Permit CITY OF TIGARD
,� DEVELOPMENT SERVICES PLUMBING PERMIT
���� I PERMIT # • PLM98 -0149
�,
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 06 / 01 / 98
PARCEL: 15136AD -04000
SITE ADDRESS...: 11535 SW PACIFIC HWY
SUBDIVISION • VILLA RIDGE ZONING: C —G
BLOCK • LOT :007 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:A3 FLOOR DRAINS 0 TRAPS • 0
STORIES • 0 WATER HEATERS • 0 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS 0 SF RAIN DRAINS : 0
SINKS : 0 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 1 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Tenant improvement to replace lavatory.
Owner: FEES
TIGARD FAMILY BILLARDS type amount by date recpt
50 SW PINE PRMT $ 25.00 DLH 06/01/98 98- 306161
SUITE 200 SPCT $ 1.25 DLH 06/01/98 98- 306161
PORTLAND OR
Phone #:
Contractor
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON OR 97005
Phone #: 643 -7619 $ 26.25 TOTAL
Reg #.. 000128
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Rough —in Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Top —out Insp
applicable laws. All work will be done in accordance with Final Inspect ion
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 lay
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
•
Issued By: P ermittee Signature:1 l L 1 C._\A AP
++++++++++++++++++++++++++++++++++++ + + + + + + + ++ + + + + + + + + + + + + + + ++ + + + + ++ 4 + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
4,,, v 3 QM -Q 2.
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i17Y' OF TIGARD Plumbing Application Retd By
p Date Rec'd Oho 61
.3125 SW HALL BLVD. Commercial and Residential
GARD, OR 97223 Date to P.E.
"
Date to DST •
XO3) 639 4171 Permit /0L/`> F e IP- Q,yf
Print or Type Related SWR S --Cw,29 - O/a 2
Incomplete or illegible applications will not be accepted Called 7,z
Name of Development/Protect FIXTURES (Individual) QTY PRICE AMT
Job Sink 9.00
i , / S treet Address Suite Lavatory / 9.00 7 '"44* Address ' /�X Tub or Tub/Shower Comb.
.rCU. 4c.+ J lC 9.00
Bldg 5 C' State Shower Only 9.00
N �/
I ' aY� ✓d Water Closet 9.00
Y'd(.s.) Choi 11-'(1 Dishwasher 9.00
Owner Madiny df ess Q� Suite Garbage Disposal 9.00
\SQ ', W- r/ PC 70‹ Washing Machine 9.00
1r/Sl4� Gr Zip Phone Floor Drain 2' 9.00
OY
3' 9.00
7% d g?U , 4' 9.00
a i DCC t g� S wty . Water Heater 9.00
/ K � ' i p J G � / � Laundry Room Tray 9.00
E , I(A.r d S 4-ZettrZe( GK Zip Phone Urinal I 9.00
1° Other Fixtures (Specify) 9.00
IJ, t1ti • PIc h. 44\1410k 9.00
I Contractor / J. � f '' ! � Su 9.00
� p V' 9.00
O�CGW J d ° r i k l iS - /X3/7 9.00
12ooVon Cont. Board Lias Ex Date_ G //�,9�
9.00
Aim* Copyof `l''
9.00
Current Plumbing Lip. Exp. Date Sewer - 1st 100' 30.00
Licensee 3'4/ - 4/ Y 0 ^Y -9 '7 4- M / ii Sewer - each additional 100' l I 25.00
COT Business 7 ax or Metro* Exp. Date_ _ Water Service - 1st 100' 30.00
■ Name Water Water Service - each additional 200' 25.00
Storm & Rain Drain - 1st 100' 30.00
I Architect
or Mailing Address g,..; Storm & Rain Drain - each additional 100' 25.00 I
Mobile Home Space 25.00
Engineer I Cry /State Zip I Phone Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
'esaibs work New 0 Addition 0 AlterationX Repair O Residential Backflow Prevention Device' 15.00
. be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture I 9.00
4 41ditkrial description of work Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per /hr
�asnnq use of Specially Requested Inspections 40.00
perhr
wikfing or property Rain Drain. single family dwelling i 30.00
Proposed use of Grease Traps 1 9.00
building or property
QUANTITY TOTAL
Are you Pping . moving or replacing a fixtures? Yes No 0 Isometric or riser diagram is requires if Cuani y Total is > 9
(If yes see back of form) •SUBTOTAL
_ 2567)
I hereby acknowledge that I hat. ad this application, that the information
liven is correct. trial I am the owner or authorized agent of the owner, and 5% SURCHARGE / a.
at brans submitted are in compliance with Oregon State Laws.
igna of r1 ent Da j � PLAN REVIEW 25% OF SUBTOTAL I i
r
Reouired d only if fixture aty. total is > 3
P / TOTAL a‘ ,
..on ct Person Nam phone (0./Vi---- ,/? g -Minimum permit fee is 525 • 5% surcharge. except Residential Backflow
Ii ye , 1.....-.., � 07 J �� �/ Prevention Device, which is 515 * 5% surtxtarge
/ i:tdststplmapp.doc 8/96
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
Page No. 1 CASE HISTORY FOR CASE NO.: PLM98 -0149
TIGARD FAMILY BILLARDS
11535 SW PACIFIC HWY
08/05/98
Action Description Req/ Schd/ End/ • Action Notes Disp By Update Upd
i Code Sent Done Done Date By
PLMC003 Application received / / / / 06/01/98 RECD JSD 06/01/98 DLH
PLMC005 Permit Created / / / / 06/01/98 DONE DLH 06/01/98 DLH
PLMC040 (F) Ready to issue / / / / 06/01/98 PASS DLH 06/01/98 DLH
PLMCO50 (F) Issue permit / / / / 06/01/98 DONE DLH 06/01/98 DLH
PLMC715 Rough -in Insp 06/01/98 / / 06/02/98 PASS TLP 06/02/98 TLP
PLMC725 Top -out Insp 06/01/98 / / 06/02/98 PASS TLP 06/02/98 TLP
PLMC799 Final Inspection / / / / 07/20/98 Sink outlet needs to be capped off PASS MS 07/30/98 J•H
(sewer gass will enter the room if not
'capped.)
PLMC800 Case Finaled / / / / 07/24/98 Sink outlet needs to be wrapped off PASS MS 07/30/98 J *H
(sewer gas will enter the room if not
wrapped.)
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CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
/// BUP
1 , q L O — Date Requested 7—(9-e --f? AM PM BLD
Location I/535" .5'0 Suite MEC r
Contact Person -7 �� �h PLM 7d — 0l
Contractor 6 7 J - 76 (y SWR
BUILDING Tenant/Owner � ��� G 1 ge 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
Aaltifffia Fire Sprinkler
Fire Alarm
Susp'd Ceiling �� ✓i�/�� ��� _ _�
� /
Misc: � 0 i-..( i� y/ J • �� • •
Final
FAIL ■
UMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
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 Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk
Final Date .2 Inspector 17 Ext3 /2
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PASS PART FAIL DO NOT REMOVE this inspection record from the job site.