Permit CITY TIGARD PLUMBING PERMIT
y , Gr � DEVELOPMENT SERVICES PERMIT #: PLM1999 -00409
w� �� � �1 DATE ISSUED: 12/6/99
13125 SW Hall Blvd., Tigard, OR 97223 ^ (503 L
SITE ADDRESS: 15350 SW SEQUOIA PKWY 150 U PARCEL: 2S112DA -01400
SUBDIVISION: PP1996 -048 _ ZONING: I -P
BLOCK: LOT: 002 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: 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: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing TI
FEES
Owner:
Type By Date Amount Receipt
PACIFIC REALTY ASSOCIATES PRMT DEB 12/6/99 $50.00 99- 320193
15350 SW SEQUOIA PKWY 5PCT DEB 12/6/99 $4.00 99- 320193
STE 300 •
TIGARD, OR 97224 Total $54.00
Phone 1:
Contractor:
DEAN WARREN PLUMBING
3111 SE 13TH
PORTLAND, OR 97202 REQUIRED INSPECTIONS
•
Phone 1: 236 -4152 Top -out Insp
Reg #: LIC 172 Final Inspection
PLM 26 -83PB •
EXPIRED
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
Notific. Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
Ye may obtal opies of thes- rules or direct questions to OUNC by calling (503) 246 -1987.
Issu - • By: �i •. /1 %f! ��If �� Permittee Signature: _we/
Call (503) • ° -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application Plan Check# NA-
13125 SW HALL BLVD. Commercial and Residential Rec'd By q_
TIGARD, OR 97223 Date Rec'd i/ - a L 4 - 9 ' 9
(503) 639 -4171 Date to P.E. NA-
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit# Pt)+/It
Related SWR# 1/ " 2.-
Called 12^1
Name of Development/ Project ;I5.IXTURES` (individual) , .A ' , ;•: 'a . " 'QTY , ,' .AMT; •
Job SovATh�A.T PAPEk NlF rza. Sink / 11.50 ) i ig
Address Street Address Suite Lavatory 11.50
151 So SW S EQ UO I PlkoAil #/ 50 Tub or Tub /Shower Comb. 11.50
Bld_g # City/State Q � "Zip Shower Only 11.50
e , 7) 6 a. 1-1 Water Closet/Urinal (Specify) 11.50
NaRe A. . k Sr Dishwasher 11.50
Owner Mailing Address Suite Urinal 11.50
) 53 50 Sw SEatubi4 NM/ 4.1C Garbage Disposal 11.50
City/State , / phone
Ti 6 9 "aa 4 &.2 Boo Laundry Tray 11.50
Name (� Washing Machine /Laundry Tray (Specify) 11.50
So ' Yt �S"" P ae _ Alk 1. co. Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
City/SS e A_ lox./ ". Phone 4" 11.50
Water Heater 0 conversion like kind 11.50 a
5
Name Gas piping requires a separate mechanical permit. I I i
MFG Home New Water Service 28.00
1::;11.4 LAM k.a ,.J PL I16.
'.
Contractor Mailing Address Suite MFG Home New San /Storm Sewer 28.00 -
3\\\ S E. 13 Hose Bibs 11.50
11 Prior to permit pity/State Zip Phone Roof Drains 11.50
ssuance, a copy o R�-{,A 1� , 0236 q�aoa - y I Sa
Drinking Fountain 11.50
all licenses are Oregon Const. Cont. Board Lic.# Exp. D to
required if oZ o23 Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. G ate
database l, la iS 3 P6 t') 3a
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, No 0 Storm & Rain Drain - each additional 100' 32.00
Residential 0 Commercial
Additional description of work: Commercial Back Flow Prevention Device 32.00
L Residential Backflow Prevention Device* 19.00
MoVI �" ISTI)/6 S, 4-1k- '*^ lt/}� 3 Catch Basin 11.50
Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00
YesA 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. QUANTITY TOTAL
f
I hereby acknowledge that I have read this application, that the information Isometnc or riser diagram is required if Quantity Total is > 9 ,..,. ?'
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL
that plans submitted are in compliance with Oregon State Laws.
Sin u of wne ent Date, ,
9 � JQ 11/ (%1191 8% SURCHARGE « . OU
Contact Pe on Name Phone /� " , ' � I
CI I-g.NPi . ,36-1-0,5-a Required o LAN REVIEW SUBTOTAL .. « y . ':F
**P
only
8A H iis 250 TOTAL ` �" I .
b4 f , J� 0
n_ fttiO includes all plumbing fixtures in dwelliiog ptheflrst� *Minimum permit tee is $50 + 8% surcharge, except Residential Backflow Prevention •
100,feet:of sancta' d erstorm°sew, er4and$water�servtce), Device, which is $25 + 8% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I tdsts\ormstplumapp doc 10/1/99 - - _
PLEASE COMPLETE:
::;: n.. ,:b WoricPerformecf
Fixture T a ra tty
,. ' . ,
.- New Moved ` ' Replaced �Reno�ed /C cl
'ice < ,... ri .y r..Y. ..,...
Sink -
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Urinal
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3
4"
Water Heater
Other Fixtures (Specify)
(Id
COMMENTS REGARDING ABOVE:
I: ldstslformslplumapp doc 10/1/99 - - -
•;, OP � SWR# Sewer Tally
renani Name: I I `� S- 1. ,Pr y ;. C2 This SR# 1
Nddress: 15 0 5 1,1 'G�LKJ a. / I SO This PLM #: I IT) " ON
=urture Value Previous Previous Credits Capped Fixtures Fixtures New total New
' # Value Capped off value added # added #s total
• Count off #s count value values
3aptistry/Font 4
3ath - Tub /Shower 4 •
- JacuzziiWhirlpool 4 _
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1 .
Dishwasher - Commercial 4 -7 7 1 Z - 3 I a
- Domestic 2 .
Drinking Fountain 1 -7 7 7 3
Eye Wash 1 .
Floor Drain/sink - 2 inch 2 ` 7 (I - 1i 7 /
- 3 inch 5
- 4 inch 6
- Car Wash Drn 6
Garbage - Disposal 16
- Domestic (to 3/4 HP) 2 Z Z Z
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48 -
Ice Machine/Refrigerator Drains 1 •
Oil Sep (Gas Station) 6 .
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2 '
Sink - 'Bar/Lavatory 2 `t L
b , 7. y/J
- Bradley 5 - 2
- Commercial 3 I1 1 2 ° ) 3
1 ‘T I- z
- Service 3
Swimming Pool Filter 1 _
Washer - Clothes 6
Water Extractor 6 /
Water Closet - Toilet 6 1'6 • 'P `( I% 10'
Urinal 6 , (D "
TOTALS 7 — f l/ A5
Total fixture values: ZqC divided by 16 = 1$. EDU , I.\ o - l v\--e}reec4
HISTORY
PLM# 0 /0 -02)-1- EDU# I'6 SWR# qb, -- 1-I PLM# °IS- Dz l EDU# 17 SWR# g5DL/I -
PLM# 0 0 .-7,A EDU# 1 (6 SWR# Pj( PLM# oJ5 -0(17- EDU# 11 SWR .15:-
5 -�Z�I
PLM# �� -o0H ° I EDU# 1 SWR# Ol6,-Ob PLM# 075 EDU# I ' 7
PLM# • ' 1 71 EDU# 17 SWR# 75 - p'- ;!-f(. PLM# , s EDU# / SWR# ' 3�v`"
Odstslswrtaty.doc