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Permit CITY TIGARD PLUMBING PERMIT tiNieI� DEVELOPMENT SERVICES PERMIT #: PLM1999 -00283 'l 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 09/14/1999 SITE ADDRESS: 16160 SW UPPER BOONES FERRYRD PARCEL: 2S113AB -00600 SUBDIVISION: B,b,fl O CREEK ACRE TRACTS ZONING: I -L 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: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: 2 SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: 1 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 PACTRUST 15350 SW SEQUOIA PKWY PRMT BON 09/14/199. $50.00 99- 318303 STE 300 .5PCT BON 09/14/199 $3.50 99- 318303 . TIGARD, OR 97224 Total $53.50 Phone 1: 503 - 624 -6300 Contractor: DEAN WARREN PLUMBING 3111 SE 13TH PORTLAND, OR 97202 REQUIRED INSPECTIONS Phone 1: 236 -4152 Top -out Insp Reg #: LIC 00000172 Final Inspection PLM 26 -83PB 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 :L - Permittee Signature: i � • / Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF NIGARD Plumbing Permit Application Plan Check j 13125 SW HALL BLVD. Commercial and Residential Rec'd By ' TIGARD, OR 97223 Date Recd - - ' (503) 639 -4171 Date to P.E. Print or Type Date to DST Incomplete or illegible applications will not be accepted Permit # PLM l� a l�Z�3 ` Related CI SW R # 1,01f-e0 �1e6g Called 1 - l0 - p t 1 Name of 4evelopment/Project FI LS ,`:_-• 4 . , fq:L' QTY PRICE AM.T Job AGRITorE Sink 40 1 1(50 Address See AddfE Suite Lavatory 9.00 / 6 f �OO S Soar FS Fk Rv Tub or Tub /Shower Comb. 9.00 Bldg # City/State Zip Shower Only 9.00 j / 6A-no - Nam Water Closet 9.00 V �- L Tip v- ST Dishwasher 9.00 Owner Mailing Address Suite Garbage Disposal 9.00 / 3 '6 0 Slii SiCiq U.t>t 4 PKw, 3 00 Washing Machine 9.00 City /State Zip Phone ! T/ UA q7a &Ati -1300 Floor Drain/Floor Sink 2" 9.00 Name 3" 9.00 4" 9I" Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind / Gas piping requires a separate mechanical permit A 1193 City /State Zip Phone Laundry Room Tray a1 d 7W Urinal 9.00 me 1=�N wit-Kep...E.., I) LACT. Other Fixtures (Specify) 9 00 Contractor Mailing Address Suite 9.00 3 ill Se 13 9.00 Prior to permit /State Zip Phone Sewer - 1st 100' 30.00 iquance, a copy o ff,1 „ er aC' ER36 •- d{ 1 sa Sewer - each additional 100' 25.00 licenses are Oregon Const. Cont. Board Lic.# Exp. Date squired if ©1 •2 a la/a3//q Water Service - 1st 100' 30.00 expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00 database 2.(0 83 e8 6/ 3a / 2066 Storm & Rain Drain - 1st 100' 30.00 Name [ Storm & Rain Drain - each additional 100' 25.00 Architect Mobile Home Space 25.00 Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00 Pollution Device Engineer City /State Zip Phone Residential Backflow Prevention Device* 15.00 (Irrigation timing devices require a separate Describe work to be done: restricted energy permit.) New 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 Additional description of work: - . _ Insp. of Existing Plumbing 40.00 A Dr ,Tiory To .fix t sT / " e J a F%- (Glj; per/hr J � . Specially Requested Inspections per/hr .00 Are you capping, moving or repia Ing any fixtures? Rain Drain, single family dwelling 30.00 Yes O No Grease Traps 9.00 If yes, see back of form to indicate work performed by QUANTITY TOTAL v fixture. FAILURE TO ACCURATELY REPORT FIXTURE . I some t r i c or riser diagram is required if �uantrty Total is > 9 $ ', WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL �� I hereby acknowledge that I have read this application, that the information h given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE ' that plans submitted are in compliance with Oregon State Laws.` h Signature of wneljit Date **PLAN REVIEW 25% OF SUBTOTAL *t 9/3/(3/3 Required only d fixture qty. total is > 9 'tact Person Name Phone - TOTAL �'� ") ./ 9.3 t -i-I (S a Prevention Device, which is $15 + 5% surcharge *'All New Commercial Buildings require plans with isometric or riser diagram and plan review i. dststplumapp.doc 7/2/98 PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed /Capped Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet Dishwasher Garbage Disposal Washing Machine Floor Drain /Floor Sink 2" 3" 4 " Water Heater Laundry Room Tray Urinal Other Fixtures (Specify) COMMENTS REGARDING ABOVE: r N)0 0}1\AX1- 1 \dsts\plumapp doc 7/7/98 `� Accumulative Sewer Tally 0/9-'00/ice Tenjnt Name: L l • e, ��-"�� This SWR# Address: I la I iii ) ee,r - ' , rr eJ ry This PLM #: i '11 - ODZ$�i 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 Cuspidor/Water Aspirator 1 Dishwasher - Commercial 4 - Domestic 2 Drinking Fountain 1 Eye Wash 1 Floor Drain/sink - 2 inch 2 - 3 inch 5 -4inch 6 •I - 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 + �. I Z Co • - Service 3 Swimming Pool Filter 1 Washer - Clothes 6 Water Extractor 6 Water Closet - Toilet 6 Urinal 6 TOTALS b Total fixture values: (� divided by 16 = 10. EDU (Cl ( `S I•D fo HISTORY O PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# PLM# EDU# SWR# rldsts\swrtaly doc •