Permit 1
CITY TIGARD PLUMBING PERMIT
r DEVELOPMENT SERVICES PERMIT #: PLM2000 -00010
„ 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 01/11/2000
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 206 PARCEL: 1S134BC -00401
• SUBDIVISION: ZONING: C -N
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 7 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI
. FEES
Owner: .
Type By Date Amount Receipt •
SISTERS OF PROVIDENCE PRMT DST 01/11/200C $80.50 00- 321062
PO BOX 13993 5PCT DST 01/11/200C $6.44 00- 321062
PORTLAND, OR 97213
Total $86.94
Phone 1:
Contractor:
FULLMAN SERVICE CO LLC
5221 SW CORBETT
PORTLAND, OR 97201 -3716 REQUIRED INSPECTIONS
Phone 1: 224 -5221 Top -out Insp
Reg #: LIC 122310 Final Inspection
PLM 26 -443PB
0 \G\
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 c- g (503 4-
Issued By: J' j'j Permittee Signature: Oid
Call (503) 639 -4175 by 7:00 P.M. for an inspection need: . hen - t ' usi ess day
CITY OF TIGARD Plumbing Permit Application Plan Ch #
1A25 SW HALL BLVD. Commercial and Residential Rec'd B
TIGARD, OR 97223 Date Rec'd 7- 5
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit # PL.UYV2 Y� — c oo
Related SWR # —O
Called I / -1 1
N me of Deve FIXTURES (Individual) QTY PRICE AMT
Job , ,5 /G6 ®/" � / Dr y Sink 7 191 ) 10,5U
Address S,reetA ` Suite �y Lavatory 9.00
1 Il a - SW 5 40/5 & _ 2V Tub or Tub /Shower Comb. 9.00
Bldg # City/State Zip Shower Only 00
Name Closet r00
/ S f &LS C, � �0u/ DERJe Dishwasher 9 00
Owner fling Address 93 Suite Garbage Disposal 9. 0
Wiling bO ie Washing Machine 9. 0
v re _.
Oily/State Zip 04.9v,„5 Phone
��YY Floor Drain/Floor Sink 2" 9. 0
Name /� ./- A f(,V �t/oigp�,s 3" 9. 0
£"A Pe- Ck M e�lill'C. 4° 9. 0
Occupant Mailing Address uite Water Heater O conversion 0 like kind ' 9. 0
t ./ Gas piping requires a separate mechanical permit. i
City/State Zip Phone Laundry Room Tray : 9. 0
Urinal 1 9.
Name
/614 G e_ Other Fixtures (Specify) j 9.0
Contractor Mailing Address Suite ' 9.0
o ( Corlett 1 9.0
Prior to permit / Zip Phone Sewer - 1st 100' 1 30. 0
issuance, a copy I `7"7 of as y" •S02,2 1 Sewer - each additional 100' 25. 0
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required If / a. 'ot 3 / O 3 -//_ o 3 Water Service - 1st 100' i 30.
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' ' 25.
F
database W N 3 P a q-31-072 Storm & Rain Drain - 1st 100' i 30.0
Name Storm & Rain Drain - each additional 100' . 25.0
Architect Mobile Home Space 25.0
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.0 .
Pollution Device
Engineer City /State Zip Phone Residential Backflow Prevention Device' ' 15.0
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial"( Catch Basin 9.00 ' I
Additional description of work: . � Insp. of Existing Plumbing 40.00
'"�`- ��/nC 4, - ` <)'1- &�1_ per/hr
Specially Requested Inspections 40.00
J, ( rr/44/1&-1(-4 per/hr
you capping, o 'rig or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes No 0 Grease Traps 9.00
If yes, see back of to Indicate work performed by
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL
Isometric or riser diagram is required if Quantity Total Is > 9
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL
I hereby acknowledge that I have read this application, that the Information 5b
given I “rrect, that - m - •wner or authorized agent of the owner, and g /o SURCHARGE (0,44
th- pl- s submitt- • : re •.mpliance with Oregon State Laws.
`` - ` ': of Own: / • 'e Date ''PLAN REVIEW 25% OF SUBTOTAL
r , I -¢ -'? Required only if fodure qty. total is > 9
TOTAL p,(Q c 'i i
• tact Pe • n • a , Phone [// t
f /// 20 �„[�Z _51/ *Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
(!/ /!� Prevention Device, which is $15 + 5% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram
/I „ --1(: _ 7 g � and plan review
1: dstslplumepp.doc 7/2/98 (� ( ( I J
PLEASE COMPLETE:
Moved Replaced Removed /Capped: ,:
Sink 1 _
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:
•
l:ldsts■phmispp.doe 717/98
2/16/00 Activities for Case #: PLM2000 -00010
3:10:45 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
" PLMC003 Application received 1/4/00 DRA RECD No Hold BON 1/10/00
PLMC005 Permit Created 1/10/00 BON DONE No Hold BON 1/10/00 Needed suite verification.
PLMC725 Top -out Insp 1/10/00 1/10/00 1/14/00 TLP PASS No Hold AKJ 1/18/00
PLMC799 Final Inspection 1/10/00 1/10/00 2/9/00 MRS PASS No Hold AKJ 2/9/00
PLMC015 DST Post Review Complete 1/10/00 BON DONE No Hold BON 1/10/00
PLMC040 (F) Ready to issue 1/10/00 . BON DONE No Hold BON 1/10/00 Must pay for SWR2000 -00009
before issuing this permit.
PLMCO50 (F) Issue permit 1/11/00. GEO DONE No Hold DST 1/11/00
PLMC800 Case Finaled 2/9/00 AKJ DONE . No Hold AKJ 2/9/00
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1 i
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
q BUP
Date Requested �/ / M AM )L PM BLD
Location r" 2 q 2 Stk) /)l S .reitAAisuite F2 — 0 MEC
Contact Person - W Q, Ph 2 Z / - ,S Z ci PLM ZOO — 0501 0
Contractor Ph SWR
BUILDING Tenant/Owner ELC �.
Retaining Wall ELR
Footing Acces
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post &Beam Clo ` I/_ �/ n P1
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
UMBIN4
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
e- - PART FAIL
,111- 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
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk Date Inspector Ex a
( K,
Other
Final
PASS PART FAIL DO NOT EMOVE this inspection record from the job site.