Permit i , ';, i1 ._ � T H PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00444
TIGARD; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
DATE ISSUED: 10/1/2007
PARCEL: 1 S136DB -00201
SITE ADDRESS: 11565 SW PACIFIC HWY ZONING: C -
SUBDIVISION: FRED MEYER LOT: JURISDICTION: TIG
PROJECT: FRED MEYER DELI
Project Description: Disconnect water and drain, connect for new rotisserie in Deli.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; 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
Owner: FEES
WILMINGTON TRUST CO, TRUSTEE
BY FRED MEYER, INC Description Date Amount
3800 SE 22ND AVE [PLUMB] Permit Fee 10/1/2007 $72.50
PORTLAND, OR 97242 [TAX] 8% State Surcha 10/1/2007 $5.80
Phone : Total $78.30
Contractor:
PORTLAND MECHANICAL CONTRACTOR
2000 SE HANNA HARVESTER DR
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 656 -7400
FAX 503- 655 -0620
Reg #: LIC 151807
PLM 3 -425PB
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 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: AP �_A
Call 503.639.4175 by 7:00 a.m. for an inspection that bu'f i s day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
• y • S
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard Received 10 //
lig EE WED D ate/By: /b? 8.43. Permit No. 1444200-?_..e,0 y 1114ECEI
. a 13125 SW Hall Blvd., Tigard, OR Plan Review
• Phone: 503.639.4171 Fax: 503.5 8.1960 1 2007 Date /By:
TIGARD Ready /By: Other Permit No.:
Inspection Line: 503.639.4175 0 C T Date Read /B J i See Pa g e 2 for
Internet: www.tigard- or.gov Tv TIGOD Notified/Method: 1 Supplemental information
l
TYPE OF WO' ' II T A J
� , yr DIUISI"r FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. Total
® Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling ® Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11565 SW Pacific Hwy Catch basin or area drain 16.60
City/State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Fred Meyer #375 Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: 1 -5 to Pacific Hwy
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Disconnect water and drain from old electric rotisserie & reconnect to new Backwater valve 16.60
rotisserie in the Deli area Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Fred Meyer
Expansion tank 16.60
Address: 3800 SE 22nd Avenue Fixture /sewer cap 16.60
City/State /ZIP: Portland, OR 97202 Floor drain/floor sink/hub 16.60
Phone: (503)232 -8844 Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Portland Mechanical Contractors, Inc. Interceptor /grease trap 16.60
Contact name: Jaymie Johnson Medical gas (value: $ ) Page 2
Address: 2000 SE Hanna Harvester Drive Primer 16.60
City/State /ZIMilwaukie, OR 97222 Roof drain (commercial) 16.60
Phone: (503) 417 -0331 I Fax: : (503) 655 -0620 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: jaymiej @portlandmechanical.com Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: same as applicant Water heater 16.60
Address: Other: Rotisserie 1 16.60 16.60
City/State /ZIP: Subtotal 1 6.60
Minimum permit fee: $72.50
72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 15180 / ' lumbing Lic. no.: 3 -425PB Plan review (25% of permit fee)
g i � State surcharge (8% of permit fee) 5.80
Authorized si n•
/,/ , � � � , r1 � TOTAL PERMIT FEE 78.30
r
Print name: Jaymie t t IF Date: 10/1/07 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1:\ Building \Pcrmits\PLM - PermitApp.doc 06/26/06 440- 4616T(10 /02/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION
AR PERMIT #: P1.1V12007-00444
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/112007
Phone: (503) 639-4171 , m
Inspection Requests (24 Hrs.): (503) 639-4175 ,_...„,.... AL .... .:
INSPECTION WORKSHEET FOR DATE: 10/8/2007 TIME: 7:00AM PAGE: 96
SITE ADDRESS: 11565 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FRED MEYER LOT #: TYPE OF USE:
PROJECT NAME: FRED MEYER DELI
DESCRIPTION: Disconnect water and drain, connect for new rotisserie in Deli.
OWNER: WILMINGTON TRUST CO, TRUSTEE, PHONE #:
CONTRACTOR: PORTLAND MECHANICAL CONTRACTOR PHONE #: 503-656-7400
Inspection Request Scheduled For: Date: 10/8/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
359 Plumbing final 057079-01 503-806 N
Corrections/Comments/Instructions:
94,
lg. PASS 1 I PARTIAL APPROVAL 7 CANCEL 7 NO ACCESS
7 FAIL 1 1 CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
p-i-K•
Inspector: V v IVI , A.--/A Xv.----. Date: VD - VT - kb/ Phone #: (503) 718-