Permit CITY TIGARD PLUMBING PERMIT
i DEVELOPMENT SERVICES PERMIT #: PLM1999 - 00406
� 13 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 12/01/1999
SITE ADDRESS: 09495 SW LOCUST ST A PARCEL: 1S126DC-04800
SUBDIVISION: LEHMANN ACRE TRACT ZONING: C -
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: DEM GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: 2 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Cap off 2 lavatories, 2 showers, and 1 toilet in existing commercial building.
FEES
Owner:
Type By Date Amount Receipt
MBM &ASSOCIATES PRMT KJP . 12/01/199 $57.50 99- 320095
9495 SW LOCUST STREET 5PCT KJP 12/01/199 $4.60 99- 320095
SUITE A •
TIGARD, OR 97223 Total $62.10
Phone 1:
Contractor:
MARXMEN PLUMBING INC
9665 SW 163RD AVE
BEAVERTON, OR 97007 REQUIRED INSPECTIONS
Phone 1: 579-2200 Insp existing /capped fixtures
Reg #: LIC 00102432 Final Inspection
PLM 34-161PB
ORIGINAL
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 '52- 0001 -0080.
You may obtain co ies of these rules or direct questions to OUNC by calling (503 .' : 1987.
1
Issued By: Permittee Signature: 't- 1 4 Ji: - j`...._
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bs day
CITY OF TIGARD Plumbing Permit Application Plan check#
13125 SW HALL BLVD. • Commercial and Residential G Reed By
TIGARD, OR • 97223 (} ` >t� Date Reed
(503) 639 -4171 �� 0° Date to P.E.
Print or Type Date to DST
• Incomplete or illegible applications will not be accepted Permit # pi_ lM Kw- 600 4.,
Related SWR # /9
Called
Name of Development/Proj ct n F
I ' ' (individual} ' "`3 ` <:' a ,IP- "�PRI•C E `AMT g
� Q� S . L ei . � �� /T . .�.�., -;, < •,� •,. �,,,..� _...s> ;� .�, . •b,.�, ,. , `
,�.0 :, , ,M ,,,�r. " .
Job U°' s9 Sink 11.50
Address Street Address Suite Lavatory a 11.50 /�?,aC
Tub or Tub /Shower Comb. 11.50
Bldg # • ' CjtylState IP Shower Only 610
d12 0 t. Shower 11.50 a
' Water Closet/Urinal (Specify) j, 11.50 / Sp
1417 �t1@l k / • Dishwasher 11.50 '
Owner 9dd ss /� Suite �-• Urinal 11.50
/ � e l�-0��L7T �� ' I Garbage Disposal 11.50
�/ i � 0 ^Zip Phone Laundry Tray 11.50
Name /� J� Washing Machine /Laundry Tray (Specify) 11.50
W € Y 1 -k:fs 'm '�oa.''-( �rls`Q , (-, 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
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Name Gas piping requires a separate mechanical permit.
IA. AftiC `-) sp 1� kc , 9 MFG Home New Water Service 28.00
Contractor Mailing Address Suit e 1 MFG Home New San /Storm Sewer 28.00
qcos.cks , 4,(p3 4-c_ Hose Bibs • 11.50
Prior to permit Ci /State Zip Phone Roof Drains 11.50 •
issuance, a copy elcat t AI Po? q - 3,2 on •
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp ate
required if 102,432- I 1 90'7 1 )-OQ/ Other Fixtures (Specify) 15.00
expired in COT Plumbing Lip. # Exp. ate J •
database %3
Name •
Architect Sewer - 1st 100' 38.00
or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City /State Zip Phone
g 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: Yes 0 No % Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
4 Residential Backflow Prevention Device* 19.00
7 0 fe M. 'O /6 - Catch Basin 11.50
Are you capping, move // or re I ci ng any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes :8 No 0 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. /;: %
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL ^N • ',4,;,.:,:'
,,; , ,
given is correct, that I am .: owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9 5 ;; ; c g;,;-
` 10:&';,,,
that plans subm'. •d are i,mpliance h Oregon State Laws. *SUBTOTAL *! , S 0
Si natur of 0 ar /A 9 en - i . Date
` f .7/ 8% SURCHARGE '0,' �;- n;s:,i,, > °_ L "
Contact rso Names , I Phone ` V ' `'
r L (�,, / � V) 5.7e-t' t') * *PLAN REVIEW 25% OF SUBTOTAL ,% ;a4' �"
�'t Required only if fixture qty. total is > 9 L
5 04 M4iOil1SE X78 00 i ,
1 , �
2 TOTAL , /���L 0
BATH tiOUS E$25D 00 _ ;.° . -. : .; f F '
`a sAT;i HOUSE $285 QO - ,,
00:
his =feel ncWes d ail jut ng fixtures „rn the dwelling 8nd the fi rst', " *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
�9
1 eef: S tl�lt81'y ! tirr18�4*011ntl_1Ndter* ;, 04 ,' „ _ t 1 Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
l: \dsts \forms\plumapp.doc 10/1/99 - - -
•
PLEASE COMPLETE:
P6 1
• IRPP IA..C:9,ft: I VIATPRY:P
Sink
Lavatory 2.
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:
•
I:\dsts\forrns\plumapp.doc 10/1/99
1/31/00 Activities for Case #: PLM1999 -00406
1:43:47 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 12/1/99 KJP RECD No Hold KJP 12/1/99
PLMC005 Permit Created 12/1/99 KJP DONE No Hold KJP 12/1/99
PLMCO50 (F) Issue permit 12/1/99 KJP DONE No Hold KJP 12/1/99
PLMC760 Insp existing /capped fixtures 12/1/99 12/1/99 12/8/99 TLP PASS No Hold TLP 12/8/99
PLMC799 Final Inspection • 12/1/99 12/1/99 12/8/99 TLP PASS No Hold TLP 12/8/99
PLMA800 Case Finaled 12/17/99 JMT DONE No Hold JMT 12/17/99
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested �' AM PM BLD
Location - 1 Suite MEC
Contact Person Ph 7'7, & PLM � % Dfi
Contractor m ClIA,P.O M Ph 3 / 'fS.3 0 ��)SWR
BUILDING{ :;; g i Tenant/Owner i .R.) fyYl + ELC
Retaining Wall ELR
Footing Access:
Foundation ' 2 . z O / /
FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Ins
DryN Ulation g ^ /7 F/ 7' /ie (CX / � D all Nailin � � v ff?0 ® �
v
Firewall
Fire Sprinkler
Fire Alarm
• Susp'd Ceiling
Roof � cd
1 /; --
/
M isc:
Final
PASS PART FAIL
PLUMBING';
Post & Beam , �r / �— /�
Under Slab P I. � ✓1 J � , ' �/
Top Out
Water Service ra s7}�1
Sanitary Sewer VV
Rain Drains
SS)PART FAIL / �\
MECHANICAL "= .. S
P
/ L,
ost & Beam
Rough In
Gas
Smoke e Dampers
Final
PASS PART FAIL
• ELECTRICAi:.'. ,....
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
- PASS PART FAIL
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
Otheoach /Sidewalk Date " - / Wtp 7 Inspector 7 Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
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