Hold AKJ 09/29/1999
PLMA800 Case Finaled 10/22/1999 JMT DONE No Hold JMT 10/22/1999
Page 1 of 1
CITY OF TIGARD BUILDING . INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/ BUP
/6 Date Requested ' a) ( 9 AM PM BLD
Location / D 5 Q. `` s - 1 ; SW
- Suite MEC
Contact Person /( Ph 's7 6 )-- ) /- ) PLM '? g' 0-0
Contractor Ph SWR
•
BUILDING Tenant/Owner LUC.SI 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
A SX2ART FAIL
MBING_
beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
4i■
PART FAIL
MECHANICAL
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
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA ,?/7
Approach /Sidewalk Date ro / q f Inspector ) Ext
Other p /Kri f
•
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.