Permit A '? CITY OF TIGARD PLUMBING PERMIT
dl DEVELOPMENT SERVICES PERMIT #: PLM1999 -00191
r 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/24/99
SITE ADDRESS: 09540 SW WASHINGTON SQUARE RD H -15 PARCEL: 1S126C0- 01401
SUBDIVISION: ZONING:
BLOCK: LOT: JURISDICTION:
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: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing for TI, move /replace existing fixtures. No change to the EDU count.
(SWR1999- 00191)
FEES
Owner:
Type By Date Amount Receipt
PRMT GEO 6/24/99 $50.00 99- 316392
MISC GEO 6/24/99 $2.50 99- 316392
Total $52.50
Phone 1:
Contractor:
ANCTIL PLUMBING INC
16900 SW MERLO RD
BEAVERTON, OR 97008 REQUIRED INSPECTIONS
Phone 1: 503 - 642 -7323 Rough -in Insp
Reg Underfloor /Underslab
eg #: LIC 00000241
Top -out Insp
PLM 26 -162P6
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.
... „731.4te z-
Issued By: .4 (! i� /i Permittee Signature:
Call (503) •39 -4175 by 7:00 P.M. for an inspection needed the next business day
CIT OF TIGARD RECEIVE' , Plumbing Permit Application Plan Check
'Iii25 SW HALL BLVD. m r �� Commercial and Residential Recd By, _ , _ .,
TIGARD, OR 372/3 ' J ` `� Date IRec'd . ..
(503) 633 -4171 Date to P.E , '.
COMMU II DEt'EIUY�I Print or Type Date toDSr,
Incomplete or Illegible applications will not be accepted Penned .. d a�
Related SWltm>t /#�; 00 �6
E ' Called. ' .-.-
Name of DevdtopmenUPro)ect v I:2 X / r-5 �. (I t i .l! rit - ---- -- - - - b r; ? -J'T( f �'T,' 1
Job E/E.OftAi v-/ GwE
Sink "
Address sheet Ad Suite Lavatory / .. •
VI At 5 t . s. . M AL L' I Tub dr TUb/Shower Comb. 9.00
q 5 1 /0 Bldg 1 I City/State Zip Shower Only .
Name Water cibset /
i}"1So v6 Dishwasher 9.00
s
Owner Mailing Address Suite Garbage Disposal :
Washing Machine
City/State Zip Phone Floor Drain/Floor Sink 2' 9.00
Name 3 9.00 .
. S>cE
• ov 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 Other Flrdures (Seedy)
. Contractor Mailing Address Suite 9
1(0 0 6 S(, ) Vi1E4 I 9.00
Prior to permit �' � Ai " Phone Sewer - let 100' 30.00 .
_ issuance. a copy " CPrV , 6 R-. Clew sa lot -(2 . -3Zs" '
Sewer • each additional 100 • 25.00
of all licenses are Oregon Const Cont._ Board Uc.a1 Exp. Date B w ate r SeMce - lmit 100' . 30.00 _ - . .
required If 2- q 1,y Li • •
expired In COT Plumbing Uc. I Exp. Date Water Service - eat% additional 200' 25.00
2-, database C o - (p Stomt a Relit 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 cfly/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 O Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commerda-*' Catch Basin . 9.00
Additional description of work: ' '
.. Insp. of Existing Plumbing 40.00 -
- fa/AMA/7 1 37'2 ,0rZVe' r6) pedhr
/ �J
Specially Requested Inspections 40.00
6 �`' �- /2_ G .(._ . . . pew. .
- Are yotl capping, Moving or replacing any fixtures? Rain Drei ", single family dwelling 30.00
Yes O No O Grease Traps 9•O0
If yes, see back of form to Indicate work performed by QUANTITY TOTAL 7 _
a A rey
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Isometric ter dlagramr I. „r.d 11 ua
qntity Total i$ > o f
WORK COULD RESULT IN INCREASED SEWER PEES. •SUBTOTAL ik - - ac
I hereby acknowledge that I have lead this application, that the i ow formation i r • . a •
given is correct, that I am the owner of authorized agent of the and 6% SURCHARGE { - I ?it;
that plans submitted are in compliance with Oregon State Lawa. t . _ : -. . '^ F!t.�
Signature of OWhet/Agent - Date "PLAN REVIEW 26% OF SUBTOTAL r
{{ F
R - • liked on if fixture • � . total b > 9 ,, _ -:1 _.. _ _ 71 TOTA
Contact Person Name Phone .
•MlnimUM permit fee is $25 + 5% surcharge, except Residential Baddlow
- Prevention Device, which Is $15 + 5% surcharge
"Ail New Commercial Buildingb require plans with Isormetric or riser diagram
. and plan review
L%rst.mplunapp.doc 7/1198
PLEASE COMPLETE:
-- •. + + ' {,/i.:: i} r ~ may
TYPO.
t j '�
.d'•
/ ��yy yySS��g:-: � �1'
dA« "a��ml�c d>. -. .a�tern s�!'
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 ldstslplumaav doc m,se
Accumulative Sewer Tally
Tenant Name 5,6X This SWR# /ff9- 00 /3
Address:•4S4o 9c3 et))/50dq -t0() c$0 This PLM #: 1449
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
-3inch 5
- 4 inch 6
- Car Wash Dm 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 7
- Bradley 5
- Commercial 3
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 / (.,• j s7D
Urinal 6
TOTALS _
EDU
Total fixture values: ° 6 ° divided by 16 = / 3 � ' /3 EDU 73O N U � a
HISTORY
PLM # /991-a6/ 3 a EDU# 130 SWR# /9g7-00092 PLM #q9 -oo63G EDU# 3 / SWR# W-00038
PLM# 449 -oo /i 9 EDU# /3 o SWR # /99T - 000ce/ PLM #91 - cO6Je/ EDU# 13/ SWR# 0 00
PLM # /r?y- ao /o 4 EDU# /36 SWR #/999 - 0001:5 PLM #Sq - 000 EDU# 130 SWR# q 1 -aa
PLM# qq ,c 5 EDU# ) SWR#gq— 000 PLM#gg- oo yj/ EDU# / 3d SWR #qg - 0063
iAdsts .swrtaly.doc