Permit CITY OF TIGARD PLUMBING PERMIT
° 1 ' � DEVELOPMENT SERVICES PERMIT #: PLM1999 -00322
��I I I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/07/1999
SITE ADDRESS: 09735 SW SHADY LN 101 PARCEL: 1 S135BD -00300
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS: 1 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Install washing machine and 2" floor drain for TI. Dummy sewer permit #SWR1999- 00217, no change to
current EDU count of 17.
FEES
Owner:
Type By Date Amount Receipt
HAZEL INTERNATIONAL, INC AND PRMT KJP 10/07/1995 $50.00 99- 318916
HIGASHIYAMA HIGHLANDS CO, LTD 5PCT KJP 10/07/199 $4.00 99- 318916
BY NORRIS + STEVENS REALTORS
PORTLAND, OR 97204 Total $54.00
Phone 1:
Contractor:
D P PLUMBING /DARREN T PLACEK
904 S CHEHALEM
NEWBERG, OR 97132 REQUIRED INSPECTIONS
Phone 1: 537 -9492 Rough -in Insp
Underfloor /Underslab
Reg #: LIC 00110612
PLM 36 -70P6 � Misc. Inspection
Final Inspection
ORIGINAL
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952-0001-0010 through OAR 952 - 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature: (IAA D M ?
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITI OF TIGARD Plumbing Permit Application Plan heck
13125 -SW HALL BLVD. Commercial and Residential Rec'd
TIGARD, OR 97223 Date Recd / ° '$-S?
(503) 639 -4171 Date to P.E.
Print or Type Date to DST,
Incom - - or ille. ble applications will not be accepted Permit#
Related SWR # ,
St v OKA- . Called I i 14 9 3 V5p rr
allz° g , l 003 i
9 r N.rien
me of De : opment/Project pill 6u(e4' c ( /'"0J1 FIXTURES (individual) QTY PRICE AMT
Job 9`735" S u f Skady L-II, Sink 11.50
Address Street Address f Suite Lavatory 11.50
10d • Tub or Tub /Shower Comb. 11.50
Bldg # City/State , Zip Shower Only 11.50
Name Water Closet/Urinal (Specify) 11.50
• Dishwasher 11.50
Owner Mailing Address Suite Urinal 11.50
Garbage Disposal 11.50
City /State Zip Phone
Laundry Tray 11.50
Name ( r Washing Machine /Laundry Tray (Specify) I 11.50
�^ / ' / ,
(�rx C al erg - Ce� L4:1*' Floor Drain /Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" I 11.50
4" 11.50
City /State Zip Phone
Water Heater 0 conversion 0 like kind 11.50
Name Gas piping requires a separate mechanical permit.
1 n Pi UP I I MFG Home New Water Service 28.00
Contractor Mailing Address ` D Suite MFG Home New San/Storm Sewer 28.00
90K 5. CL Lat em (4 Hose Bibs 11.50
Prior to permit City/Stale Zip J Phone Roof Drains 11.50
issuance, a copy N p , OK cr2 i 32 5-37_ g el 9 Z
olt Drinking Fountain 11.50
of all licenses are Oregon C st. Cont. Board Lic.# Exp. Date
required if i106/2_ Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # 6 Exp. Date
database 3 6-70 pi?
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
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 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
Residential Backflow Prevention Device' 19.00
•
Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
Yes 0 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
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9
•
t t plans submitted are in compliance with Oregon State Laws. 'SUBTOTAL
`igr ature of Own ent Date ' /Q 8% SURCHARGE
\ ontac Person Name horse '
n 7 r 9 2 * *PLAN REVIEW 25% OF SUBTOTAL
b V rC Required only if fixture qty. total is > 9
BATHHOUSE $178.00
2 BATH HOUSE $250.00 TOTAL , It`
3 BATH HOUSE $285.00 ,
(This fee includes all plumbing fixtures in the dwelling and the first 'Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
100 feet of sanitary sewer storm sewer and water service) Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
1:ldstsVorrns\plumapp.doc 9/30/99 - "
7 a
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New 'Moved I Replaced Removed /Capped
Sink
Lavatory
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: /1 ( r v�
-�s wa tj v dtrite, box '1 r LGIvLhy took', A.4,a TtA- sittar
a ' oor ctirrArK ,T -Pi 1 t4A P a`o c.e SSor
I: dstsUorms\plumapp.doc 9/30/99 — -'
Accumulative Sewer Tally o r7
Tenant lame: ) g s FAA/1J I y CL l - I G This SWR# • f 1 00 2 / !,
Address: q 3 S S c.J S h a Ot L ml e- S c-- /0 / This PLM #: '/ <I - 0 0 3 �• o
J
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New •
Value Capped off value . added # added #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- Jacuzzi/Whirlpool 4
Car Wash- Each Stall 6
- Drive Through 16
CuspidorlWater Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1
Eye Wash 1
Floor Drain/sink - 2 inch 2 I 2--
-3inch 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
= 1%e 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 I �°
Water Extractor 6
•
•
Water Closet - Toilet 6
Urinal 6 •
TOTALS a(e
•
Total fixture values: 4* divided by 16 = ///3 EDU = / 7 F
HISTORY
PLM #44'r — oocd EDU# / 7 SWR# c, 9 -0e5 PLM# EDU# SWR#
PLM# ;6r - � EDU# / SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
i:\dsts\swrtal .
1/25/00 Activities for Case #: PLM1999 -00322
3:17:20 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 10/5/99 DEB RECD No Hold GEO 10/6/99
PLMC005 Permit Created 10/6/99 KJP DONE No Hold GEO 10/6/99
PLMC715 Rough -in lnsp 10/6/99 10/6/99 10/11/99 MS PASS No Hold AKJ 10/11/99 1) clothes washer waste
film processor waste
PLMC720 Underfloor /Underslab 10/6/99 10/6/99 No Hold GEO 10/6/99
• PLMC740 Misc. Inspection 10/6/99 10/6/99 No Hold GEO 10/6/99
PLMC799 Final Inspection 10/6/99 10/6/99 10/22/99 MS PART No Hold JMT 10/27/99 call back on photo processor
PLMCO50 (F) Issue permit 10/7/99 KJP DONE No Hold KJP 10/7/99
PLMC799 Final Inspection 10/20/99 10/20/99 MS FAIL No Hold MRS 10/20/99 not ready
PLMC800 Case Finaled 11/30/99 MRS DONE No Hold MRS 11/30/99 backflow devise for photo
processor installed and tested
ok
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