Permit CITY OFTIGARD
4,, DEVELOPMENT SERVICES PLUMBING PERMIT
1J 13125SW Hall Blvd., Tigard, OR97223 (503)639.4171 DATE PERMIT
ISSUED: 04/29/98 -0116
PARCEL: 2S1O2BD -01701
SITE ADDRESS...: 12830 SW PACIFIC HWY
SUBDIVISION •"FREWINGS ORCHARD TRACTS ZONING: C —G
BLOCK • LOT •O0A JURISDICTION: TIG
CLASS OF WORK..:ADD GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 1
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 • 0 GREASE TRAPS • 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Add new commercial backflow prevention device to a commercial bldg.
Owner: FEES
DAVIDSONS RESTAURANT type amount by date recpt
12830 SW PACIFIC HWY PRMT $ 25.00 GEO 04/29/98 98- 305367
TIGARD OR 97223 5PCT $ 1.25 GEO 04/29/98 98- 305367
Phone #:
Contractor
MARK GUNDERSON LANDSCAPE
PO BOX 230125
TIGARD OR 97281
Phone #: 639 -8791 $ 26.25 TOTAL
Reg #..: 000110
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Backf 1 ow Prey
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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 - 0001-6010 through OAR 952-0001-6080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
r,
Issued By: Ar �I /� i Permittee Si gnat ure.% /i, .,�, //
+ + + + + + + + + + + + + ++ + + ++ ++++++++++++++ + + + + + + + + + + + + + + + + + + ++ + + + + + + + + + ++ + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next bu iness day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Application Rec'd By
13125 SW HALL BLVD. Commercial and Residential Date Rec'd
TIGARD, OR 97223 Date to P.E.
(503) 639 -4171 Date to Ds
Permit* PC m 65
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project On back Indicate Work Performed by fixture.
Job pi (0 ( DSc&) tS ' ES-rAc, a FIXTURES (Individual) . QTY PRICE AMT
Address Street s `� 1 Suite Sink 9.00
a! 2* 3 S� {�f;C I f - E( A f Lavatory 9.00
Bldg I City/State Zip / Tub or Tub /Shower Comb. 9.00
r r ( CARD DP_ /7;193
Shower Only 9.00
Name
Water Closet 9.00
Owner Mailing Address Suite Dishwasher 9.00
Garbage Disposal 9.00
City/State Zip Phone Washing Machine 9.00
Name Floor Drain 2' 9.00
3' 9.00
Occupant Mailing Address Suite 4' 9.00
City/State Zip Phone Water Heater 0 conversion 0 like kind 9.00
Laundry Room Tray 9.00
NName Urinal 9.00
r / `_
( 9 U13�(se.1 L.Apgr)X-ii F & Other Fixtures (Specify) 9.00
Contractor Mailing Address Suite
o B-sx X3(2 9.00
?
Prior to permit Ci /State Zip Phone
9.00
issuance, a copy ' I CARO Ok. q 7 A f X 39 -g7° ( 9.00
of all licenses are Oregon Const. Cont. Board Licit Exp. Date 9.00
required if S`i 77 7- `'$ Sewer - 1st 100° 30.00
expired in COT Plumbing Lic. # Exp. Date
database /(c 7 3 G( ( Sewer - each additional 100' 25.00
�
Name Water Service - 1st 100' 30.00
Architect Water Service - each additional 200' 25.00
Or Mailing Address Suite Storm & Rain Drain - 1st 100' 30.00
Storm & Rain Drain - each additional 100' 25.00
Engineer City/State Zip Phone Mobile Home Space 25.00
Commercial Back Flow Prevention Device or Anti- 25.00
Describe work New 0 Addition ® Alteration 0 Repair 0 Pollution Device
to be done: Residential 0 Non - residential ® Residential Backflow Prevention Device* 15.00
Additional description of work: Any Trap or Waste Not Connected to a Fixture 9.00
/ &) STALL TAG kTLock) (D o/( CE Y * Catch Basin 9.00
&---(s - r ilU 6- 5 P ,1v k-cE6 Sys S T EM Insp. of Existing Plumbing 40.00
per /hr
Existing use of Specially Requested Inspections 40.00
building or property per/hr
Rain Drain, single family dwelling 30.00
Proposed use of
building or property Grease Traps 9.00
QUANTITY TOTAL • I hereby acknowledge that I have read this application, that the information Isometric or riser diagram is required if Mandy Total is > 9 IR
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL
that plans submitted are in compliance with Oregon State Laws. I,
Sig ature f Owner /A • : • t A Date ,
/' S /o SURCHARGE
Contact Person N ' / Phone �e /- fg PLAN REVIEW 25% OF SUBTOTAL -
Required only if fixture qty. total is > 9
/ 6-0Ar 6 3/ - V? ( TOTAL %u
'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
Prevention Device, which is $15 + 5% surcharge
I:tdstslplmapp.doc 5/97
PLEASE COMPLETE:
Fixture Type Quantity by. Work Performed
New Moved Replaced Removed /Capped
Sink
.avatory
ub or Tub /Shower Combination
Shower Only
/later Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
;`later Heater
Laundry Room Tray
Jrinal
Jther Fixtures (Specify)
•
OMMENTS REGARDING ABOVE:
1:ldstslplmapp.doe 5/97
•
CITY OF TIGARD BUILDING INSPECTION DIVISION
24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: c /� ; Av l A.M. P.M. MST:
Location: J • d 3 () c� ) I ' . • L / BUP:
Tenant: 4 CUh , Suite: /� Bldg: MEC:
Contractor: S Phone:
Q / i / c 639- p 0 7q1 PLM: ? r ' (2/ /e
Owner: Phone: ELC:
ELR:
SIT:
BUILDING BLDG (con't) ' MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab � , /� / � /
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt CZ /f C
Approved Approved Approved Approved .a a. .I'lw.�
Appr /Sdwlk Not Approved Not pproved Not Approved Not Approved Not A roved
FINAL ,..- ,a-
,..., FINAL FINAL
L 14 OPVIV --11 C- : 4 Or Ly j5 aP
•
O Call for re' O Reinspection fee of $ ed befor next inspection O Unable to inspect
Inspector: Date: ! Page of