Permit CITY TI GARD PLUMBING PERMIT
I DEVELOPMENT SERVICES PERMIT #: PLM2002 -00155
A I � 13125 SW Hall Blvd., Tigard, OR 9 (503) 639 -4171 DATE ISSUED: 5/15/02
SITE ADDRESS: 11640 SW PACIFIC HWY PARCEL: 1S136DB -02400
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: A3 FLOOR DRAINS: 8 TRAPS:
STORIES: 1 WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: 1 SF RAIN DRAINS:
SINKS: 4 URINALS: GREASE TRAPS: 1
LAVATORIES: 2 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Tenant improvement to convert retail space to restaurant.
FEES
Owner:
Type By Date Amount Receipt
CHAMPION, RONALD V AND PRMT CTR 5/15/02 $395.00 27200200000
ROBERTA E PLCK CTR 5/15/02 $98.75 27200200000
11642 SW PACIFIC HIGHWAY 5PCT CTR 5/15/02 $31.60 27200200000
TIGARD, OR 97223
Phone 1: Total $525.35
Contractor:
DRAIN MASTER
5111 NE ALBERTA ST •
PORTLAND, OR 97218 REQUIRED INSPECTIONS
Phone 1: 503 - 307 -8116 Rough -in Insp
Underfloor /Underslab
Reg #: LIC 96622
PLM 26 -525P6 Top -out Insp
RP /Backflow Preventer
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.
,' O r
Issued By: , ! 4 .- _ A . / Permittee Signature:,,V/Z � iu�`�
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
I
5/e 2,
Plumbing Permit Application
Date received: 5 f 4A Permit no.: 41/6/4,a-p0/55
4'0' : City of Tiga>i''s � oh �
Sewer permit no.: Building permit no.:
� y
'� , Address: 13125 SW . 1 ' I,
City of Tigard Phone: (503) 639 - 4171 Project/appl. no.: p date:
Fax: (503) 598 -1960 M' ;AY "1 211R? Date issued: Byk Receipt no.:
Land use approval: C l l Y Of !WARD D Case file no.: Payment type:
I . n.nv ' 1 L Y T
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
JOB SITE INFORMATION FEE SCHEDULE (for special information use checklist)
Job address: t i 640 5 W /4-c t t= 1 i Description Qty. Fee (ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: I Block: I Subdivision: SFR (2) bath
Project name: (J #Oage'S 6,,,„,7 gc,A,) e g s i' SFR (3) bath
City /county: I ZIP: \ Each additional bath/kitchen
Description and location of work on premises: Site utilities:
_ Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lib. ft.)
Manufactured home utilities
Business name: j7(2 A / 0-i ivf A57 Manholes
Address: tS / / i is 6 /0-(b El? t S7 Rain drain connector
City: . ? o a r / . 40- Af D I State: G t2 I ZIP:c7 Z 18, Sanitary sewer (no. lin. ft.)
Phontge) 307 -Q/ i C. I Fax: I E -mail: Storm sewer (no. lin. ft.)
CCB no.: r !o k' 2. -. / I Plumb. bus. reg. no: 2/0- 52. 5 P g Water service (no. lin. ft.)
City /metro lic. no.: K 114 .' 0/62- Fixture or item:
Contractor's representative signature: /,u, e Absorption valve
l �"""`" Back flow preventer
Print name: / (..r H 9. /2 ,v b-W Date: - Backwater valve —
CONTACT PERSON Basins/lavatory ✓ \ Q
Name: le r 1 f3A-i2 ei e S r Clothes washer —
Dishwasher /
Address: Drinking fountain(s) ---
City: I State: I ZIP: Ejectors/sump —
Phone: Fax: E -mail: Expansion tank —
Fixture/sewer cap --
Floor drains/floor sinks/hub to / - 3!(r
Name (print): Garbage disposal .(--
Mailing address: Hose bibb
City: I State: I ZIP: Ice maker / ,
Phone: I Fax: I E -mail: Interceptor /grease trap /
Owner installation/residential maintenance only: The actual installation Primer(s) 8
will be made by me or the maintenance and repair made by my regular Roof drain (commercial) —
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) ,/ Si
Owner's signature: Date: Sump
IMMIMIWOMMEI Tubs/shower /shower pan —
Urinal —
Name: Water closet a
Address: Water heater /
City: I State: I ZIP: Other: " p� Sys» l - /
Phone: I Fax: I E -mail: Total 2.4
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at _ %) $
O Visa CI MasterCard expires if a permit is not obtained
credit card number: / / State surcharge (8 %) .... $
Expires within 180 days after it has been TOTAL $
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440-4616 (6100/COM)
PLUMBING PERMIT FEES:
PRICE TOTAL New 1 and 2- family dwellings only:
FIXTURES (individual) QTY (ea) AMOUNT (includes all plumbing fixtures in PRICE TOTAL
Sink / 4 16.60 6,6, t/() the dwelling and the first100 ft. QTY (ea) AMOUNT
for each utility connection)
Lavatory / 16.60 y ?3•2 One (1) bath $249.20
Tub or Tub /Shower Comb. _ 16.60 - Two (2) bath $350.00
Shower Only _, 16.60 _ Three (3) bath $399.00
Water Closet a 16.60 3 3, ZV SUBTOTAL
Urinal -- 16.60 8% STATE SURCHARGE
Dishwasher V . ` ) 16.60 /- (o PLAN REVIEW 25% OF SUBTOTAL
Garbage Disposal 16.60 TOTAL
Laundry Tray Vdthi.0 am L / I 16.60 &,60
Washing Machine 16.60
Floor Drain /Floor Sink 2" 16.60 / / PLEASE COMPLETE:
3" / 16.60 /4 vf)
4" l 16.60
W ater Heater conversion 0 like kind 16.60 Quantity by Work Performed
as 1pin quires a separate mechanical Fixture Type: New Moved Replaced Removed/
permit. i 4ae.r) f . Cared
MFG Home New Water Service ..- 46.40 Sink 4 -
MFG Home New San /Storm Sewer - 46.40 Lavatory ./ ' 2-
Tub or Tub /Shower
Hose Bibs - 16.60 Combination
Roof Drains - 16.60 Shower Only
Drinking Fountain - 16.60 • Water Closet ✓ : 2.- - --0,
Other Fixtures (Specify4apawkamM 16.60 D
Dishwasher i / I.
Z" 41p / alto e / G it Z Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Sink: 2" / 72
Sewer - 1st 100' �- 55.00 3" /
Sewer - each additional 100' _. 46.40 4" ,
Water Service - 1st 100' - 55.00 Water Heater /
Water Service - each additional 200' - 46.40 Other Fixtures
(Specify)
Storm & Rain Drain - 1st 100' -,-" 55.00 / /xr. HA-L',4 r7,
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device / 46.40 d/4, f/®
Residential Backflow Prevention Device' 27.55
Catch Basin 16.60
Inspection of Existing Plumbing or Specially 62.50
Requested Inspections - per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling - 65.25
Grease Traps / 16.60 / 6,4()
QUANTITY TOTAL
Isometric or riser diagram is required if 2
Quantity Total is > 9 -
*SUBTOTAL ?9.5. a7 U 6
8% STATE SURCHARGE 7
"PLAN REVIEW 25% OF SUBTOT j ,
-
Required only if fixture qty. total > 9 . 1 /R,
T TA $e-ZSr3.s-'
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow .
Prevention Device, which is $36.25 + 8% state surcharge.
"Ali New Commercial Buildings require 2 sets of plans with Isometric or riser
diagram for plan review.
i:\dsts \forms\plm- fees.doc 12/26/01
5/16/02 Activities for Case c ... 002 -00155
8:11:34 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes T
PLMC003 Application received .5/7/02 DEB DONE No Hold BLD 5/7/02
PLMC005 Permit Created 5/7/02 DEB DONE No Hold BLD 5/7/02
PLMC007 Plans routed to Plans Examiner 5/7/02 DEB DONE No Hold BLD 5/7/02
PLMC008 Plans Approved /Routed to PT 5/8/02 5/8/02 5/8/02 DWJ DONE No Hold DWJ 5/8/02
PLMC120 Plumbing Undersl No Hold DWJ 5/8/02
PLMC715 Rough -in Insp No Hold DWJ 5/8/02
PLMC720 Underfloor /Underslab No Hold DWJ 5/8/02
PLMC725 Top -out Insp No Hold DWJ 5/8/02 ,
PLMC750 RP /Backflow Preventer . No Hold DWJ 5/8/02
PLMC799 Final Inspection No Hold DWJ 5/8/02
PLMC015 Post - review complete 5/14/02 DEB DONE No Hold DEB 5/14/02
PLMC040 (F) Ready to issue 5/14/02 DEB DONE No Hold DEB 5/14/02 Must pay sewer fee prior to
issuance of permit.
PLMCO50 (F) Issue permit 5/15/02 BB DONE No Hold BLD 5/15/02
•
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Page 1 of 1
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
l BUP
Received Date Re uested / ( AM PM - BUP
L ��11
Location it �° `(v Suite MEC
Contact Person Ph ( ) l ' 'f " gvod-7 PLM ° 2 6D /3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain j‘iY4
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler • ORAVIAMMe � A ' Fire Alarm , Susp'd Ceiling
Roof Ar4T/
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Water S he
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
i 10'
•AS' 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 Ell Please ca for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date 1 /I
Approach/Sidewalk Inspector / / . 7 / Ext
Other:
Final DO OT REMOVE this Inspection record from the Job site.
PASS PART FAIL
— ��: —
, CITY OF TIGARD 24 -Hour .�
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISI Business Line: (503) 639 - 4171 MSS
BUP
Received Date Requested S� ¥ AM M BUP
Location / / Suite MEC
Contact Person Ph ( ) 3 PLM —
Contractor Ph ( ) e q D - ?4 ? 7 SWR
BUILDING Tenant/Owner . ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation 4111°)"
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Un Slab
6ugh -I
a er ervice
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Fi I
PART FAIL
MECHANICAL
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: El Unable to inspect — no access
Fire Supply Line 411k
ADA
Approach/Sidewalk Date Z� D L Inspector ' Ext
Other:
Final DO NOT REMOVE this in ction record from the Job site.
PASS PART FAIL