Permit . r
CITY OF TIGARD
r
DEVELOPMENT SERVICES PLUMBING PERMIT
PERMIT #: PLM2005 -00661
"W it
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 11/29/2005
PARCEL: 2 S 102AA -00200
SITE ADDRESS: 11920 SW PACIFIC HWY ZONING: CBD
SUBDIVISION: TIGARD HIGHWAY TRACTS LOT: 013 JURISDICTION: TIG
Project Description: (2) Backflow preventers in kitchen.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft • DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
BARNES, SANDRA L
c/o TUMAY CORPORATION Description Date Amount
11920 SW PACIFIC HWY [PLUMB] Permit Fee 11/29/200f. $92.80
TIGARD, OR 97223 [TAX] 8% State Surcha 11/29/200: $7.42
Phone : Total $100.22
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS
Phone : 503- 643 -7619
Reg #: LIC 128892
PLM 34 -4PB
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 or 1- 800 - 332 -2344.
Issued By: ,66 £L, Permittee Signature: � C>c �.
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Nov 29 05 05:07p Beaverton Plumbing Inc 5036437620 p.2
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Building Fixtures Ei �� D
Plumbinf Permit Annli a l'OR Oi i 'i( IL l SE ONLY
City of Tigard �
\ f �p Permit r �o "�\ hz05 dd 66 /
13 125 SW Hall Blvd., Tigard, OR 97223 Nov 2 9 D 1 � f 7
Phone: 503.639.4171 Fax: 503.598,1960 Plan Review
T I "`'' ' ' " -" i 1?atdtty: Other Permit No.:
24- I loth' Inspection Line: 503.639.4175 C ITY OF I ' . t
�1, .. Date Ready/By: r d°' 67 Sec Page 2 for
Internet: www.ci.tigard.or.us gU ILpING � ' - Nntified/c �� U I Supplemental Information
TYPE OF W ORK FEE" SCIIEDULE
❑ New construction ❑ Demolition y For special iarformalion use checklist
Dmariptinn I Qty. I rat. 1 Total
'' Addition /alteration /replacement ❑ Other: New I. 2-family dwellings (includes I00 R for each utility connection)
CATEGORY OP COlvs'1'RUCTION SIR (1) bath I 249.20
❑ I- and 2- family dwelling r_ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi-family st>rt (3) bath 399.00
❑ Master builder Fuels additional bath/kitchen '15.00
❑ Other Fire sprinkler ( sq. II.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: • Q � - w • 1 _1 Catch basin or area drain 16.60
Git y/Sta(cJ /.IP: � ' " y j C ( _• 7 2.23 Drywcll, Icach line, or trench drain 16.60
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Prujtxa mime:
Cross strcet/dir ctions to job site:
Manufactured home utilities 110.00
Manholes 16.60
- Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear R.; ) Page 2
Subdivision: l Lot no.: Witter service (no. linear IL: ) Pagc 2
Tax map/parcel no.:
Mixture or item
Absorption valve 16.60
DESCRIPTION OF WORK ^ Back flow prcventtx - 2. Pnge 2 g
•
�' Backwater valve 16.60
r , J Clothes. washer 16.60
V `- � - Dishwasher 1 6.60
r-• PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
r , ejectors/sump 16.60
Name: ')e�•�C'rl5 (3. 1 1' 1?xpnnsion tank 16.60
Address: Fixture /sewer cap 16.60
City /State/ZIP: Floor drain /floor sink /huh 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice makes 16.60
Business name;
Interceptor/grease trap 16.60
Contact name: Medical gas (value: S ) Pagc2
Address: Primer 16.60
City /StatdLIP: Ronfdrain (commercial) 16.60
I'honc: ( ) Fax: ( ) Sink/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR Watts' closed 16.60
Business name: r .- 4 vt lQv,. f ii `L..`o $
;1c, Water honer 16.611
Address: -�� S. ` r ,, f f.•.s Other:
City/State/ .IP: .rt 1A. �}*� X 1. 5 ` Subtotal Ci7
Phone: (.av3),, c / ' - /"�'„ (`7 F a x : (7 ; J � e _ Minimum permit fee: 36.25 I )�u �S" 7 � �� Residential br�elluw minimum permit fee: E3625
_
CCBLic. PlumbingLic.no.3!c/_ -Cj//1 _ Plan review (25%of permit fee) _
•
Authorized sit stare' i f /irk _ / State surcharge (8% of permit (cc) 7, ! Z
---� TOTAL PERMIT FEE / 23.. 27.,
Print name:. •• yi< 0 1 M1 Date:/ / 66 This permit application espirea if a permit Is not obtalaed within
"' 1 Nl1 days after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry service hoard.
i ;VW ldine rermiIWLMt'- l'ermicApp.dac MOS 40401 Oil I0/ULCOM/wt0)
CITY OF TIGARD
BUILDING DIVISION " - " PERMIT #: PLM2005.00661
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/29/2005
Phone: (503) 639 -4171 a&arir
Inspection Requests (24 Hrs.): (503) 639 -4175 '__
INSPECTION WORKSHEET FOR DATE: 17/2/2005 TIME: 7:19AM PAGE: 42
SITE ADDRESS: 11920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: TIGARD HIGHWAY TRACTS LOT #: 013 TYPE OF USE:
PROJECT NAME: MIXERS BAR & GRILL
DESCRIPTION: (2) Backflow preventers in kitchen.
OWNER: BARNES, SANDRA L, PHONE #:
CONTRACTOR: BEAVERTON PLUMBING INC PHONE #: 503 - 6437619
Inspection Request Scheduled For: Date: 12/2/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 022754 -01 503-643.7619 N
Corrections /Comments /Instructions:
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PASS ❑ PARTIAL APPROVAL • ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /79'11 Date: Phone #: (503) 718 -