Permit A CITY OF TIGARD PLUMBING PERMIT
; . I , DEVELOPMENT SERVIC ll itNA1,,,, PERMIT #: PLM1999 -00408
13125 SW Hall Blvd., Tigard, OR 97223 () DATE ISSUED: 12/6/99
SITE ADDRESS: 16290 SW UPPER BOONES FERRYRD PARCEL: 2S113AB-01201
SUBDIVISION: MEMO CREEK ACRE TRACTS ZONING: I -L
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Remove and replace 2 sinks, 1 lavatory, and 2 water closets in existing commercial building.
FEES
Owner:
Type By Date Amount Receipt
PACTRUST
15350 SW SEQUOIA PKWY PRMT DEB 12/6/99 $57.50 99- 320192
#300 SPOT DEB 12/6/99 $4.60 99- 320192
PORTLAND, OR 97224 Total $62.10
Phone 1:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
Phone 1: 236 -4152 Top -out Insp
Reg #: LIC 172 Final Inspection
PLM 26 -83PB
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.
Y ay obtain c ies of these rules or direct questions to OUNC by calling (503) 246 -1987.
•
I ued By: , , /44 4111 ���/ Permittee Signature: �_„&„■gory �
Call (503) 63' -4175 by 7:00 P.M. for an inspect needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check# \
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd - - F
(503) 639 -4171 Date to P.E.
Print or Type Date to DSJ
Incomplete or illegible applications will not be accepted Permit# R# /p) onY
Related SWR ## StndM119- AOZ Sb
Called d1/( jl 0 Pii /4•J
Name of Development/Project FIXTURES (individual) QTY 7 . PRICE AMT
Job , % � f % C d �✓b , Sink 11.50 23 • W
Address Street Address lA iIW bR l a ,5,.. Lavatory / 11.50 ' j , s o
1 /' 2 cin Si-) JF s czGz. �� AD_ Tub or Tub /Shower Comb. 11.50
Bldg # ie . Ci Zip Shower Only 11.50
Nape / �-� r rater Glos ' rinal (Specify) a 11.50 ,Z 3 ••%1 IV A-�T `� LA- .5 ? Dishwasher 11.50
Owner Mailing Address Suite, Urinal 11.50
1 S t5 Sr. otkeCLA P gw� Garbage Disposal 11.50
Cit /State Zip Phone
- & , q 7aa 44 Laundry Tray 11.50
Name � Washing Machine /Laundry Tray (Specify) 11.50
-5A /
Cfc 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.
II) ElApf 1,,/P,tQE?C: u
/ tt MFG Home New Water Service 28.00
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 28.00
7 I i L 5 gi f3 Hose Bibs 11.50
Prior to permit g Zip Phone Roof Drains 11.50
issuance, a copy 09F�h`�` 2.. 6 e` A a3(;; °zq D R
Drinking Fountain 11.50
all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if 0 1 -) g) i , , Z % ^ 1 Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date ,(�
database g ( » 3 PA l?� 1,,� � >�� Ur
Name
Architect Sewer - 1st 100' 38.00
or Mailing Address EX ' F P 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 0 Repair 0 Replace with like kind: ¥esN No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial P
Additional description of workv \ Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device' 19.00
R E Iv∎ 0 0 F a s . 7 AR-, r„ c
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 NO 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. QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total is > 9
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL
that plans submitted are in compliance with Oregon State Laws. S7•
Sig, = •f Owner /A en Date
9 ; 9 Aj, 8% SURCHARGE Li 46°
Con t Person Name P one
(� A/ P n Pa°' 0s-a. **PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE x178.00 _ Required only if fixture qty. total is > 9
' BATH HOUSE $250.00 TOTAL (DZ 0
BATH HOUSE $285.00 . -
fhls fee includes all plumbing•ixtures in the dwelling and the first *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention •
1100 feet of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge
**All New Commercial Buildings require plans with Isometric or riser diagram and
plan review.
I:\dstsVormstplumapp.doc 10/1/99 - - .
A
• )4,
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
Sink
Lavatory j
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:
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I:tdstsVomistplumapp.doc 10/1/99
•
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
! BUP
Date Requested (/ Z I C50 - AM PM BLD
Location 1(02_ (A pe,yi /J Suite _
Contact Person U VeG1,1� Ph Z g(O r / 5 //l `-/d 0
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain * .. SGN
Crawl Drain Inspection Notes: /L !� �
Slab �I ✓✓ • 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
bllm6
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rai Drains r �
=, 1' PART FAIL " .
M ` 1 ANICAL -
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
Approach /Sidewalk /
d
Other Date v?//00 Inspector Yin Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.