Permit CITY OF TIGARD
/41 ' A DEVELOPMENT SERVICES PLUMBING PERMIT
- IL. 13125 SW HaII Blvd., Tigard, OR 97223 (503) 639.4171 PERMIT # PLM97 -0291
DATE ISSUED: 08/20/97
PARCEL: 18136CC -00100
SITE ADDRESS...: 11765 SW PACIFIC HWY
SUBDIVISION • ZONING: C —P
BLOCK • LOT • 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..:B FLOOR DRAINS • 0 TRAPS • 0
STORIES • 0 WATER HEATERS 0 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0
SINKS • 0 URINALS • 6 GREASE TRAPS • 0
LAVATORIES • 9 OTHER FIXTURES • 9
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 1 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Tenant improvement
Owner: FEES
GENERAL MOTORS TRAINING CENTER type amount by date recpt
11765 SW PACIFIC HWY PRMT $ 198.00 JSD 08/20/97 97- 298485
TIGARD OR 97223 PLCK $ 49.50 JSD 08/20/97 97- 298485
5PCT $ 9.90 JSD 08/20/97 97- 298485
Phone #: INSP $ 80.00 JSD 08/20/97 97- 298485
Contractor
..DETEMPLE CO INC
1951 NW OVERTON ST
PORTLAND OR 97209
Phone #: 227 -2641 $ 337.40 TOTAL
Reg #..: 000025
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Water Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other PL M / Un d e r f l o o r
applicable laws. All work will be done in accordance with Top —out Insp
approved plans. This permit will expire if work is not started Drinking F o un t a i
within 180 days of issuance, or if work is suspended for more Insp existing / ca
than 180 days. ATTENTION: Oregon law requires you to follow rules Final Inspect ion
adopted by the Oregon Utility Notification Center. Those rules are
set forth in OAR 952400110 through OAR 952-0001-0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
� da.Cdr
Issued By: Permittee Signature:
+ + + + + + + + + + + + + + + + + + ++ +++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 6:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
7- 52 - 2 .
CITY OF TIGARD Plumbing Application Recd By
1 3125 SW HALL BLVD. Commercial and Residential Date Recd ? -1(e
TIGARD, OR 97223 Dare to P.E. -237
Date to DST' S^ q 7
(503) 639 -4171 Permit s Y1--M - 02-11
Print or Type Related SWR s 1 7 - (92-ti
Incomplete or illegible applications will not be accepted Called g (! 4 i 9 r1
Name of Oevelopment/Prolect FIXTURES (individual) 9 Ne- 1 'n Sink 9.00 QTY PRICE AMT
Job
rlbT�t, I itf CH,/e. Lavatory �
Address Street Address Suite l ,�Q- " I )
9.00 cy a p
11'146 5 , w • PACs r tt Pw Tub or Tub/Shower Comb. ' 9.00
Bldg s City/State Zip Shower Only 9.00 I
....6(0 ....6(0 09 D � '0 /7 Closet 1 9.00 4.Ql.
Name Dishwasher
aM 9.00 I
Owner Mailing Addre s Suite Garbage Disposal 9.00
Washing Machine 9.00
Clty /State Zip Phone Floor Drain 2' 9.00
Name
3 9.00
5AM 4 - 9.00
Occupant Mailing Address Suite Water Heater 9 f
Laundry R om Tray 9.00
City/State Zip Phone Urinal - 4!' �� Ii ' � �qcs � _ 9.00 • 1XL 3:0
.. rrte Other Fixtures (Specify) f w RS,i! 1 9.00 4 , D
- 4 I PI- Co , �• W <, I!!TwF[ I \' 9.00 9, 0
Contractor Mailing Address Suite ' u 10,10 b 9.00 �
1951 N.W, e -i' i o ✓,tilc, w � , s.00
l 9 ,
City/State Zip Phone
I ' P0�'r De '7 Zc / 227 z641 9.00
9.00
Oregon cow a nt. Board Licit Exp.
Meal Copy of o(J ( (e1 s.00
Current Plumbing c. C r) Exp.
e !ate n Sewer - 1st 100'
7 1' fl 3' I't ' 30.00
Waimea Sewer -each additional 100' � 25.00
COT ! s�e o Exp. Dote/
q Water Service - 1st 100' 30.00
• Name Water Service - each additional 200' 25.00
I Architect ix 4,40,g 6 t Storm & Rain Drain - 1st 100' 30.00
or Mailing Address 5,..;e Storm & Rain Drain - each additional 100' I 25.00 I
)C/Ljf �� w, D►JE�1') Mobile Home Space 1 25.00 I
Engineer C Zip Phone Commercial Back Flow Prevention Device or Anti-
Pollution Device ' I 25.00
POr1 p 9 7i 119 2'' �� I
Or$Ctbe wont Jew 0 Addition 0 Alteration Repair O Residential Bacxflow Prevention Device' ` 15.00
to be done: Residential 0 Non - residential 0 ' Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work Catch Basin I I 9.00
TM /Wit, w 11. r (P6 Insp. of Existing Plumbing 4 0.00
per/hr
Speaaty Requested Inspections 40.00
use of //.��-t! �� C , � oer, � '
• or propertyF� N10TKy �rE'Alt� I ' �
Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property 5 A M f-___
QUANTITY TOTAL 3 4
Are you capping . moving or replacing any fixtures? YesA No a Isometric or riser aiagram is required if Cuanit Total is > 9 4. •;;f'
(If yes see back of form) 'SUBTOTAL 3p
I
hereby acknowleage that I have read this application, that the information
3 '
given s correct. trial I am the owner or authorized agent of the owner, and 5% SURCHARGE q s- ' ,
net clans submitted are in compliance with Oregon State Laws.
Sign rure of of OwneriA ent ' Hil at@ PLAN REVIEW 25% OF SUBTOTAL 5L) 7
/� /�' "vl � �` � "''V S l q7 4eauired only if `oRUre cry, total is 9 it " •
� i aJ� ��
p i umb _ TOTAL C ontact Person Name ' Phone I .:.::
'Minimum permit fee is S25 • 5% surcnarge. except Residential Bacxflow
Prevention Device, which is 815 • 5% surcnarge
i:ldststplmapp.doc 8196 1 v1 A/ lip i4 D
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory b ' 1/75
Tub or Tub /Shower Combination
Shower Only • W at-C e _ p r i. a - -
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4 "
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify) UQ,1 pY L g "( -' Ee t,5 7'r
0617-r y
VO0046 FDuN Ive w
COMMENTS REGARDING ABOVE:
7/26/99 Activities for Case #: PLM97 -00291 •
1:52:40 PM •
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 7/16/97 B RECD BON 7/23/97,
PLMC005 Permit Created 7/23/97 B PASS BON 7/23/97 •
PLMC799 Final Inspection , 9/22/97 MS PASS J'H 9/26/97 Do not case final until the SWR
is paid after MIKE S does a
walk through to determine total
• fixtures in building and the new .
EDU
PLMC007 Plans routed to Plans Examiner 7/23/97 B PASS BON 7/23/97
PLMC008 Plans Approved /Routed to DST 8/5/97 MS PASS MRS 8/5/97 five fixtures added - existing
fixtures to be cleaned up and
re -set
PLMC725 Top -out Insp 8/5/97 9/22/97 MS PASS J'H 9/26/97
PLMC745 Drinking Fountain 8/15/97 9/22/97 MS PASS J'H 9/26/97
PLMC760 Insp existing /capped fixtures 8/15/97 9/22/97 MS • PASS J'H 9/26/97
PLMC040 (F) Ready to issue 8/15/97 JDA PASS JDA 9/4/97
PLMCO50 (F) Issue permit 8/20/97 JSD PASS JD 8/20/97
PLMC060 Hold Release 9/4/97 JDA PASS . JDA 9/4/97
PLMC800 Case Finaled 9/22/97 MS PASS J *H 9/26/97
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