Permit CITY OFTIGARD
,wN , DEVELOPMENT SERVICES PLUMBING PERMIT
�p ; i l , l� PERMIT #.......: PLM98 -0372
4!#' l 13125SWHallBlvd .,Tigard,OR97223(503)639.4171 DATE ISSUED: 10/12/98
PARCEL: 2S101BD -00105
SITE ADDRESS...: 12805 SW 77TH PL
SUBDIVISION ° ZONING: I —L '
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..:U2 FLOOR DRAINS : 0 TRAPS ..... .........: 0
STORIES........: 0 WATER HEATERS ° 0 CATCH BASINS : 0
FIXTURES LAUNDRY TRAYS ° 0 SF RAIN DRAINS • 0
SINKS.........: 0 URINALS 0 GREASE TRAPS.. ..... : 0
LAVATORIES....: 0 OTHER FIXTURES 2
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS....: 0 RAIN DRAIN (ft)...: 0
Remarks: Add hose bib and drinking fountain.
Owner: FEES - - --
PACIFIC UTILITIES type amount by date recpt
12805 SW 77TH PRMT $ 25.00 DLH 10/09/98 98- 309861
TIGARD OR 97223 5PCT $ 1.25 DLH 10/09/98 98- 309861
Phone #:
Contractor
POWER PLUMBING CO
P 0 BOX 23144
TIGARD OR 97281
Phone #: 244 -1900 $ 26.25 TOTAL
Reg #..: 000523
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Misc. I n s p e c t i o n
Tigard Municipal Code, State of Ore. Specialty Codes and all other Drinking F o un t a i
applicable laws. All work will be done in accordance with Final Inspection
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.
Issue By: 4111 . .� /i Permittee Signature: L , , i A
+ + + + + + + +- - +++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OETIGARD Plumbing Permit Application Plan Check # /O - 3 9c.._
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd /6/9/7
( 639 -4171 /I (" Date to P.E.
Print or Type � Date to DST
Permit # lii -40
Incomplete or illegible applications will not be accepted Related SWR # f fr-o
Called /Q - /R -9' EC
Name of Development/Project FIXTURES'(indrvtdi al) :ZS)� ri9TY mRicq roar
Job rl T- Lir■VC \e%. Sink- 9.00
Address Street Address ` Suite Lavatory 9.00
12f " 5(.. t�1 Tub or Tub /Shower Comb. 9.00
Bldg # City/State Zip Shower Only 9.00
TI 1 aAL Water Closet 9.00
_ Name
\ U %LTlrS Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal • 9.00
Washing Machine 9.00
City /State Zip Phone
Floor Drain /Floor Sink 2" 9.00
Name 3" 9.00
4" 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
• Name
• �Owrh .a Al Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite 4 SP l'Ich l 9.00 ci, u0
(a‘, (I SW WtW.TrUorwl4 1 -17th. - 61L'tw/1.�itl \ I 9.00 a'' ou
Prior to permit City /State ' Zip Phone Sewer - 1st 100' 30.00
issuance, a copy ? 04.0_, 9 ZZ3 2-"Ptieluta Sewer - each additional 100' 25.00
of all licenses are Oregon Conet. tont. Board Lic.# Ex � / � ate
Water Service - 1st 100' 30.00
required if 5 �f .
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database 3 y /Su pf � / ! 9 Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00 •
• Architect Mobile Home Space . 25.00 -
or 'Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City /State Zip Phone Residential Backflow Prevention Device' 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial O Catch Basin 9.00 •
Additional description of work: - -
_ Insp. of Existing Plumbing 40.00
S j UL1 W 4- W { U SiouTSS .b� a r per /hr
c Specially Requested Inspections 40.00
(_ \ S� i1 . rn/� 1: val,,d 1 140 �.1 ;y ih. per /hr
Are you Ca Rain Drain, single family dwelling 30.00
y pping,•moving or repiactn fixtures?
Yes O No Grease Traps 9.00
If yes, see back of form to indicate work performed by QUANTITY TOTAL A
Ol t" fixture. FAILURE TO ACCURATELY REPORT FIXTURE - Isometric or riser diagram is required if Quantity Total is > 9 „ k4„
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL r / /`
1 hereby acknowledge that t have read this application, that the information r ` Z'J i
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE es ' 2 I
•
that plans submitted are in compliance with Oregon State Laws. J.,-'
-'
Signature of Owner /Agent Date * *PLAN REVIEW 25% OF SUBTOTAL F.M4 f
` A Required only if fixture qty. total is > 9 TOTAL 'RAirtg
Contact Person Name Phone , ,t
7 -7.L./.; im _ t� • *Minimum permit fee is $25 surcharge, except Residential Backflow
1Ce�1 �/� S�QJ �P.reve_ntion_Devvice ,_which- is- $ -1-Y +5 %surcharge
* *All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I: \dsts\plumapp.doc 7/2/98
•
1
PLEASE COMPLETE:
Fixture Type
Quantety by 11Vork Performer!
New Moved Re laced Removed /Ca` ed
Sink
-
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet -
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2"
3 "
4 "
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
1- k-ose
•
COMMENTS REGARDING ABOVE:
ST wa 4_ w L To Si ► s.�e — Etc_ \ o ,
•
•
•
I:\dsts\plumapp.doc 7/7/98
// P" /' 5 Accumulative Sewer Tally
• nant Name: Pff a
e�F�e r / This SWR# IS` " d ' $
•
!dress: / $ SW ? .7� PL/cLe This PLM #: x$-
:ture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count off #s count value values
• ptistry/Font 4 •
:th - Tub /Shower 4 ,
•
- Jacuzzi/Whirlpool 4
it Wash - Each Stall. 6 .
- Drive Through 16 -
Ispidor/Water Aspirator 1
shwasher - Commercial 4
- Domestic 2
inking Fountain 1 / / / /
•
re Wash 1 ,
oor Drain /sink - 2 inch 2
-3inch 5
• - 4 inch 6
- Car Wash Drn 6
arbage Disposal 16
- Domestic (to 3/4 HP) .
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) .48 -
e Machine /Refrigerator Drains 1
•il Sep (Gas Station) 6 .
ec. Vehicle Dump Station 16 .
hower - Gang (Per Head) • 1
- Stall . 2
ink - Bar /Lavatory 2 .
. - Bradley 5
- - Commercial 3
Service 3 .
swimming Pool Filter 1 ,
Vasher - Clothes 6
Vater Extractor 6
Vater Closet - Toilet 6
Jrinal 6
-OTALS y i I 6v 5
. ,
total fixture values: g divided by 16 = 06' EDU No 6 /'J b- P4' s
-1I STORY Stie- /Ai PE r /o - 4R 4$'
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
:ldsts\swrtaly.doc
•
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
G BUP
D I'5Date Requested j �� � AM PM BLD
/
Location l28 5 ja) 77/ l fZ(° Suite MEC
Contact Person Ph _1 —Z a, 7?-637J-
Contractor - /L ') /i .Ph / i1 SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing ACC- S: 1 �
Foundation
Ftg Drain :, G 4 /I x•19 61"k
11am- —6111e
Crawl Drain nspection Notes: ' SGN
Slab '� /� SIT
Post & Beam .d/ up Aid" t
Ext Sheath /Shear l gz-,
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Po
nder Slab
Top Ou
Water Service
Sanitary Sewer
Rain Drains
1' a ) 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 _ .. .
Backfrll /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 Date ft / `/ Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 1 /?-G AM . PM - BLD
Location 1 L') 05 7 7 vi-k- /v Suite MEC ,r
Contact Person / Ph c4 'a 6 PLM � 31D-,
Contractor Ph SWR
BUILDING. Tenant/Owner ,`(i_1 _ , A j / _ 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 // D � �l�� /r (� �j 1 „ Drywall Nailing `/�/ J / V ! J /
Firewall •
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
-_. Misc: , ....
Final ..; ,, : ,
PAS _ PART FAIL = _
Po "• O/
Under Slab , — - _
Top • c 1.
Sarntary, Sewer - .
Rain Drains -
art, PART FAIL
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA // Approach /Sidewalk
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.