Permit CITY TIGARD PLUMBING PERMIT
�i PERMIT #: PLM2000 -00272
DEVELOPMENT SERVICES DATE ISSUED: 7/24/00
� ' � 13125 SW Hall Blvd., Tigard, OR 97223 (50 639 -4171
SITE ADDRESS: 07105 SW VARNS ST PARCEL: 2S101 DA -00800
SUBDIVISION: VARNS ACRES ZONING: C -P
BLOCK: LOT: 011 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: 2 WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Installation of new kitchen sink and dishwasher.
FEES
Owner:
Type By Date Amount Receipt
GRANGE MUTUAL INSURANCE CO PRMT BLD 7/24/00 $50.00 0003916
7105 SW 5PCT BLD 7/24/00 $4.00 0003916
PO BOX 230969 30969
TIGARD, OR 97223 Total $54.00
Phone 1:
Contractor:
ASSOCIATED PLUMBING CO
P O BOX 301362
PORTLAND, OR 97230 REQUIRED INSPECTIONS
Phone 1: 331 -0582 . Underfloor /Underslab
Top-out
Reg #: LIC 00057890
PLM 26 -412PB Final nal Inspection
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
Notif Tenter. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
Yo main cops of these rules or direct questions to OUNC by calling (503) 246 -1987.
dIP
Issu B _ o // i�/d.. )' Permittee Signature: I - r " Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check# -
13125,:SW MALL BLVD. Commercial and Residential Rec'd By .a 1--h
TIGARD, OR 97223 Date Rec'd 7 /2y/0 - e)
(503) 639 -4171 ' f i Date to P.E.
Print or Type Date to DST
4I? R vi - - Incomplete or illegible applicati will not be accepted Permit #�L�`9o?O DO a 7.2- I' 6 Related SWR #
,/� /c/ 14P/799 -Qo 5 Called
Name of Development/Project .f lA" F.IX�T - S(Indi'vldu'all Mil PRICE AMT
Job V L, St,cJ 8 Icl; S Sink I 9.00
Address Stre�t Address SW �/ams S & R e Flo o,. Lavatory 9.00
Tub or Tub/Shower Comb. 9.00
Bldg # City/State, . Zip Shower Only 9.00
-7-- toe 9 1ZZ3 Water Closet 9.00
Na a An1
,;M0/1t, EVrt/IS a LA*sov1 Dishwasher ' 9.00
Owner Mailing Addres ' Suite Garbage Disposal 9.00
7 5W AriiS S+ pr FI000, Washing Machine
9.00
City/State , Phone
T;,A, 0 R 91 223 Floor OralNFloor Sink 2° 9.00
Name ' SyM o NI D•4 - 1.1111•15 Ltt [ 0 3° 9.00
Wit of Own tr 4° 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
Gas piping requires a separate mechanical permit.
City/State Zip Phone Laundry Room Tray 9.00
Urinal 9.00
Name l / I' I
A sSOC.a l U■Lnq Other Fixtures (Specify) 9.00
' Contractor Mailing Address Suite 9.00
PO (3 30136X 9.00
Prior to permit / to Zip Phone Sewer - 1st 100' 30.00
issuance, a copy �o n,0 , QR 97111 -1341 331059‘
Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. a e
required if 57890 ///5/6-6 Water Service - 1st 100' 30.00
expired in COT Plumbing Uc. # Exp. Date Water Service - each additional 200' 25.00
database )6 - 44 Q1,3 /0/3 J Storm & Rain Drain - 1st 100' 30.00
Name J Storm & Rain Drain - each additional 100' 25.00
Architect 14 0 nt. 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 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 IB[ Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
per/hr
I nCW K' i L1 C Specially Requested Inspections 40.00
�1
1 S ink t D lid per/hr
Rain Drain, single family dwelling 30.00
Are you capping, moving or replacing any fixtures? Grease Traps 9.00
Yes O No p(
If yes, see back of form to indicate work performed by
fixture. FAILURE TO ACCURATELY REPORT FIXTURE isometric or riser QUANTITY TOTAL
diagram Is required K Quantity Total Is > 9
WORK COULD RESULT IN INCREASED SEWER.FEES. *SUBTOTAL - -
I hereby acknowledge that I have read this application, that the information Sa et
given Is correct, that I am the owner or authorized agent of the owner, and e . 6, u o SU y,
RCHARGE
that plans submitted are in co Hance with Oregon State Laws.
Signature f r /Agent Date "PLAN REVIEW 26% OF SUBTOTAL - -
7 2/-2000 Required only If fixture qty. total is > 9
Contact Person Name Phone TOTAL - _ 5y, O
Ii at k L6 331 0501 'Mlnimum 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
and plan review
tldstalplumapp.doc 72198
g • a
PLEASE COMPLETE:
:. .., Fixture Type : Quantity by Work Performed >: ::::..::;.•
Ne w ` `... 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:
tldstMp►mapp.doc 7/7/98
7/1 7/e
Accumulative Sewer Tally
Tenant Name
ame: - .,Mc & , 6V9' S L AS °n/ This SWR# .
Address: 7/0 S Sw k"?/ ATS S • This PLM #: 2r v - 00 , 7 7a_,
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 .
- JacuzzilWhirtpool 4
Car Wash - Each Stall 6
- Drive Through 16 .
Cuspidor/Water Aspirator 1 .
Dishwasher - Commercial 4 / g .
- Domestic 2 . , .
Drinking Fountain 1
Eye Wash 1
Floor Drain/sink - 2 inch 2
- 3 inch 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 • _.-.
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6 •
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2 . .
in - Bar /Lavatory 2 " - .
- Bradley 5 .
r
- Commercial 3
- Service 3 •
Swimming Pool Filter 1 .
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6
Unnal 6 , -
TOTALS J 5�
Total fixture values: 5Y' divided by 16 = 3.3d EDU y .3 A/0 (' eAf6 e - i'/ 6 u
HISTORY Ct-t6e5^I EL @ 3 Ps - ue 9 /a0
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
i:1dsts'swrtaly.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
_ BUP
Date Requested 7- z AM PM BLD
Location 7 / 0) $ v UG rv+ 5 Suite MEC
Contact Person Ph ?Y/ PLM ,2e/v// - o > 7 7-
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
_PAS RT FAIL
�LUMBI
Post & Beam
Un• - ab
off,
e ater Service
Sanitary Sewer
Rain Drains
Fin
PART FAIL
CHANICAL
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 [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA �J
Otheoach /Sidewalk Date Inspector Ext ✓
Final ��
PASS PART FAIL DO NO REMOVE this inspection record from the job site.