Permit CITY OF TIGARD
�„�di00 0) DEVELOPMENT SERVICES PLUMBING PERMIT
� 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # • PLM97 -0389
DATE ISSUED: 10 /01/97
PARCEL: 2S1O1BC -01000
SITE ADDRESS...: 08485 SW HUNZIKER ST
SUBDIVISION - KNOLL ACRES ZONING: R -4.5
BLOCK • LOT °005 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..:B FLOOR DRAINS : 0 TRAPS 0
STORIES ° 0 WATER HEATERS : 0 CATCH BASINS 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0
SINKS . 0 URINALS • 1 GREASE TRAPS 0
LAVATORIES • 0 OTHER FIXTURES • 1
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 1 RAIN DRAIN (ft)...: 0
Remarks: TLT Day School
Owner: FEES
TLT DAY SCHOOL type amount by date recpt
8485 SW HUNZIKER PRMT $ 27.00 DRA 10/01/97 97- 299695
TIGARD OR 97223 SPOT $ 1.35 DRA 10/01/97 97- 299695
Phone #:
•
Contractor
CENTURY PLUMBING
2710 E HANCOCK
NEWBERG OR 97132
Phone #: 538 -2388 $ 28.35 TOTAL
Reg #..: 001090
REDU I RED INSPECTIONS
This permit is issued subject to the regulations contained in the Rough-in Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other PLM /Underfloor
applicable laws. All work will be done in accordance with Top-out Insp
approved plans. This permit will expire if work is not started Drinking F o un t a i
within 180 days of issuance, or if work is suspended for more Final Inspection
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- .'rq-0010 through OAR 952-8801-6080. You may •
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issue By: Permittee Signature:
' _. ►�
+++++++++++++++++++++++++++++++++++++++++++++++ ++ + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + ++ + + + + + + + + ++
Recd B
CITY OF TIGARD Plumbing Application 1.P_
13125 SW HALL BLVD. Commercial and Residential Date Recd
TIGARD, OR 97223 Date to P.E.
Date to DST
(503) 639 -4171 Permit # ga "/ - 03 `a`(
Print or Type Related SWR it T ? 3
Incomplete or illegible applications will not be accepted Called6IGYZi) 9 /S-'
/J
Name of Development/Project
'" '
Job '7L1 1) y CciilocL FIXTURES (individual) i = ;' "' *� l •;'' . 1 �. 'P RICE `AMT
k ; • t .cam,: ,, .�..
Address Street Address r, Suite Sink 9.00
S `f a - S 5 k! l/vNZi P4,,,- Lavatory
9.00
Bldg # City/State Zip Tub or Tub /Shower Comb. 9.00
--rt c cy v.4 c -, 9 2_23
Name 1 Shower Only 9.00
I' LT �14 Water Closet f 9.00 9 .� `
Owner Mailing Address , Dishwasher 9.00
5 Zs- Sl vt/tn zt kp r Garbage Disposal 9.00
City/State Zip Phone
`hc . 9'722-3 Washing Machine 9.00
Name Floor Drain 2" 9.00
.---3'►14...(2-, 3' 9.00
Occupant Mailing Address Suite 4" 9.00
City /State Zip Phone Water Heater 0 conversion 0 like kind 9.00
Laundry Room Tray 9.00
Name - " A Urinal
( e- Y;ToV' TLaW b Other Fixtures (Specify) 9.00
Contractor Iviailing Address r Suite
I E. i1-a- ncack_ lbi thkt:nc t- o1,;n'Ta1v. ) 9.00 C ....-
(Prior to issuance City/State Zip Phone 9.00
applicant must 11 Qw b e- 9 , 01. • 91 t 32- 53 % - 2 3g2s 9.00
provide all Oregon Const. Cont. Board Licit Exp. Date 9.00
contractors / 90$3 ) / -, 7 9.00
license Plumbing Lic. # Exp. Date Sewer - 1st 100" 30.00
information if
expired 7 V ' -9 V 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
Storm & Rain Drain - 1st 100' 30.00
Architect Storm & Rain Drain - each additional 100' 25.00
Or Mailing Address Suite
Mobile Home Space 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
' Describe work New 0 Addition 0 Alteration lk Repair O Residential Backflow Prevention Device* 15.00
. to be done: Residential 0 Non - residential Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work Catch Basin . 9.00
Insp. of Existing Plumbing 40.00
per/hr
Specially Requested Inspections 40.00
Existing use of - �+ per/hr
building or property , J A Y `AAv e Rain Drain. single family dwelling 30.00
• Proposed use of
Grease Traps 9.00
building or property S 0. W1 QUANTITY TOTAL '
Isometric or riser diagram is required if Quanity Total is > 9 '
Are you capping , moving or replacing any fixtures? Yes No ❑ *SUBTOTALJ
(If yes see back of form)
-.(
I hereby acknowledge that I have read this application, that the information
5% SURCHARGE
given is correct. that I am the owner or authorized agent of the owner, and
/
that plans submitted in compliance with Oregon State Laws. PLAN REVIEW 25% OF SUBTOTAL
Si atu o ner /Ag ' t Date
Required only if fixture qty, total is > 9 i)1
OS -9") TOTAL
Contact Person Name Phone ° // w
•Minimum permit fee is 525 + 5% /° surcharge, except Residential Ba�kflow
Prevention Device, which is S15 + 5% surcharge
cstskplmapp. 5197
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I:\dsts\pfnapp.doc 5/97
~ � s £ ( Accumulative Sewer Tally q c 7 _ X 37-0
• Tenant Name: / This SWR#
Address: L, H�.T ?-4 This PLM #: ' � - c3
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count s off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 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
- 3 inch 5
- 4 inch 6
- Car Wash Drn 6
Garbage Disposal 16
- Domestic (to 3/4 HP)
- 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 /
- Bradley 5
• - Commercial 3
- Service 3
Swimming Pool Filter 1 •
Washer - Clothes 6
•
Water Extractor 6 _
Water Closet - Toilet 6 I (c; / (a
Urinal 6 / (/)
TOTALS /(..6 ( Ci l
Total fixture values: / divided by 16 = 1 EDU ( i k - a -- � C rC jZ,
HISTORY n (,,�. (e q /,r -
PLM# EDU# � V J PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
is \dsts\sw'taly.doc
, 7) lti
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CITY 0 -. IGA -RD- BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: 0 - q i A. / P.M. MST:
Location: 71--T 0 BUP:
Tenant: / d / Suite: Bldg: MEC:
Contractor: ! �' L /j . � _ t . Phone: 533 -‘21323 PLM: — .L.1/7
Owner: /L I Pho e: ELC:
� Q
/_4. Ii A 44! �L
'1 L I A'. .4 /4 _ R:
I ■-- SIT:
BUILDING BLDG (con't) PLUMB I MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt .
Approved Ass • • • Approved Approved Approved •
Appr /Sdwlk Not Approved. -nmr• . • ved Not Approved Not Approved Not Approved
FINAL FINAL FINAL FINAL FINAL
•
O Call for inspect, / O Reinspection fee of $ required before next inspection O Unable to inspect
Inspector: 11_ Date: -/ Z 7/72 Page of
t