Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00091
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/11/2008
PARCEL: 1S136DC-04500
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO ZONING: C -G
SUBDIVISION: PP1995 - 013 LOT: JURISDICTION: TIG
PROJECT: WINCO
Project Description: Adding water quality facility to site. Installing (2) manholes and 82' of storm sewer.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: 1 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: 82 ft
Owner:
FEES
WINCO FOODS INC.
650 N. ARMSTRONG PL Description Date Amount
BOISE, ID 83704 [PLUMB] Permit Fee 6/11/2008 $88.20
[TAX] 12% State Surch 6/11/2008 $10.58
Phone : 208- 672 -2017 Total $98.78
Contractor:
ROMP PLUMBING & MECHANICAL
PO BOX 836
STAYTON, OR 97383 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 769 -4335
Reg #: LIC 110648
PLM 24 -357PB
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 B ��h Permittee Signature:/'
Call 503.639.4175 by 7:00 a.m. for an inspection that business 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.
_) T Lr/You
P . a .. -i ng Permit Applicatio
,� ,f ° ° °�' ��`4 ti 17OR O �Ff ICI USI O NLY
Site Utilities , „ M :4. g:.
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City of Tigard MAR - 5 0008 Received i • (/ i Date/By: V PermitNo.�
F f `'' v 13125 SW Hall Blvd., Tigard, OR 97223
k e Plan Review
Phone: 503.639.4171 Fax: 503.598.1 rIGARD Date /By: 4919- / Other Permit No.:
Inspection Line: 503.639.4175 BU/ Date Ready /By: /� ./ / / � y/y/ J / /�, See Page 2 for Supplemental Information
'-,T; LGARD Internet: www.tigar or.gov LDiAiGDI i�f� Notified /Metho : 6 G 4 \_ / g am " � _fi CY
T OF WORK Vi,/ k!/ Ci1 elf* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Otv 1 Ea. 1 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
❑ I- and 2- family dwelling ® Commercial /Industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- finally 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: 7501 SW Dartmouth Street Catch basin or area drain 16.60
City/State/ZIP: Tigard, Oregon
Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: Project name: Tigard WinCo Parking Lot Improvements Footing drain (no. linear ft._ ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 2 16.60 $ 33.20
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: gg ) Page 2 55 •
Subdivision: I Lot no.: Water service (no. linear fit.: ) Page 2
Fixture or item
Tax map /parcel no.: 1 S 136CD04300, 1 S 136DC04500 Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Adding a water quality facility to the site Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name WinCo Foods Inc.; Dave Van Ettan Expansion tank 16.60
Address: 650 N Armstrong Place Fixture /sewer cap 16.60
City /State /ZIP: Boise, ID 83704 Floor drain /floor sink/hub 16.60
Phone: 208- 672 -2017 Fax: Garbage disposal 16.60
® APPLICANT ® CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: WRG Design, Inc. Interceptor /grease trap 16.60 '
' Contact name: 'Chris Negelspach Medical gas (value: $ ) Page 2
Address: 5415 SW Westgate Drive, Suite 100 Primer 16.60
City/State /ZIP: Portland, OR 97221 Roof drain (commercial) 16.60
Phone: ( 503) 419 -2500 Fax: ( 503 ) 419 -2600 Sink/basin / lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: chris.negelspach @wrgdesign.com Urinal 16.60 •
CONTRACTOR Water closet 16.60
Business name: I H P � - 1 v- /`�� / _,J, ( r , Water heater 16.60
Address: Po , Other: $ --
x � 3� 2 G .4 SS 46. )
City /State /ZIP: �V re/0 p� /�"] d p 5 - -j ,
Minimum permit fee: $72.50 g „
Phone: 2) 7( ? -113 3 Fax: ( ) permit Residential back ow minimum pert e 'i ..
CCB Lic.: / /do 4 6 At//o Plumbing Lic. no.: 1P 'I j5 n f' `Pla review (25% of permit fee); V j` 1
/ State surcharge (12% of permit fee) lO
l
Authorized signature: e ? l t ±l� TOTAL PERMIT FEE g
Print name: Chris Negelspach Date: 02/26108 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.
:1Building \Permits \PLMU- PermitApp.doc 12127/06
:` . CITY OF TIG D , , ,
COMMUNITY DEVELOPMENT � �p ? 1 -60 0 % 1
,T1GAR.D' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
Plumbing Signature Form
IMPORTANT PERMIT NOTICE
ROMP PLUMBING & MECHANICAL
PO BOX 836
STAYTON, OR 97383
Permit #: PLM2008 -00091
Date Issued: 6/11/2008
Parcel: 1 S136DC -04500
Site Address: 07501 SW DARTMOUTH ST 100 WINCO
Subdivision: PP1995 -013
Lot:
Jurisdiction: C -G
Zoning: TIG
Project Name: WINCO
Description: Adding water quality facility to site. Installing (2) manholes and 82' of storm
sewer.
Your company has been indicated as the plumbing contractor for the permit referenced above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return this
Plumbing Signature Form prior to the start of the work. Please mail the form to: City of Tigard, Building Division,
13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
WINCO FOODS INC. ROMP PLUMBING & MECHANICAL
650 N. ARMSTRONG PL PO BOX 836
BOISE, ID 83704 STAYTON, OR 97383
Phone #: 208- 672 -2017 Phone #: 503 - 769 -4335
Reg #: LIC 110648
PLM 24 -357PB
AN K SIGNATURE IS REQUIRED ON THIS FORM
X / / /�7� i //e I �) J
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Sign ure Aut orized Plumber Name (printed)
CITY OF ��nn m n.�m— n mn�m��uu�� v 4
BUILDING DIVISION PERMIT ~�~°"~~~�""~~= �°"°"~~"~~"~ ' #: PLh�2OO8-UO091
131258VVHaU8|vd.. Tigard, OR97223 DATE ISSUED: 6/11/2008
Phone: (503) 639-4171
Inspection Requests Q24Hraj: (503) 639-4175 ^� J . + .L11:
MR
INSPECTION WORKSHEET FOR DATE: 1/14/2009 T|/NE: 7 PAGE: 33
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINC0 CLASS OF WORK:
SUBDIVISION: LOT TYPE � PP193��O1� #: �
PROJECT NAME: N8Nc0
DESCRIPTION: Adding water quality facility to site. Installing (2) manholes and 82i of storm yewwr.
OWNER: WINCD FOODS INC, PHONE #: 208-672'2017
CONTRACTOR: ROMP PLUMBING & MECHANICAL PHONE #: 503-769-4335
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Inspection Request Scheduled For: Date: 1/14/2009 1�`^ Pour Time: -'')
C�do# Inspection Description Confirm # (�ontaot# Me ^ag' ^ '� ij , I A
399 Plumbing final 07967101 511-91.1;4278 Y �-~ (' ~
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Corrections/Comments/Instructions:
Corrections/Comments/Instructions: ~
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P4ASS 0 PARTIAL ��
�LAPPR�VAL CANCEL 7 NO ACCESS
FAIL 0 CALL FOR INSPECTION || ADDITIONAL FEES ASSE SED
Vi ,./i '�; |napec�o�� �/ Oate� \ / ^�'�/l � � Phone # /G83> 71G ^� (u�
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLivI2008-00091
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/11/2008
Phone: (503) 639-4171 .400441,p
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET WORKSHEET FOR DATE: 9/12/2008 TIME: 7:OOAM PAGE: 8
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 WINCO CLASS OF WORK:
SUBDIVISION: PP1995-013 LOT #: TYPE OF USE:
PROJECT NAME: WI NCO
DESCRIPTION: Adding water quality facility to site. Installing (2) manholes and 87 of storm sewer.
OWNER: WINCO FOODS INC., PHONE #: 208
CONTRACTOR: ROMP PLUMBING & MECHANICAL PHONE #: 503-769-4335
Inspection Request Scheduled For: Date: 9/12/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm drain 07542a.ol 208-484-2878
Corrections/Comments/Instructions:
4.e" -r s f\- Ectv I At tj 4_eui
-t/ krC-- F v)\-- .3—
X PASS El PARTIAL APPROVAL 1 CANCEL fl NO ACCESS
FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: 0 Date: vi.‘Dct) Phone #: (503) 718-
CITY OF TIGARD " ,:
BUILDING DIVISION PERMIT # : PLM2008-00091
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED 6/11/2008
Phone: (503) 639 -4171 "
Inspection Requests (24 Hrs.): (503) 639 -4175 :� ` :_..
INSPECTION WORKSHEET FOR DATE: 8/12/2008 TIME: 7.00AM PAGE: 31
SITE ADDRESS: 07501 SW DARTMOUTH ST 100 W NCO CLASS OF WORK:
SUBDIVISION: PP1995 -013 LOT #: TYPE OF USE:
PROJECT NAME: W1NCO
DESCRIPTION: Adding water quality facility to site. Installing (2) manholes and 82 of storm sewer.
OWNER: WiNCO FOODS INC., PHONE #: 208 - 672 -2017
CONTRACTOR: ROMP PLUMBING & MECHANICAL PHONE #: 503- 7693.4335
Inspection Request Scheduled For: Date: 8/12/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm drain 074051 -01 208. 484 -2878 Y
Corrections /Commen s /Ictions:
X PASS ❑ PARTIAL APPROVAL fI CANCEL n NO ACCESS
❑ FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: c\ Lvi.A. -1 t \V 1 -----a_.. Date: 7 J 0 ,1 041 Phone #: (503) 718-
CITY OF TIGARD , a
BUILDING DIVISION PERMIT #: PLM200B -00091
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/11/2008
Phone: (503) 639 -4171 14 j��
Inspection Requests (24 Hrs.): (503) 639 -4175 -
INSPECTION WORKSHEET FOR DATE: 816/2008 TIME: 7 :03AM PAGE 1
SITE ADDRESS: CLASS OF WORK:
SW
SUBDIVISION: 07501 DARTMOUTH ST 100 NS S LOT #: TYPE OF USE:
PROJECT NAME: PP1395 0 i3
WiNCO
DESCRIPTION:
Adding water quality facility to site. Installing (2) manholes and 82' of storm sewer.
OWNER: WINCO FOODS INC., PHONE #: 208 -672 -2017
CONTRACTOR: ROMP PLUMI3ING & MECHANICAL PHONE #: 503469.4335
Inspection Request Scheduled For: Date: 816/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm drain 073822 -01 208 -484 -2878 N
Corrections /Comments /Instructions:
/ 61 %- , I-\a \4. 44 1 a2 3-„..,44-, I Ve.J.
1 I PASS N1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C1 44--A-A \ ►` ---2- Date: cri 6 I Oql Phone #: (503) 718 -