Permit • CITY OF TIGARD PLUMBING PERMIT
alt DEVELOPMENT SERVICES PERMIT #: PLM1999 -00234
r ' f II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 09/16/1999
SITE ADDRESS: 11735 SW QUEEN ELI ABETH ST PARCEL: 2S110CD -00104
Z
SUBDIVISION: KING CITY NO. 2 ZONING: •
BLOCK: LOT: JURISDICTION: KIN
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 6 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 6 OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: 6 WATER LINE: 100 ft •
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing for new office building.
FEES
Owner:
Type By Date Amount Receipt
JACK MEDAK PRMT BON 09/16/1995 $360.00 99- 318380
4029 NE SANDY BLVD PLCK BON 09/16/1995 $90.00 99- 318380
PORTLAND, OR 97212 5PCT BON 09/16/1995 $25.20 99- 318380
Phone 1: Total $475.20
Contractor:
MARKMAN INC
9955 SE ASH ST
PORTLAND, OR 97216 REQUIRED INSPECTIONS
Phone 1: 255 -9923 Rain Drain Insp
Reg #: L IC 12857 RP /Backflow Preventer
g Final Inspection
PLM 26 -183PB Water Service Insp
Top -out Insp
Final Inspection
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 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By Y v �— Permittee Signature: #
Call (503) 639 -4175 by 7:00 P.M. for an inspection neede the next business day
t
CITY OF TIGARD Plumbing Permit Application Plan Check __
13125'SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd 1
(503) 639 -4171 Date to P.E. 7 - af -4'7
Print or Type Date to DV
Incomplete or illegible applications will not be accepted Permit# GIiIQ 4-66.73e/
p 1I Related SWR # 1 evu 3 ' tJ 4M'v Called /0 -14 - 1- L�� r /11c�5A g: /c/
Name of Develo Project f� FIXTURES (individual) QTY PRICE AMT
Job Hf Nth 6t77 v /el ' J Sink 11.50
Address Street Addre Suite Lavatory 11.50
I I." C _ Tub or Tub /Shower Comb. 11.50
Bldg # City /State n6,t.-ry / l
f- �`� r Shower Only 11.50
Name 1 Water Closet ( 11.50
A(, -ie 104- Dishwasher 11.50
•
Owner M i ing Address Suite Garbage Disposal 11.50
462 1 r `� ss S/ 13 L A / `/ it Washing Machine 11.50
. City/State Zip Phone
?tti! A -JJ r � ce 9917-17-- Floor Drain/Floor Sink 2" 11.50
Name f 3" 11.50
4" 11.50
Occupant Mailing Address Suite
P Water Heater 0 conversion 0 like kind . � 11.50
Gas piping requires a separate mechanical permit.
City/State Zip Phone Laundry Room Tray 11.50
Name Urinal 11.50
PIAOv i n (N I Other Fixtures (Specify) 15.00
Contractor Mailing Address Suite
‘1955 As sr
Prior to permit �City Zip Phone (SoSS
issuance, a copy r �` �I .J s ) 6e '9 S 4 2 ' 43
of all licenses are Oregon Const. Cont. Board Lic.# Exp Date ,
required if i .51 'Z / /00
expired in COT Plumbing Lic. # Exp Date
database 2 I R 3? 10 I3c5 i ao Sewer - 1st 100' 1 38.00
Name / Sewer - each additional 100' 32.00
Architect -11‘.1 � 1 1J�l�C 6S Water Service - 1st 100' I 38.00
Or Mailing Address Suite Water Service - each additional 200' 32.00
7616 Sw . I .: 1 l /� � OD Storm & Rain Drain - 1st 100' 38.00
Engineer City /State Zip Phone (.5 3 )
71 6A t c,2 97z3 *I 3'2 613 Storm & Rain Drain - each additional 100' 32.00
Describe work to be done: Mobile Home Space 32.00
New Repair 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device ! 32.00
Resi en lal 0 Commercial 0 Residential Backflow Prevention Device' / 19.00
Additional description of work: Catch Basin 11.50
Insp. of Existing Plumbing 50.00
Are you capping, moving or replacing any fixtures? permr
Yes 0 No Specially Requested Inspections 50.00
If yes, see back of form to indicate work performed by per/hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45.00
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL
given i rrect, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9
that an ' d are in compliance with Oregon State Laws.
*SUBTOTAL
Si atu f ne Agent Dat q ,
i�' (
7% SURCHARGE R0
Co I4 R ntact Person Name Phone aS -
�11`a tANS Z65 99 `*PLAN REVIEW 27% OF SUBTOTAL ? ¢�
1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9
2 BATH HOUSE $250.00
3 BATH HOUSE $285.00 TOTAL "
(This fee Includes all plumbing fixtures in the dwelling and the first
100 feet of sanitary.sewer storm sewer and water service) *Minimum permit fee is $50 + 7% surcharge, except Residential Backflow Prevention
-- - Device, which is $25 + 7% surcharge
• "All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
l:ldststormslplumapp.doc 7/9/99
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved Replaced Removed /Capped
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)
COMMENTS REGARDING ABOVE:
I: dstsVorms\plumapp.doc 7/9/99
•
01/05/2000 - Activities for Case #: PLM1999 -00234
11:14:26 AM
Assigned Hold • Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. • Level By Updated Notes
PLMCO50 (F) Issue permit 09/16/1999 BON DONE No Hold BON 09/16/1.999
PLMC003 Application received 07/20/1999 BON DONE No Hold BON 09/14/1999 USA sewer permit copy is with
the building permit for this case.
PLMC005 Permit Created 07/29/1999 DEB DONE No Hold DEB 07/29/1999
PLMC007 Plans routed to Plans Examiner 07/29/1999 DEB DONE No Hold DEB 07/29/1999 King City permit so no need to
do sewer tally sheet. •
PL■C007 Plans routed to Plans Examiner 08/04/1999 MRS SENT No Hold MRS 08/04/1999
PLMC120 Plumbing Undersl • 08/04/1999 08/04/1999 10/08/1999 TLP PASS No Hold AKJ 10/10/1999
PL■C711 Water Service lnsp 08/04/1999 08/04/1999 . , No Hold MRS 08/04/1999 -
PLMA735 Rain Drain Insp 08/04/1999 08/04/1999 11/05/1999 TLP PASS No Hold VT 11/05/1999 contractor: correct permit # is
PLM1999-00234
perimeter rain drain
PLMA750 RP /Backflow Preventer 08/04/1999 08/04/1999 No Hold MRS 08/04/1999
PLMC725 Top -out lnsp 08/04/1999 08/04/1999 11/24/1999 TLP DONE No Hold TLP 11/24/1999
PLMC015 DST Post Review Complete 08/10/1999 GEO DONE No Hold GEO 08/10/1999
PLMC040 (F) Ready to issue 08/10/1999 GEO PASS No Hold BON 09/14/1999 USA sewer permit has been
obtained. Green copy of the
permit is in the building file.
. - Bon
PLMA740 Misc. Inspection • 11/03/1999 11/03/1999 11/03/1999 MRS FAIL No Hold VT 11/03/1999 There are no rain drains on
plumbing; misc is substitute for
. it.
• 1. raindrain have reverse grade
2. raindrain belong to the
plumber ( needs to be grade
. properly)
3. catch basic require a quarter
. end plus a clean out.
PLMC799 Final Inspection 12/06/1999 12/06/1999 12/30/1999 MRS PASS No -Hold AKJ 01/02/2000
PLMC800 Case Finaled 01/02/2000 • AKJ DONE No Hold AKJ 01/02/2000
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