Permit CIT OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00083
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/28/2007 •
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 245 ZONING: C -
SUBDIVISION: TIGARD PLAZA LOT: 002 JURISDICTION: TIG
PROJECT: RICHARD'S DELI
Project Description: Backflow preventer for commercial.
CLASS OF WORK: ALT 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: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TIGARD PROPERTIES INC
2106 SE OCHOCO ST Description Date Amount
MILWAUKIE, OR 97222 [PLUMB] Permit Fee 2/28/2007 $72.50
[TAX] 8% State Surcha 2/28/2007 $5.80
Phone : Total $78.30
Contractor:
OREGON CASCADE PLUMBING
PO BOX 12127
SALEM, OR 97309 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -588 -0355
FAX 503- 364 -2276
Reg #: LIC 127
PLM 24 -33PB
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: 3 1.,4&(L � Permittee Signature:V
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.
"� FEB 28 2007
Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard 1 �.;I! UI 1 gU dt t. :. Receive _ ` : Permit No. r D , - 600:94k5 13125 SW Hall Blvd., Tigard, OR 9.2� i p�,r ,T�' �4•nrF. ,,' Plan .. U
Phone: 503.639.4171 Fax: 503.598.1960 />,;4 I )\ Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 e•� I Date Ready/By: Juris: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I 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
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: w 5 S W A ` F` L (Ito y �� a it S Catch basin or area drain 16.60
City/State/ZIP: `r� ae.c/ 6R. S 7 .1a 3 J Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: k ,,, ,1 Project name: 0, ; c 0, G./4i 0 d (., Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: ti 3 a Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer • / Page 2
i •^ 5 k-4(I ckS1os -. ,p 1-, Jti 0 ...e s— Backwater valve 16.60
o �c._ �.' u+a. cl.: 4-a- 1 16.60
a ,,
Drinking fountain
❑ PROPERTY OWNER ❑ TENANT 16.60
at
Name:
Expansion tank at
Address: Fixture/sewer cap ..t
City/ State/ZIP: Floor drain/floor • t
Phone: ( ) Fax: ( ) ' " ' ' •
Hose bib 16.6
❑ APPLICANT ❑ CONTACT PERSON t
Ice maker 16.60
Business name:
Interceptor/grease .t
Contact name:
Medical
Address: Primer 16.60
City/ State/ZIP: Roof a 16.60
at
Phone: ( ) I Fax: : ( )
Tub/shower/shower pan ,t
E -mail:
Urinal 16.60
CONTRACTOR Water closet t
Business name: O 3a� C c,.SC Pkir Wl � (-1`1‘°•-"k 'c 16.60
Address: / ?,Z$ to 54_ 5E J ocher:
Subtotal '
City/ State/ZIP: 50.1e ,,, 4R. .9 ?3,...1 _
Minimum pemit fee: t
Phone: (SO3 ) S S Q- O 3 s S Fax: ( ) a Wo Plan review (25% of ,
CCB Lic.: j .Z _ t /0 S Plumbing Lic. no.: g6,2 I `��f� of permit fee) Willa. ermit fee)
Authorized signature: v---- 33 7, f -6 :'
TOTAL PERMIT FEE IMM7
Print name: jM,. a , r .J C . cc 6 3 ,j re • Date: -� 8' -D 7 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
is1Butfdin ePennats\PLM- PemdtApp.doc 17/07 440 - 4616T(10 /02/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLIV12007 -00063
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/28/2007
Phone: (503) 639- 4171'.� rl
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/5/2007 TIME: 7 :00AM PAGE: 35
SITE ADDRESS: 11945 SW PACIFIC HWY 245 CLASS OF WORK:
SUBDIVISION: TIGARD PLAZA LOT #: 002 TYPE OF USE:
PROJECT NAME: RICHARD'S DELI
DESCRIPTION: Bacadlow preventer for commercial.
OWNER: TIGARD PROPERTIES INC, PHONE #:
CONTRACTOR: OREGON CASCADE PLUMBING PHONE #: 503 - 588 -0355
Inspection Request Scheduled For: Date: 3/5/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 044318 -01 503 -932 -1425 Y
Corrections /Comments /Instructions:
•
►;a PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL // ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CJ Date: 3 0 ?Phone #: (503) 718-.0)-P/3/