Permit - • • CITY OF TIGARD O PLUMBING PERMIT
' r4 DEVELOPMENT SERVICES I PE RMIT #: PLM1999 -00436
.I II 13125 SW Hall Blvd., Tigard, OR 97223 (50 6 39 -4171 , DATE ISSUED: 12/16/99
SITE ADDRESS: 09800 SW WASHINGTON SQUARE RD 44/
PARCEL: 1S126C0 -01108
SUBDIVISION: - ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Installation of sump pump and basin for ground water.
FEES
Owner:
Type By Date Amount Receipt
SEARS ROEBUCK AND CO PRMT DEB 12/16/99 $50.00 99- 320485
DEPT 768TAX, 62 -116A 5PCT DEB 12/16/99 $4.00 99- 320485
3333 BEVERLY RD
HOFFMAN ESTATES, IL 60179 Total $54.00
Phone 1:
Contractor:
MR ROOTER OF PORTLAND
PORTLAND SERVICES INC
15033 SE MCLOUGHLIN BLVD #344 REQUIRED INSPECTIONS
MILWAUKIE, OR 97267
Phone 1: 503 - 653 -5301 Misc. Inspection
Reg #: LIC 98346 Final Inspection
PLM 3 -296PB
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 Ge t`er. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
Jo You m•. obtain copies of the - rules o direct questions to OUNC by calling (503) 246 -1987.
Issued = I A "jjk / /4►_ /I Permittee Signature: : `fi�
Call (503) 639 • 75 by 7:00 P.M. for an inspection ne. • ed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check#
13125 SW HALL BLVD. Commercial and Residential Rec'd By6-
TIGAR OR 97223 Date Rec'd /. - /3 f 9
(503) 639 -4171 Date to P.E.
Print or Type Date to D
Permit# 4 - DD �f P
Incomplete or illegible applications will not be accepted
Related SWR # /4
Called
Name evelopmenUPro' ct FIXTURES (individual) QTY PRICE AMT
Job ears � C Sink 11.50
Str t d r s J ��/ """"` Suite Lavatory 11.50
Address ��� s S C043 � ` '� St; Rid, Tub or Tub /Shower Comb. 11.50
Bldg # /Stat Zip
/{G, j_ (fj� 970 is 3 Shower Only 11.50
Name / Water Closet/Urinal (Specify) 11.50
1 0 ft4 . g 2 4fR4.04, a-eo " Dishwasher 11.50
Owner Mailing Address Suite Urinal 11.50
`DtP r 7 (f€ - r - A- 6).--11(0)- 1 C, Garbage Disposal 11.50
/St to Zip Phone Co 0 79 Laundry Tray 11.50
"3 J � LY / I , lf f rii4 - /is 5
Name d n Washing Machine/Laundry Tray (Specify) 11.50
t ��G 7 ht 4.1 l 2 Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City /State Zip Phone -
Water Heater 0 conversion 0 like kind 11.50
Name Gas piping requires a separate mechanical permit.
AA ,e, / ia2 p r 1 , 1 ' ?o J f 1 k MFG Home New Water Service 28.00
M ailin Address (�`I MFG Home New San/Storm Sewer 28.00
Contractor / 5 4 � r Suite
�S � /t G/ �/ qy � Hose Bibs 11.50
Prior to permit City / tate ., Zip Phone Roof Drains 11.50
issuance, a copy / L ,Z1 "c 9702(0`7 o -�d1
/ Drinking Fountain 11.50
of all licenses are Orp.goD Cons!. C nt. Board Lic.# Exp. to
required if MS (1p q ,f/ / Other Fixtures (Specie) L 15.00 /s • CIO
expired in COT Plumbin Lic. # 3 CP (j Ex Date �C- /(,( P u MP
database V/
Name
Architect Sewer- 1st 100' 38.00
or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City /State Zip Phone Water Service - each additional 200' • 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New I& Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' - 32.00
Residential 0 Commercial 410
Additional description of work: Commercial Back Flow Prevention Device 32.00
I _` ( Residential Backflow Prevention Device* 19.00
J Gt•S 4 1 1 gash e put1.'Q W& 1N 7 r�f (01140 V0 A r Catch Basin 11.50
Are you capping, moving or replacing any fiitures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 No lfr Inspections per/hr
If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps . 11.50
WORK COULD RESULT IN INCREASED SEWER FEES.
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL
given is correct, that I am the owner or authorize • agent of the owner, and isometric or riser diagram is required if Quantity Total is > 9
that plans submittesLajs- compliance wit % 'on State Laws. *SUBTOTAL 5, / ,�
,,
Signatu , • • er /Age • Date n V ��
- '----111° / 1 /3 / ff 8% SURCHARGE 91/0 onta - , rpon Na Phone l
ray j 5 a /,`,.) as-3-5701 "PLAN REVIEW 25% OF SUBTOTAL
1' BATHHOUSE $178:00' Required only if fixture qty total is > 9
`& HOUSE $250.00 �- -; � TOTAL 5f A
HOUSE $285.00:
includes da plumbing-fixtures In the dwellIng and ,„ : *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
100 feet of sanandpwater service) • ; ' ;r Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review
I hdsts\formstplumapp doe 10/1/99 - • -
. / 5 / .? 6 a c j / /O(
PLEASE COMPLETE:
• Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Urinal
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3
4"
Water Heater
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
•
I:ldstsformslplumapp.doc 10/1/99 -
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested / - f ( AM PM BLD
Location qgl SU- W IP-S- Suite MEC
Contact Person IYUlS (vn.11--4 / Ph 3(u 9 " '7 PLM tgei 9-60 4.3cc,
Contractor Ph 40-5 0/ SWR
BUILDING Tenant/Owner a.P,f S e. -71e 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 B /> / /t i�jL / 1. _l4.a
Fire Alarm
Susp'd Ceiling
Roof
Misc: /AV
Final
PASS PART FAIL
PLUMBING
Post & Beam �� I '
Under Slab ��,,,;� ,I1 1 `
Top Out ���''ii 1
Water Service 0r
Sanita Sewer p/' •
r ain Drains
PAir
PART
7I- . HANICAL
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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA `� J
Approach /Sidewalk D 7 ! Inspector MO
Other EXt
Final
PASS PART FAIL DO NO REMOVE this inspection record from the job site.
•