Permit (172) CITY OFTIGARD
,,.,;ei. , ,� , , ,, DEVELOPMENT SERVICES PLUMBING PERMIT
� � �q I I PERM PERMIT # • PLM97 -0374
-. II. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 DATE ISSUED: 10/07/97
PARCEL: 2S115BA -00101
SITE ADDRESS...: 16200 SW PACIFIC HWY 04
SUBDIVISION ZONING: C —G
BLOCK • LOT • JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:M FLOOR DRAINS • 3 TRAPS • 0
STORIES • 0 WATER HEATERS • 1 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0
SINKS • 0 URINALS • 1 GREASE TRAPS : 0
LAVATORIES • 5 OTHER FIXTURES • 3
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 5 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Plumbing TI
Owner: FEES
CAPITAL /BIT HOLDINGS TWELVE IN type amount by date recpt
C/O FORUM PROPERTIES PRMT $ 162.00 GEO 10/07/97 97- 299842
8705 SW NIMBUS PLCK $ 40.50 GEO 10/07/97 97- 299842
BEAVERTON OR 97005 5PCT $ 8.10 GEO 10/07/97 97- 299842
Phone #:
Contract or
KEEFER PLUMBING INCORPORATED
52300 SW SOUTH RD
GASTON OR 97119
Phone #: 503 - 640 -7451 $ 210.60 TOTAL
Reg #..: 056481
REQUI RED INSPECTIONS
This permit is issued subject to the regulations contained in the Water Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other PLM /Underf 1 oor
applicable laws. All work will be done in accordance with Top —out Insp
approved plans. This permit will expire if work is not started Final Inspection
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.
T
Issued By �� L . Permittee Signature. , i � //
++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + ++ '� + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
• .. •r a M r MM a
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' ' r o �2' - 29 P))) � 1 . PL, A )) 012.10,
CITY OF TIGARD ? Plumbing Application By
l Date Rec'd 9- 9'9 7
13125 SW HALL BLVD. Commercial and Residential �V �� D ate t P.E. 'B■
TIGARD, OR 97223 \ Date to DST ®,
(503) 639 -4171 Permit# ?LK! -a
Print or Type Related SWR # / iW.
Incomplete or illegible applications will not be accepted Called r' AZ r 0 C
Name of OevelopmenUPro'e ��^^✓ 1oo6% .� -3S �w
Job 776 FIXTURES (Indlvldual) •'. ..t:,.4,, ..' ,. ,. QTY.- PRICE, ;-AMT ;
Address Street Address �,(� Suit Sink 9.00 ex
/GLGO Jll /Oak Lavatory i i� .. � r 9.00 �1s
Bldg # City /State Zip
1 ' F- '
f �� . Tub or TublShower Comb. 9.00
. 02_,.....
Name cop /r / il6 /r ty-r oi"'fit Rvt/
ete Shower Only / 9.00
a vji; �/l(/Pe/inel Water Closet 5 9.00
Owner Wailing Address Suite Dishwasher 9.00
B7QS" Sit) 0/141/1 JPV0 L30 Garbage Disposal 9.00
Ci /State Zip Phon
� j elve72 J Veer- � u 77 Washing Machine 9.00
Name ! Floor Drain 2' .3 9.00 2T g-
Occupant
Mailing Address t_ 15 ,
Suite 4' 9.00
Water Heater 0 conversion Y like kind I 9.00 a
City/State Zip Phone !
. Laundry Room Tray 9.00
Name / _ v sfiv." - 7 e0r pt uo i rl‘ Urinal / 9.00 Y
i \ 4 (/ Other Fixtures (Specify) 9.00
= Contractor Mailing Address Suite e - m/c Whr - aabre 2 9.00 41.00
■
(Prior to issuance City/State Zip Phone /- Aro? S 0 Si -- / 9.00 r
applicant must ( 9.00
provide all Oregon Const. Cont. Board Lic.# Exp. Date 9.00
contractors 9.00
license Plumbing Lic. # Exp. Date Sewer - 1st 100' 30.00
information if
expired Sewer - each additional 100' 25.00
in COT COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 30.00
database). Water Service - each additional 200' • 25.00
Name
AOW r /e/ Storm & Rain Drain - 1st 100' 30.00
Architect t� Storm & Rain Drain - each additional 100' 25.00
or Mailing Suite
' / ram
Mobile Home Space 25.00
Engineer C�J(yr/S�tate Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
_ f0� l7/IA/ai 9710/ -000 21.4 -y.Slo Pollution Device
' Describe work New 0 Addition 0 Alteration Repair 0 Residential Backflow Prevention Device' 15.00
to be done: Residential 0 Non - residential `OC Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work / Catch Basin 9.00
49 Ey /.r2' f'•t to /" tra L !e/df& fP4 083 .
array ey/re vc ntr £oc" PR -�� Insp. of Existing Plumbing 40.00
per/hr
,)
s� / /LCT" /' ,� - Specially Requested Inspections l 40.00 1(
Existing use of �� / / - per/hr
building or property /'L[/�Q4/ GrQi'(■ Splt+ Rain Drain, single family dwelling 30.00
Proposed use of �� , / Grease Traps 9.00
building or property
QUANTITY TOTAL /// _
Are you capping • moving or replacing any fixtures? Ye s No o Isometric or riser diagram is required if puanity Total is > 9 Y'
(If yes see back of form) *SUBTOTAL 7 ��L7�
I hereby acknowledge that I have read this application, that the information 5% SURCHARGE �i4477 //''
given is correct, that I am the owner or authorized agent of the owner, and �, /o , ,5 V
that plans submitted are in compliance with Oregon State Laws. PLAN REVIEW 25% OF SUBTOTAL L/0,1;1) � -3 - ,`
Signature of Owner / Date Required only d fixture qty. total is > 9 p j� ' T G �T�
rv f7 TOTAL "eta° / ` +Sea Contact Person Name P w
� , ) •Minimum permit fee is $25 + 5% surcharge. except Residential Backflo
JO - an I H /J� v4- Prevention Device, which is $15 + 5% surcharge
'.a atstptmepp.doc 5/97 1 ' 1 "l� ���fff 9• -Q
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to b capped moved or replaced Qty
Sink 4Z
Lavatory �.
Tub or Tub /Shower Combination
Shower Only
Water Closet - l
Dishwasher •
Garbage Disposal < 1 /c'iff /
Washing Machine
Floor Drain 2"
3" / `
4„ r,
Water Heater '
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I:hstslp rnapp.doc 557 ',
M keoP �vs P Accumulative Sewer Tally
Ten,nnt•lslarlie: /, -- 9,? , - cr G �� This SWR# c►� 1 _ 3 S
Address: / � —.--e c,._J /�.- / ` 'ems SI .Q- S This PLM#: pc „R ci 7 _ 63
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
- Jacuzzi/Whirlpool 4
4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator • 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain • 1
Eye Wash 1 .
Floor Drain /sink - 2 inch • 2 1 J / 0 - 1 6-
- 3 inch • 5 //, 5
4
- 4 inch 6 2(1
- Car Wash Dm 6
Garbage Disposal 16 /
- Domestic (to 3/4 HP) / / c
- 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 ? L L /G
- Bradley • 5
- Commercial 3 .5 9
- Service 3 / 7 I 7
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6 _
Water Closet - Toilet 6 -' / 5 3C
Urinal 6 i 6 / G'
- �v
TOTALS • g(0 / � �� • f � G divided b 16 = U EDU r - 2 �� '
Total fixture values: by (�� C
HISTORY
PLM# T - 4 ED 'SWR# q PLM# EDU# SWR#
PLM# EDU# .,�.:.-. • WR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# - PLM# EDU# SWR#
is \dsts\swrtaly.doc '
6/30/99 - Activities for Case #: PLM97 -00374 • .
4:44:33 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received - 9/9/97 DRA RECD BON 9/10/97
PLMC005 Permit Created • 9/10/97 B DONE BON 9/10/97
PLMC799 Final Inspection 11/13/97 TLP PASS TLP 11/13/97
PLMC007 Plans routed to Plans Examiner 9/10/97 B SENT BON 9/10/97
PLMC008 Plans Approved/Routed to DST 9/24/97 MS PASS MRS 9/24/97
PLMC710 Water Line Insp 9/24/97 11/12/97 TLP PASS J'H 11/14/97
PLMC720 PLM /Underfloor 9/24/97 11/12/97 TLP PASS ' J'H 11/14/97
PLMC725 Top-out Insp 9/24/97 10/9/97 MS PASS J'H 10/13/97
Km= 5 DST Post Review Complete • 9/29/97 JSD PASS JD 9/29/97
PLMC041 Return to pending 9/30/97 B PEND BON 9/30/97 returned to pending for
re -evaluation by Mike Sheehan.
PLMC040 (F) Ready to issue 10/6/97 JSD PASS JD 10/6/97 Delay due to confusion as to
whether MikeS was dealing with
tenant space or Marshalls;
confirmation of confusion made
at 1:10PM 10/06/97.
PLMCO50 (F) Issue permit 10/7/97 GEO PASS DST 10/7/97
PLMC015 DST Post Review Complete 10/9/97 B DONE BON 10/9/97
PLMC725 Top -out Insp 10/20/97 TLP PASS J *H 10/29/97 Contractor called for topout,
space adjacent or AS, not
space X ? ? ? ??
PLMC800 Case Finaled 11/13/97 TLP PASS TLP 11/13/97
-
PLMC799 Final Inspection 11/12/97 TLP PASS J'H 11/14/97 .
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