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Permit CITY TIGARD PLUMBING PERMIT ', 'I� DEVELOPMENT SERVICES PERMIT #: PLM2000 -00340 -�� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 6 - DATE ISSUED: 9/13/00 SITE ADDRESS: 09546 SW WASHINGTON SQUARE RD H -16 PARCEL: 1S126C0 -01107 SUBDIVISION: WASHINGTON SQUARE ZONING: C -G 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: TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Tenant Improvement/replace water heater FEES Owner: Type By Date Amount Receipt PRMT CTR 9/13/00 $72.50 27200000000 5PCT CTR 9/13/00 $5.80 27200000000 Total $78.30 Phone 1: Contractor: MODERN PLUMBING 11120 SW INDUSTRIAL WAY TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone 1: 691 -6166 Final Inspection Reg #: LIC 87906 PLM 34 -250PB 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 (503) 246 -1987. Issued By: L '/ Permittee Signature: I ik £ '' Call 503) 639 -4175 by 7:00 P.M. for an inspection needed t e next business day CITY OF TIGARD Plumbing Permit Application Plan Check# 13125 SW9-IALL BLVD. Commercial and Residential Rec'd By - /3 - d - ei Date Recd TIGARD, OR 97223 Date to P.E. (503) 639 -4171 Date to DST Permit #/ lJ 20 V - . 09 . Print or Type Related SWR # Incomplete or illegible applications will not be accepted Called Name of Development/Project FIXTURES (individual) Job The.. ShAr/o0./ "2/77/96_, Sink Qty Price Total 16.60 Address Street Address Suite Lavatory 16.60 Bldg # City/State s01 G(>/f ... din Zip St 2n ate o Zip Tub or Tub /Shower Comb. 16.60 77(/4i24)l 07 Shower Only 16.60 Name Water Closet 16.60 Urinal 16 60 Owner Mailing Address Suite Dishwasher 16.60 City /State Zip Phone Garbage Disposal 16.60 Laundry Tray 16.60 Name Washing Machine 16.60 -ePd -t? =m4 Floor Drain/Floor Sink 2" 16.60 . Occupant Mailing nA - , . Suite c per, Q ,5ri .5W W�hmi et, 3" 16.60 City /State Zip Phone tv/vv/ 4" 16.60 77 Gvr'Yp Water Heater 0 conversion • like kind / 16.60 /� /� Name Gas piping requires a separate mechanical permit. ta.J /1 ? t / (,e e Um ! G 1!? p/ MFG Home New Water Service 46.40 Contractor Mailing Address ite MFG Home New San/Storm Sewer 46.40 /PJ 1 .5(.3 and u L W P.-V Hose Bibs 16.60 Prior to permit City /State Zip Phone / issuance, a copy TUR/ . O/c q-)(,z 0/ 'ro /(p(0 , Roof Drains 16.60 1 of all licenses are Oregw Const. Cont. Board Lic.# Exp. Date Drinking Fountain 16.60 required if 79() Other Fixtures (Specify) 21.75 expired in COT Plumbing Lic. # Exp. Date � database e3/ g S o P B 1 OO Name Architect or 55.00 M Address Suite Sewer - 1st 100' Sewer - each additional 100' 46 40 Engineer City /State Zip Phone Water Service - 1st 100' 55.00 Water Service - each additional 200' 46.40 Describe work to be done: Storm & Rain Drain 1st 100' 55.00 New • Repair 0 Replace with like kind: Yes 0 No 0 Residential 0 Commercial • Storm & Rain Drain - each additional 100' 46.40 Additional descripti9n of work: Commercial Back Flow Prevention Device 46.40 SU� /, �.07 Wa ✓ h_Q C "• Residential Backflow Prevention Device* 27.55 Are you capping, moving or replacing any fixtures? Catch Basin 16.60 Yes • No 0 Insp. of Existing Plumbing or Specially Requested 72.50 If yes, see back of form to indicate work performed by Inspections per /hr fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 65.25 WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 16 60 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 plans submitted are in compliance with Oregon State Laws. *SUBTOTAL W.5 Signature of Owner /Agent Date 8% SURCHARGE Contact Person Name Phone / j Sa "PLAN REVIEW 25% OF SUBTOTAL , ` 'HOUSE 249°20 r , ' ` °* ti � Required only if fixture qty. total is > 9 9 0_ SEA 50.I 1 - TOTAL 3I2 DOUSE, 399.00 :" /O� ,ftNi' nc udes . II plumb ng f d e t 1' '7 , so i , i i . t jr ,.M., ewer to , C ) to service) �`' 'Minimum permit fee ism +8 % surcharge. "All New Commercial Buildings require plans with isometric or riser diagram and plan review. * /1 /N /MUM /°E' I1,7 ' 6c fD2 /€5S i1EM77"9 - I.\ dsts\formstplumapp_rev.doc 8/29/00 //9(2K/LD KI "'Wei/En/77.o N be-t ec As 4 ' 34,25 t I9a SuRef/MGf CITY OF TIGARD BUILDING INSPECTION DIVISION MST • 24 -Hour Inspection Line: 639 -4175 Business Line: Z39 -4171 9/26 BUP Date Requested 2 AM PM BLD Location q5 tVA Suite - � . MEC Contact. Person Ph 2lltV ' © Contractor �i!? 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 '-- . - ins PART FAIL d CHANICAL Post & Beam Gs In Gas Line Smoke Dampers 1\ • 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 Fire Supply Line [ ] Please cal for reinspection RE: [ ] Unable to inspect - no access ADA `� �( - • %�Jff� Approach /Sidewalk d (f � / ' Other Date Inspector Ex t Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.