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Permit CITY TIGARD PLUMBING PERMIT PERMIT #: PLM2000 -00304 Aletj DEVELOPMENT SERVICES DATE ISSUED: 8/18/00 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 15705 SW 116TH AVE PARCEL: 2S110CD 07600 SUBDIVISION: KING CITY NO. 2 ZONING: BLOCK: LOT: JURISDICTION: KIN CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: M FLOOR DRAINS; 8 TRAPS: STORIES: WATER HEATERS: 2 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: 2 OTHER FIXTURES: 2 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 2 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Plumbing work associated with commercial tenant improvement. Other fixtures are one mop sink and one hose bib. FEES Owner: Type By Date Amount Receipt TOBIAS INVESTMENT CO PRMT JMT 8/18/00 $195.50 0004584 300 SE SPOKANE ST PRM3 JMT 8/18/00 $195.50 0004584 PORTLAND, OR 97202 5PCT JMT 8/18/00 $15.64 0004584 PLCK JMT 8/18/00 $48.88 0004584 Phone 1: Total $455.52 Contractor: PENINSULA PLUMBING PO BOX 16307 PORTLAND, OR 97216 REQUIRED INSPECTIONS Phone 1: 503-761-0500 Underfloor /Underslab Top -out Insp Reg #: LIC 2244 PLM 26 -64PB Final 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 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. Issued By: I/! /f'1 Permittee Signature: , ,ak Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day CITY OF TIGARD Plumbing Permit Applic ti. Plan Check# J s_C 13125 SW HALL BLVD. Commercial and Residen l Rec'd By TIGARD, OR 97223 AUG 1 6 �oo� Date Rec'd b9-1--.'"' (503) 639 -4171 Date to P.E. /t0-0e Print or Type to DST t i QQy�MUNITY DEVELOPMEN i Permit # 4-1-i pope -L'DOv Incomplete or illegible applications will not be accepted Related SWR # N/ " ( • e:) GULF A...• ; id, re, - -- Called ' 61.2 ' . Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job Grocery Outle Sink 11.50 /50 Address Street Address Suite Lavatory 11.50 X3,00 15705 SW 116th Tub or Tub /Shower Comb. 11.50 Bldg # City /State Zip Shower Only 11.50 Water Closet/Urnaf- (Specify) 11.50 :3,00 Name Dishwasher 11.50 Owner Mailing Address Suite Urinal 11.50 Garbage Disposal , , �n�� 11.50 City /State Zip Phone Laundry Tray SL!(//� try" "' / 11.50 ,y. S'O Name Washing Machine /Laundry Tray (Specify) 11.50 Floor Drain /Floor Sink 2" 11.50 ,?3, 0 Occupant Mailing Address Suite 3" .' 11.50 9,00 4" 11.50 City /State Zip Phone Water Heater 0 conversion a like kind 11.50 Gas piping requires a separate mechanical permit. 2 '3.00 Name MFG Home New Water Service 32.00 Peninsula Plumbing Co Contractor Mailing ddress Suite MEG Home New San /Storm Sewer 32.00 PO B 16307 Hose Bibs 11.50 ,/,so Prior to permit City /State Zip Phone Roof Drains 11.50 issuance, a copy Portland Or 97292 761 -0500 11.50 Drinking Fountain of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date required if 002244 9 2 / 2 8 / 01 Other Fixtures (Specify) 15.00 expired in COT P �i�# F�cq. p�te O 1 database G t� b Z+ Y j 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 0 No 0 Storm & Rain Drain - each additional 100' 32.00 Residential 0 Commercial O'` Additional description of work: Commercial Back Flow Prevention Device 32.00 Residential Backflow Prevention Device' 19.00 Catch Basin 11.50 Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 0" 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 I hereby acknowledge that I have read this application, that the information D given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required t Quantity Total is > 9 that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL Si nature f Owner /A ent Date /71 O, /6e; 1. -,1� // 8% SURCHARGE i c.44 Contact Person Name Phone - ti 7&/-05-0D * *PLAN REVIEW 25% OF SUBTOTAL �6' g-e 1 BATH HOUSE" $178.00 Required only if fixture qty. total is > 9 2ATH HOUSE $250,00 TOTAL B ,/�5, 5.--2-, 3 BATH HOUSE $285.00 (This fee includes all plumbing fixtures in the dwelling and the first *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention 100 feet of sanitary sewer stone sewer and water service) Device, which is $25 + 8% surcharge "All New Commercial Buildings req; I y s e plans w'h i� metric r riser diagram and ��� � Plan review. I I- \dstslforms \plumapp.doc 10/8/99 - - - 9� -fi PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved Replaced Removed /Capped Sink / _ Lavatory 2 Tub or Tub /Shower Combination Shower Only Water Closet Dishwasher Urinal Garbage Disposal Laundry Room Tray Amp 3/NN Washing Machine Floor Drain /Floor Sink 2" 3 " 4 W€8 DRAINS 4" Water Heater /,iVW / PloV& Other Fixtures (Specify) floSS 8 / B Doak. eK ff�D FG 0 0A 1 044il as COMMENTS REGARDING ABOVE: I. \dsts \forms\plumapp. doc 10/8/99 - - KING CITY )146111( 15300 S.W. 116th Avenue, ling City, Oregon 97224 -2693 I■il Phone: (503) 639 -4082 • FAX (503) 639 -3771 Notice To Contractors Working In King City Due to an intergovernmental agreement with the City of Tigard, many building related permits for projects in King City are issued and inspected by the City of Tigard. If your permit application DOES NOT REQUIRE PLAN REVIEW, simply complete the appropriate application legibly and submit it to the King City staff. The King City staff will collect all fees and fax the application to the City of Tigard. City of Tigard staff will then create the permit, issue the permit, and perform inspections. Please indicate on the permit application whether you would like the Tigard staff to call you when the permit is ready for issuance or whether you prefer it to be mailed without any notification. Any incomplete or illegible application will be returned to King City staff for correction and no processing will occur until a complete, legible application is received. If your permit application DOES REQUIRE PLAN REVIEW, this form must be signed by a King City staff person. King City staff will simply sign this form indicating land use approval. Take this signed form to the City of Tigard Development Services Counter located at 13125 SW Hall Blvd. Tigard, to submit applications and plans. Development Services Technicians are available at 639 -4171 Ext. 304 should you have any questions concerning submittal requirements. All permit fees will be assessed and collected at the City of Tigard. The City of King City hereby authorizes applicant to pursue permits at the City of Tigard Building Department for the following project: ' A /� - �'►t -b ` �� U tA located at: 1 r1 °5 5--(&) � U King City Representati 6- /S-00 I DSTS XCINST DOC CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP 711 V3C, Date Requested 0 5 — ' eV AM PM BLD _ Location /571) 5 ` Suite MEC , V ' Contact Person J- Ph 76 / Q 5' Cc PLM 040 -dd'3� 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 /C- © / L 7 - d C Q v - e / / ( D Q I , e (D77U /{V - Susp'd Ceiling Roof X6/4 0/e 7 Misc: �` Final PASS PART FAIL Post & Beam Under Slab Water Service Sanitary Sewer Rain Drains F'.�01%., 1 ART FAIL MEC - ANICAL 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 [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA �) 7 Approach /Sidewalk Date C� / 7 �' /O _ . Inspector Ext Other Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP /9 Date Requested ° L AM PM BLD Location (cid S' ' (AJ // * Suite MEC Contact Person -)/,/r. Ph `7/0 � 1 PLM 20,00 --00 3.1/ Contractor Q Ph SWR BUILDING Tenant/Owner 6 ' G a2Adel 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 ^ 2 4 Susp'd Ceiling l V 1 Roof iF)1� i Misc: �/ Final PASS PART FAIL duCulasiNd Post & Beam 7.ae Mab Water Service Sanitary Sewer Rain Drains / t Final PASS PART MECHANICAL Post & Beam ,� Rough In Gas Line Smoke Dampers 111 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 [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date ► Inspector Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 �,�1 P BUP � v ( 1/I / - Date Requested � AM PM BLD Location / ,c 4 _ 0 //b Suite MEC Contact Person J.1- Ph 7 D 17 PLM 3Dy Contractor Ph SWR BUILDING Tenant/Owner ��y )C e-9G2il 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 Fire wall Fire Sprinkler i ' Fire Alarm r Susp'd Ceiling Roof Misc: Final PASS PART FAIL P131N9 )4.< Post & Beam L SIa6, Top Out Water Service Sanitary Sewer Rain Drains Fi• ie PART FAIL HANICAL 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 [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk Other Date //) Inspector /, Ext' Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site. CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 BUP Date Requested � AM PM BLD Location 15 se-Li // Suite MEC ■ Contact Person J evv � Ph 70 o G v PLM m2 E30 Contractor Ph SWR 1•:�. BUILDING Tenant/Owner ELC '1� Retaining Wall ELR I 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 PASS PART FAIL LUMB INfag s & Beam Under Slab Top Out Water Service Sanitary Sewer - .7. - ins A 0 PART FAIL - ANICAL 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 [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA Approach /Sidewalk �� Other Date ?//9/ Ol� Inspector I �� Ext Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.