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Permit 0 . 0 /0 V jpiu;:itz-4:13 rt4&44 Cadol U 5 U 97, X- DOW() C ITY OF TIGA D PLUMBING PERMIT � ;� DEVELOPMENT SERVICES PE DEVELOPMENT P -00303 I 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/26/20026/200 4 SITE ADDRESS: 11535 SW PACIFIC HY PARCEL: 1S136AD -04000 W SUBDIVISION: VILLA RIDGE ZONING: C -G BLOCK: LOT: 007 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; 3 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 4 , URINALS: GREASE TRAPS: 2 LAVATORIES: 2 OTHER FIXTURES: 2 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: 1 RAIN DRAIN: ft Remarks: Building fixtures. Other fixtures: 1 ice maker and 1 primer. All Fixtures are new. 8/20/04: Adds of (2) hand sinks and (1) 2" floor drain FEES Owner: Description Date Amount SMITH, EDITA M 833 NW 170TH DR [PLUMB] Permit Fee 7/26/2004 $149.40 BEAVERTON, OR 97006 [PLMPLN] Plan Review 7/26/2004 $37.35 [TAX] 8% State Surcharl 7/2612004 $11.96 [PLUMB] Addl Permit 8/20/2004 $49.80 Phone : [TAX] 8% State Surchari 8/20/2004 $3.98 Contractor: Total $252.49 POSITIVE PLUMBING 618 MEADOW VIEW RD FOREST GROVE, OR 97116 REQUIRED INSPECTIONS Phone : 503 - 720 - 3849 Rough -in Insp Underfloor /Underslab Reg #: LIC 00078209 Top -out Insp MET 0004726 Final Inspection PLM 34 -234pb 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. Issued By: Permittee Signature: etAAA Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day I :111_ 111 L — 1.111__ I I I I I I I r( s �-- :/; ' L_ 7 c -gs / . . -1 I I -11 I- 1= _III -1 I I- -- - I =III =III= 1— (E) PARKING — II1E1II= ��� ' =1 I 1 =1 I 1 =111 =1 — 111 -111— III I I I_I I 1E111= Ell RE VIS IO N 4-4-,d,02 rhea I iz fric,fal _=1 I I =1 I I- III- j !ffl=fflE — _ //s 9 .44�A, — _ s a y 1 — — Yo►' 7 z A City of Tigard =`' `� Approved Plan �- _ = I � G� pp I III— III g �rt�rE. --Date TJ2-a1ay.' 1 —111=111=111— Pia- C vt4 ,. 'tot,..- 11 Relk;,0,41 r,Jc...- 1.:., , 4.74 t 1 V ; V 1 r ; D O. O ✓ G •c 1Qp.i; - : 1 SITE PLAN 1--....4,41,...÷, J ._, 04 ` � g 1z o /o n -� ReA/i/ DIN ,. 0 ,ir r . .. ,, Sl.o. L 1 Qe A.1 o : 4.- L-....11 pr r eof 0\ plw.r.1,;,. An dust 0...,4 s L..vi .1- -s; 7.: ,� Re a... - r' Ta61t. / a --2 OS PSG. D S HWA HER (E) "STORAGE , t " r STORAGE I DIS'4 AY FREEZER DISPLAY COOLER (NW) RESTROOM 5 0 5 0 WALK -IN 12' -O" ME' ' GRINDER T 0 COMPARTMENTw„ k R p (E) 12' -O" COOL : SAW SINK TOTAL L/ RESTROOM 01144 �� . U+- WORK ' to �"( �, TABLE 1 F .. HANDSINK ill 14424.4.)) � .,� $�_0" Approved 1 .V Q TY OF TIGARD ....... P .. �r ••`ti% � , ts II C e 7 -,,Y" - :c!;' z Y © , v Conditionally App fed ( )• , �� 9 � ..: For only the work as ., :scribed in: J? [DOOR 14' -O" PERMIT NO. Pi 4_ oo3O3 WALK -IN see Letter to: Follow I ]: •= _ FREEZ T� Attach - [ ?: _ (OW !/ COMPA' TM: NT 4 Job Address: / 16 $ per` FiL tit,. , , J I N K TO AL v - By: CI L .i i 111 i••'.• Date. 0 0 0 e ; � , EXISTING � � � INK cl MAINT. N— GROCERY SHELVES, TYP. T o (N) HALF - HEIGHT s WALL ., ET q—_ 7 (N) HALF - HEIGHT (E) 3'- 0 "x7' -0" WALL MEAT CASE COOLER, (E) 3'- 0 "x7-0" EXIT DR 3 TOTAL COUNTER EXIT DR SITE COPY B „ r y �E WINDOW, TYP. -� (E) DOOR REMAIN � (E) ..... rT • t • r u r• •rr. DOUBLE DOOR . . CITY TIGARD PLUMBING PERMIT iA, DEVELOPMENT SERVICES PE A, PLM2004 -00303 .K � �� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 7/26/2004 SITE ADDRESS: 11535 SW PACIFIC HY PARCEL: 1S136AD -04000 W SUBDIVISION: VILLA RIDGE ZONING: C -G BLOCK: LOT: 007 JURISDICTION: TIG CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: FLOOR DRAINS; 2 TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 2 URINALS: GREASE TRAPS: 2 LAVATORIES: OTHER FIXTURES: 2 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: 1 RAIN DRAIN: ft Remarks: Building fixtures. Other fixtures: 1 ice maker and 1 primer. All Fixtures are new. FEES Owner: Description Date Amount SMITH, EDITA M 833 NW 170TH DR [PLUMB] Permit Fee 7/26/2004 $149.40 BEAVERTON, OR 97006 [PLMPLN] Plan Review 7/26/2004 $37.35 [TAX] 8% State Surcharl 7/26/2004 $11.96 Phone : Total $198.71 — Contractor: POSITIVE PLUMBING 618 MEADOW VIEW RD FOREST GROVE, OR 97116 REQUIRED INSPECTIONS Phone : 503 - 720 - 3849 Rough -in Insp Underfloor /Underslab Reg #: LIC 00078209 Top-out Insp MET 0004726 Final Inspection PLM 34 -234pb 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. Issued By: / / _�� _ ` Permittee Signature: K. Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the usiness day Building Fixtures ECE[IV�D S , • _, OW Plumbing Permit App1i ion FOR OFFICE USE ONLY City of Tigard . `` 'r 200,. Ragged • D y � /3/j Permit No 0/1 a 0 0303 13125 SW Hall Blvd., Tigard, OR 9722 / r Plan Review Phone: 503.639.4171 Fax: 503.598.1 Other Permit No.:Swr . 04/'9'9' Gtr�n D ate/By: OF 24- Hour Inspection Line: 503.639.40�71LDIN c' I 4 Ready/By: Ready ® See Page 2 for Internet: www.ci.tigard.or.us C' DIVISIO g N otified/Method: Supplemental Information . - TYPE OF .WORK - . FEE *. SCHEDULE ,; -. - c :: :- . "' ❑ New construction ❑ Demolition For special information use checklist. Description 1 Qty. I Ea. I 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 rA ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/ldtchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities 1 � Job site address: //5:35 //5:35 ,S AJ r/� ,,/,', Her Catch basin or area drain 16.60 City/State/ZIP: _ O i - 3 Drywell, leach line, or trench drain 16.60 O Suite/bldg./apt. no.: a I Project name: Footing drain (no. linear ft.: ) Page 2 f Cross street/directions to job site: 5/I r` Manufactured home utilities 110.00 Manholes 16.60 ■ Rain drain connector 16.60 Sanitary sewer (no. linear ft.: Page 2 ( V��, Storm sewer (no. linear ft.: ) Page 2 Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2 Fixture or item I Tax map /parcel no.: Absorption valve 16.60 DESCRIPTION OF WORK Backflow preventer Page 2 \, Backwater valve 16.60 ' Clothes washer 16.60 Dishwasher I. 16.60 l i , ❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60 I' Ejectors /sump 16.60 I Name: AO 44 1 Q Expansion tank 16.60 Address: Fixture/sewer cap 16.60 ( . City/ State/ZIP: Floor drain/floor sink/hub A 16.60 3a-, U Phone: ( ) I Fax: ( Garbage disposal : 16.60 ��` � � �� Hose bib 16.60 ® APPLICANT ` ❑ CONTACT PERSON t Ice maker 4, 16.60 /(p.1$0 Business name: (fu e � jV1 , Q y Interceptor /grease trap 16.60 6 6 Contact name: ` � r rrnn ,� U. S � l cy lr-F 07 ?) ti; /3 / Medical gas (value: $ ) Page 2 Address: tide g C hi 31 (' ( Primer 1 16.60 ) to , City/ State/ZIP: ?O L'/ ,r( 691j‹ 5 7 ?/ 9 - Roof drain (commercial) 16.60 Phone: (f03) TcPs/ jf`� d Fax: ��f�) CZ �� ) f 7 Sink /basin/lavatory �, 16.60 . 3 J Tub /shower /shower pan 16.60 E -mail: ' Urinal 16.60 CONTRACTOR Water closet 16.60 Business name: p051 ,�A (, e �+ �y` � � Water heater 16.60 Address: !Q /)f C at/c/ ViCc/ j (, Other: - City/ State/ZIP: roves+ cg Ud(/' D/ 0 S u b total icy 70 M inimum permit fee: $72.50 Phone: �a3 ,75 ST � Fax: ( ) $/7f1 Residential backflow minimum permit fee: $36.25 _ CCB Lic.: 7 Pp g Plumbing Lic. no. % �l7 7' s f2 Plan review (25% of permit fee) s 7. 35 [, y) r/31104 State sur (8% of permit fee) /(•"& r Authorized signature: 0 ' A 3 / ' 2J ` (� pa TOTAL PERMIT FEE Print name: A N N Z /7-(.._ l L.4- ' L Date: ! -- Q This permit application expires if a permit is not obtained within /' 180 days after it has been accepted as complete. JJ *Fee methodology set by Tri-County Building Industry Service Board. is\ Building \Pemtitv'PLMF- PermitApp.doc 12/03 440.4616 O0/07/COM/WEB) t Cal 1 1 Plumbing Permit'Application - City of Tigard Page 2 - Supplemental Information Fee Schedule: Residential Fire Suppression Systems: Site Utilities ,Qty. Fee (ea) Total Square Footage:' Permit Fee: .' ; :. Footing drain - 1" 100' 55.00 0 to 2,000 $115.00 Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00 3,601 to 7,200 $220.00 Sewer - 1st 100' 55.00 7,201 and greater $309.00 Sewer - each additional 100' 46.40 Water Service - 1st 100' 55.00 Medical Gas Systems: Water Service - each additional 100' 46.40 Storm & Rain Drain - 1st 100' 55.00 Valuation: Permit Fee: ' , $1.00 to $5,000.00 Minimum fee $72.50 Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each Fixture or'Item • Qty. Fee (ea) Total additional $100.00 or fraction thereof, to and including $10,000.00. Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for Residential Backflow Prevention Device each additional $100.00 or fraction thereof, to (minimum permit fee $36.25) 27.55 and including $25,000.00. Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for each additional $100.00 or fraction thereof, to Inspection of existing plumbing or and including $50,000.00. specially requested inspections - per hour 72.50 Subtotal: $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for each additional $100.00 or fraction thereof. • Fixture Work: Are you capping, moving or replacing existing fixtures? If "yes ", please indicate work performed by fixture. Failure to accurately report fixtures could result in increased sewer fees * . Quantity by (Fixture) Work Perf ed Fixture Type: Replace New Moved Existing Capped) Comments regarding fixture work: Baptistry/Font Bath - Tub /Shower - Jacuzzi/Whirlpool Car Wash -Each Stall -Drive Thru Cuspidor/Water Aspirator Dishwasher -Coma *tuial - Domestic Drinking Fountain Eye Wash • Floor Drain/sink - 2" -3 „ -4" Car Wash Drain Garbage - Domestic Disposal - Commercial *Note: If the fixture work under this permit results in an - Industrial increase of sewer EDUs, a sewer permit will be issued and Ice Mach./Refrig. Drains Oil Separator (Gas Station) fees assessed for the sewer increase must be paid before the Rec. Vehicle Dump Station plumbing permit can be issued. Shower -Gang -Stall Sink - Bar/Lavatory Quantity Total - Bradley - Isometric or riser diagram is required if fixture quantity - Commercial - Service total is >9. Swimming Pool Filter Washer - Clothes Water Extractor Plan Review Water Closet - Toilet Plan review is required if fixture quantity total is >9. Urinal Other Fixtures: is Building \Permits\PLM•PemtitApp.doc 3/03 CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 MST IN P CTION DIVISION Business Line: (503) 639 -4171 BUP Red tw% Date Requested /(,) AM PM BUP Location 1/ 3 ()A G! 1 C Suite MEC Contact Person Ph ( ) / e e ( ( - 6 6 3 6 1 Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC Ftg Drain ELR Crawl Drain Slab Inspection Notes: SIT Post & Beam Shear Anchors Ext Sheath/Shear Int Sheath/Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm LSusp'd Ceiling Roof Other: Final PASS PART FAIL 11131.0 Post & Beam Under Slab Rough -In Water Service • Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower Pan Other: PART FAIL CHANICAL Post & Beam Rough -In Gas Line Smoke Dampers Final PASS PART FAIL ELECTRICAL Service Rough -In UG/Slab Low Voltage Fire Alarm Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd. PASS PART FAIL SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access Fire Supply Line ADA Approach/Sidewalk Date l C70 l LC - Inspector / / ?/� Ext Other: Final DO NOT REMOVE this Inspection record from the Job site. PASS PART FAIL - - — ci,�.10 o hm t 11 FLY. 10 0 s - a (�- 7 .-' 9- P7° /f Positive Plumbing c t✓ Andrzej KulesZQ - 41 3 I �rlt 6 1B Meadarwtew Rd. a .. ('!Z F orest Grove, OR 97110 m f i ( / 359.5750 N CD • r r i/ � � - cc B.78209 m IXSiel / J I ( V fa gi pod i p, C0 �� 1 f slAil. I ^ ti t S`�- ( f � 2" �� GOI 1 2r. RECEIVE f ' � 2 tie ,� ( D A' �' (1 I 221 r % 1 , ` 2004 CITY Cat = i lGAHD m S e Z — P BUILDING DIVISION er (`1/ cv a� V ( r 03 03 ljt I -$) is � i gay I I ei Id )6 ih z I rr l O� n tQK cLvvt 5 5 7/ 2'/ l x s• 2 It 4 G 0\r ft 0 5c�c1 b ���� n . 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