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Permit CITYOFTIGARD �, ) �;� DEVELOPMENT SERVICES PLUMBING PERMIT } :At+ 9 - .1J - I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # • PLM98 - 0172 DATE ISSUED: 07/01/98 • 1 PARCEL: 2S101AD -02600 I1 SITE ADDRESS...: 12625 SW 69TH AVE SUBDIVISION : WEST PORTLAND HEIGHTS ZONING: MUE BLOCK • LOT •031 JURISDICTION: TIG CLASS OF WORK..:NEW GARBAGE DISPOSALS.: 1 MOBILE HOME SPACES.: 0 TYPE OF USE •COM WASHING MACH 0 BACKFLOW PREVNTRS..: 1 OCCUPANCY GRP..:B FLOOR DRAINS • 1 TRAPS • 0 STORIES • 0 WATER HEATERS • 1 CATCH BASINS : 0 FIXTURES LAUNDRY TRAYS 0 SF RAIN DRAINS • 0 SINKS • 9 URINALS • 0 GREASE TRAPS : 0 _ LAVATORIES • 3 OTHER FIXTURES • 0 TUB /SHOWERS...: 0 SEWER LINE (ft)...: 100 WATER CLOSETS.: 3 WATER LINE (ft)...: 100 ISISHWASHERS : 1 RAIN DRAIN (ft)...: 100 Remarks: McCroskey Clinic Owner: FEES JOHN MCCROSKEY type amount by date recpt 14125 SW FARMINGTON PRMT $ 286.00 GEO 07/01/98 98- 306979 BEAVERTON OR 97005 PLCK $ 71.50 GEO 07/01/98 98- 306979 5PCT $ 14.30 GEO 07/01/98 98- 306979 Phone #: Contractor GRIDLINE PLUMBING & HEATING 4343 SE 37TH AVE PORTLAND OR 97202 Phone #: 771 -8790 $ 371.80 TOTAL Reg #..: 74105 REQUIRED INSPECTIONS This permit is issued subject to the regulations contained in the Sewer Inspection Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Line Insp applicable laws. All work will be done in accordance with Water Service In approved plans. This permit will expire if work is not started Underfloor /Under within 180 days of issuance, or if work is suspended for more Top -out Insp than 180 days. ATTENTION: Oregon law requires you to follow rules Storm Drain Insp adopted by the Oregon Utility Notification Center. Those rules are Crawl. Drain set forth in OAR 952 - 0001.8010 through OAR 952-0001-0080. You may Rain Drain Ins p obtain copies of these rules or direct questions to OUNC by calling Final Inspect ion (503)246 -1987. Issued By: .1 /, /_ " - Permittee Signature: 4021g60 +++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day +++++++++++++++++++++++++++++++++++++++++++++++ + + ++ + + + + + + + + + + + + + + + ++ + + + + + + + + ++ (0 - CITY OF TIGARD Plumbing Application Rec'd By 1 ( AJ °- 13125 SW HALL BLVD. Commercial and Residential Date Rec'd i TIGARD, OR 97223 P: BUP #� 97 =0525 Date to P.E. 000I(ocilS (503) 639 -4171 Date to DST Permit # A;" qg 0 (7-e. Print or Type Related SWR # - o (3 9 • Incomplete or illegible applications will not be accepted Called Name of S elopment/Project On back Indicate Work Performed by fixture. .lob / ,� �j�. ���) / Q FIXTURES (Individual) QTY PRICE AMT Address ' Stree A: dress V Suite Sink &1 9 9.00 81 .00 Lavatory ,/ 3 9.00 27.00 Bldg # ate Zi ...irlity/ 2 Tub or Tub/Shower Comb. 9.00 Name - / �� /� J` Shower Only 9.00 DR. J. Washing Machine McCroskey �� J Suite Dishwasher Water Closet t 3 9.00 9.00 27. C 0 Owner % ai ing d ss / 24 ,� / l op / � 1 Garbage Disposal 9 9 r , g !State Z' / 5/ ,r- �Il �d�• r4/5-70f_ 95=f 9.00 Name ��N' lJ�� / Floor Drain 2" / v 1 9.00 9.0C Dr. McCroskey 3" 9.00 ' Occupant Mailing Address Suite 4" 9.00 ' 12645 SW 6 9th Av Water Heater 0 conversion 0 tike kind 9.00 City /State Zip Phone 1 9.0 0 Tigard Or. Laundry Room Tray 9.00 Name Urinal 9.00 Gridline Plumbing & Heatin; Other Fixtures (Specify) 9.00 Contractor Mailing Address Suite r, -.'...------c-: � _ - 9.00 4343 SE 37th Av " -� .1. Prior to permit City /State Zip Phone 9.00 issuance, Port, Or. 97202 771-8790 9.00 of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date - 9.00 ' required if 74105 0 5 23 00 sewer -1st 100" 30.00 3 i D expired in COT Plumbing Lic. # Exp. Date / database 26 -449 PB 11 30 98 Sewer - each additional 100' 25.00 Name Water Service - 1st 100' 100 ' 30.0 ` 30 .00 Architect THE Env iro design Water Service - each additional 200' 25.00 Or Mailing Address Suite Stonn &Rain Drain -1st 100' ' 30.00 3D, �d 091 S. Mopac 420 Storm & Rain Drain - each additional 100' 25.00 Engineer Ct aus t ti n TX 4 /8748 5 3287744 Mobile Home Space 25.0 Commercial Back Flow Prevention Device or Anti- / •, 25.00 25.00 Describe work New if Addition 0 Alteration 0 Repair 0 Pollution Device to be done: Residential 0 Non - residential Residential Backflow Prevention Device* j 15.00 Additional description of work: Any Trap or Waste Not Connected to a Fixture 9.00 Catch Basin 9.00 All r , , 1 - ( - ,O s Insp. of Existing Plumbing 40.00 ' [/l/V (�4 per/hr Existing use of Specially Requested Inspections 40.00 building or property _ per /hr Rain Drain. single family dwelling 30.00 Proposed use of Dental Clinic Grease Traps 9.00 building or property / QUANTITY TOTAL 4 1 hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quanity Total is > 9 given is correct, that I am the owner or authorized agent of the owner, and "SUBTOTAL � Q� that pia s submitted are in compliance with Oregon State Laws. Or ' -re4.6. Signs o OwnerlA t Date 5% SURCHARGE IA.- �./.� 6/15/98 j�' a0. ©S ntac Person Name Phone P LAN REVIEW 25% OF SUBTOTAL . o n l y 7 /' -.5 4.2 5 John Duncan 771-8790 TOTAL 37/.0 .28 3.10 *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow Prevention Device, which is 515 + 5% surcharge ldstsVImapp.doc 5/97 PLEASE COMPLETE: Fixture Type • . Quantity by Work Performed New Moved Replaced RemovedlCapped Sink 9 Lavatory 3 Tub or Tub /Shower Combination • Shower Only Water Closet 3 Dishwasher 1 Garbage Disposal Washing Machine Floor Drain 2" 1 3" 4" Water Heater 1 Laundry Room Tray Urinal Other Fixtures (Specify) Solenoid Valve w/ R.P. device. operatory water COMMENTS REGARDING ABOVE: dststpknapp.doc 5/97 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 , p BUP R 717 Date Requested ' `I 4 — o AM PM K BLD Location -t- 6 - �5 s S1 k) {C� 7 / r I a e . Suite MEC p �7 Contact Person Ph 0 Contractor � � �" // �� ,/ & M � - Ph 7 7 / - s 7 ! O !0 3 7 BUILDING Tenant/Owner 011!/C . ,6 ELC Retaining Wall ELR Footing Access: Foundation M ^T� /v 65 I ' FPS Ftg Drain / lJ / SGN �i Slab Crawl Drain Inspection Notes: � SIT C-- VO t / Post & Beam Ext Sheath /Shear 0 v" "�" QFS� �A"` �Y "' `o`er /�w'' Qr l� v p r Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL �LUMBING Post & Beam Under Slab Top Out (= rit,, e �2a�n n ains j PART FAIL 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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access Fire Supply Line ADA Approach/Sidewalk r : 9� Other Date . - ttt�/ Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.