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Permit CITY OF TIGARD ra 'fn DEVELOPMENT SERVICES PERMIT #: G PERMIT 0-01000 �� II PLUMBING PER 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 04/04/2000 SITE ADDRESS: 11945 SW PACIFIC HY PARCEL: 1S135DD -03301 W SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G BLOCK: LOT: 002 JURISDICTION: TIG CLASS OF WORK: REP GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 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: 100 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Sanitary sewer line repair in front of Gaffers restaurant. FEES Owner: Type By Date Amount Receipt MILTON O. BROWN PRMT BON 04/03/200C $50.00 0001134 301 NW MURRAY BLVD 5PCT BON 04/03/200C $4.00 0001134 PORTLAND, OR 97229 Total $54.00 Phone 1: 503 - 643 -5756 Contractor: MICHAEL + CO PLUMBING P 0 BOX 23008 TIGARD, OR 97281 REQUIRED INSPECTIONS Phone 1: 639 -3189 Sewer Inspection Final Inspection Reg #: LIC 000678 PLM 26 -333PB ORIGINAL 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. , Issued By: m kt oitAavu,..„ Permittee Signature: NI. t(eot.VOY\ Call 503 639 -4175 by 7:00 P.M. for an inspection needed the neiness day CITY OF-TIGARD Plumbing Permit Application Plan Check 13125 SW HALL BLVD. Commercial and Residential Recd By TIGARD, OR 97223 Date Rec'd 'l ( 20 (503) 639 -4171 Date to P.E. Print or Type Date to DST Incomplete or illdgible applications will not be accepted Permit # R# -Mao Related SW # Called Name of Development/Project FIXTURES (individual) QTY PRICE AMT Job / � # / e/9249 Sink 11.50 Address Street'Address r • Suite Lavatory 11.50 I 11 US Tub or Tub /Shower Comb. 11.50 4 S- Bldg # City /State Zip Shower Only 11.50 Water Closet 11.50 m , 0 (-211- rbexr-e•- Urinal 11.50 Owner Mailing Address Suite Dishwasher 11.50 3 01 /./uJ Ow c (I n 2 Garbage Disposal 11.50 City/Statg Zip Phone Laundry Tray 11.50 v1 L4 0 r q 722 a / ,5 Name Washing Machine 11.50 Floor Drain/Floor Sink 2° 11.50 Occupant Mailing Address Suite 3" 11.50 4° 11.50 • City/State Zip Phone Water Heater 0 conversion 0 like kind 11.50 Name rr Gas piping requires a separate mechanical permit. , y Dale f ( -4 Co P JU w b /Kj MFG Home New Water Service 32.00 Contractor it Address Suite MFG Home New San/Storm Sewer 32.00 ' ODIC 0 OP Hose Bibs 11.50 Prior to permit Ci / tate Zip Phone Roof Drains 11.50 issuance, a copy - 77c 9 4 1 2 t 1 ode. 972 Si 639-3/ P Drinking Fountain 11.50 of all licenses are Orefgon Const. Cont. Board Lic.# Exp. Date required if C''? rP 7 7 Other Fixtures (Specify) 15.00 expired in COT Plumbing Lic. # Exp. Date database a-L " 333 i a Name Architect Sewer- 1st 100' 38.00 3$ ou Or Mailing Address Suite Sewer - each additional 100' 32.00 Water Service - 1st 100' 38.00_ Engineer City /State Zip Phone Water Service - each additional 200' 32.00 Describe work to be done: Storm & Raln Drain - 1st 100' 38.00 New 0 Repair,- Replace with like kind: Yes 0 No )?L Storm & Rain Drain - each additional 100' 32.00 Residential 0 Commercial Silk Commercial Back Flow Prevention Device 32.00 Additional description of work: Residential Backflow Prevention Device* 19.00 Catch Basin 11.50 Are you capping, moving or replacing any fixtures? Insp. of Existing Plumbing or Specially Requested 50.00 Yes 0 No 0 Inspections per/hr If yes, see back of form to indicate work performed by Rain Drain, single family dwelling 45.00 fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50 WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL 1 I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Quantity Total Is > 9 a given is correct, that I am the owner or authorized agent of the owner, and - that plans submitted are in compliance with Oregon State Laws. • *SUBTOTAL 3g�' P Sig Owner /A2ggL� Date 8% SURCHARGE °�{ d �j c-- P�jn 3'ao 3 �' CRntact Person ,Name Phone JA vQ Person (o3i -3/6-9 **PLAN REVIEW 25% OF SUBTOTAL 1. BATH HOUSE $178.00 Required only if fixture qty. total is > 9 2 BATH HOUSE $250.00 TOTAL d� ati 3 BATH HOUSE $285.00 0 2 (This fee includes all plumbing fixtures In the dwelling and the first *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention ,S ys 100 feet of sanitary sewer storm sewer and water service) + Device, which is $25 + 8% surcharge **All New Commercial Buildings require plans with isometric or riser diagram and plan review. I:ldstsVorms\plumapp.doc 12/17/99 PLEASE COMPLETE: Fixture Type Quantity by Work Performed New Moved I Replaced Removed /Capped Sink Lavatory Tub or Tub /Shower Combination Shower Only Water Closet Urinal Dishwasher Garbage Disposal Laundry Room Tray Washing Machine Floor Drain /Floor Sink 2" 3" 4" Water Heater Other Fixtures (Specify) COMMENTS REGARDING ABOVE: • I: ldstsfommslplumapp.doc 12/17/99 4/21/00 Activities for Case #: PLM2000 -01000 4:28:33 PM • Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes PLMC003 Application received 4/3/00 BON RECD No Hold BON 4/4/00 PLMC005 Permit Created 4/4/00 BON . DONE No Hold BON 4/4/00 PLMC705 Sewer Inspection No Hold BON 4/4/00 PLMC799 Final Inspection 4/4/00 MRS PASS No Hold AKJ 4/4/00 PLMCO50 (F) Issue permit_ 4/4/00 BON DONE No Hold BON 4/4/00 PLMC800 Case Finaled 4/4/00 AKJ DONE No Hold AKJ 4/4/00 • • • • Page 1 of 1 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 /L - BUP Date Requested 99 4/q( DO AM PM ��"` BLD Location P 9-k.4 1 1 Suite MEC Contact Person / 91 pain Ph& 31-'7)/ g 9 " Contractor '' ` Ph SWR BUILDING Tenant/Owner � ELC Retaining Wall R Footing ss:/ WCIS Foundation Re 6 L MI 1 (195s t iv/ (la T _ F Ftg Drain t�l 1 �+rJ"[ Crawl Drain • o Notes: OK - S Slab IT Post & Beam Ext Sheath /Shear Int Sheath /Shear Framing Insulation Drywall Nailing Firewall Fire Sprinkler Fire Alarm Susp'd Ceiling Roof Misc: Final PASS PART FAIL 0 P(UMBI ' Post & Beam Under Slab Top Out Water Service . , /�■ rid r Sewer � / R... Drains rte dor PART FAIL I i CHANICAL t �) /.( j Post & Beam .. v /� Rough In ____________—_----1L . Gas Smoke e Dampers Final PASS PART FAIL / ELECTRICAL n Service • Rough In -∎ UG /Slab sAA. Ali Low Voltage Mr r - Fire Alarm Final PASS PART FAIL SITE Backfill /Grading Sanitary Sewer Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd Catch Basin Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access ADA ` 1� IA Approach/Sidewalk Date 1 1 i / A I nspector //� ✓ ' / 7 Ext �/ Other - Final PASS PART FAIL DO NOT REMOVE this inspection record from the job site.