Permit •
411, CITY OF TIGARD PLUMBING PERMIT
P ERMIT #: PLM1999 -00235
Ag- d' DE SERVICES DATE ISSUED: 8/12/99
13125 SW Hall Blvd., Tigard, OR 97223 (503) 6 -4171
SITE ADDRESS: 09300 SW WASHINGTON SQUARE RD PARCEL: 1S126C0 -01403
SUBDIVISION: ` ,,,�, ZONING: C -G
BLOCK: LOT: `� TIG
CLASS OF WORK: ALT GARBAGE DISPOSAL MOBILE HOMESPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: 2 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing for tenant improvements. Move existing 2" floor drain /sink, sink, water heater, and remove /cap one
sink. Add CW stub for vending. (SWR1999- 00159, no fee).
FEES
Owner:
Type By Date Amount Receipt
MAY DEPT STORES COMPANY PRMT DEB 8/12/99 $57.50 99- 317604
ATTN: PROPERTY TAX DEPT 5PCT DEB 8/12/99 . $4.03 99- 317604
611 OLIVE STREET
ST LOUIS, MO 63101 Total $61.53
Phone 1:
Contractor:
ISLAND MECHANICAL INC
PO BOX 17264
PORTLAND, OR 97217 REQUIRED INSPECTIONS
Phone 1: 503 - 285 -8510 Rough -in Insp
64254 Underfloor /Underslab
Reg #: LIC 64
PLM 64 4PB Insp existing /capped fixtures
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
You ma i copies of these rules or direct questions to OUNC by calling (503) 246 -19
Issu d By: �KL/�P Permittee Signature: �
■
/ . /✓ .�
Call (503) 6 9-4175 by 7.00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Chec #
1 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Recd
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit 4 /999 - (
Related SWR #/999 a0/$
, 9 f7 ► L o Z4 / _ Called �L�/ - T
l/ r °'� 1 V (� G Ew /i'1�ss "30 - $:S/
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job I<I -)2 K Sink 11.50 r
Address Street Address � , Suite Lavatory 11.50
73(0 73(0 . , 0 / a: WL 1: 2 CArb Tub or Tub /Shower Comb. 11.50
Bldg # Ci ty /State Zip Shower Only 11.50
/ /licED l ?
Name (Specify)
MA-) Water Closet/Urinal S eci 11.50
, " 1
• ) Coi /i e.-t;_ c
4 rv2A/.J k. Dishwasher 11.50
Owner Mailing Address T4 Suite Garbage Disposal 11.50
CO24 6t.Z 5 Washing Machine /Laundry Tray (Specify) 11.50
City/State zi-2. t Zip M Phone
Floor Drain/Floor Sink 2" 1 11.50 /1 �'
Name / `7 , L 3" 11.50
1'1E10 T Qzt�k 4 " 11.50
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 11.50
9,373..) t',4 b 72=A.- Gas piping requires a separate mechanical permit. `-N
City/State Zip Phone MFG Home New Water Service 28.00
' `kA t O 4 7Z MFG Home New San /Storm Sewer 28.00
Name /
i3�7J >) 1 1ti�NA,l iGAL- .x:-.)G, Hose Bibs 11.50
Contractor Mailing Address Suite Rain Drains 11.50
1, $fix / 7a1 Drinking Fountain 11.50
Prior to permit City /State Zip Phone Other Fixtures (Specify) 15.00
issuance, a copy r z-12 4 ,0 zla q7j,0
of all licenses are Oregon ConsVCont. Board Lic.# Exp. ate & Tt$ u
ROI; ET�4�i L / J/•Sa //S5
required if
expired in COT Plumbin Lic. Exp. Date" 9
database & - a341 ''P 9- Cry
Name q - iv ( qq - 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
9 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 a ' 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 �c ,�/)
given is correct, that I am the owner or authorized agent of the owner, and Isometric or nser diagram is required if Quantity Total is > 9 .�J V 7 �"
that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL
Sign ure-or I er /A nt - Date
I 7- °U - q. 7% SURCHARGE 463
Contact Pe n Name Phone
77 p1 C1L4 L -/ kp f , --4 0��j/C * *PLAN REVIEW 25% OF SUBTOTAL
1.BATH HOUSE 178.00. ;, - Required only if fixture qty total is > 9
2 S BATH HOUSE_ ` . , TOTAL 5
43 B H HOUSE 6285.00 ; = •:< -e' .. ;, . . ._,:_ =- , `= . . .. . ; - s r , W. 3
'� ' ° lumbing _
:(This f aaincludes fixtures'in the f' dwelling and the first '
W " " �^�"*� `Minimum permit fee is $50 + 7% surcharge, except Residential Backflow Prevention
00 feet of sanitit sewerstorm`sewer and water service) , y ,i ,�.1,_ Device, which is $25 + 7% surcharge
"All New Commercial Buildings require plans with isometnc or nser diagram and
plan review
i:\dstslformslplumapp doc 7/19/99
•
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
Sink a e rt () v ,-b 1 1
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2" 1
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I \dsts\forms\plumapp doc 7/19/99
•
Accumulative Sewer Tally
Tenant Name:Ng /E /C "V` Fp,v)K This SWR # /q9q —O0/S9
Address: Q43 00 SG, J If f f / / 41 --rd t) , 9torb•-Z- This PLM #; / fly —
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
Value Capped off value added # added #s total
Count off #s count value values
Baptistry/Font 4 -
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2 •
Drinking Fountain 1
Eye `Nash 1
Floor Drain /sink - 2 inch 2
-3inch 5
- 4 inch 6
- Car Wash Drn 6
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6 •
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar /Lavatory 2 ) a
- Bradley 5
- Commercial 3
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
`hater Closet - Toilet 6
Urinal 6
TOTALS o?( °? J — v= O$
Total fixture values: ,R0? O divided by 16 = /30 EDU ICJ Q h'" E (30
HISTORY
PLM # /99 % - a 0/9/ EDU# d SWR # /qq- PLM# 99 oca5- EDU# /3 0 SWR # oa5
PLM # /40q 0 o,3 ,7 EDU# ,3o SWR # /y99 -o6o. z PLM #99 -ocy EDU# 1.3 SWR #99 - oc ,
PLM #, 5Fq -eoi / EDU# / 3d SWR # /9f -octn / PLM 9Q - EDU# / 3 / SWR #99 - 0003F
PLM #,q - ,c/o1 EDU# /3e SWR #,9yy- 0o09,5 PLM#9' -000 EDU# /30 SWR #99 - 78`
i:\dsts\swrtaly doc
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP
Date Requested D �to 7 AM PM BLD
Location ( 3 (L 5l1 .q • Suite MEC /;/�
Contact Person n/A Ph ZSS- S/() PLM i�l'7 Z .&S
Contractor n^ 1 Ph SWR
__ __
BUILDING Owner I Y l �T F - c m , cry Q LC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: eile a � c e nt —
Slab SIT
Post & Beam r
Ext Sheath /Shear e i (v),��I yV vY lS
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
�.� PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage sg‘c,
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
Fire Supply Line [ ] Please call for reinsp ction RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date 8 I Inspector I E x t cD1A
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.