Permit a
• - CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM2006 -00370
�ii DEVELOPMENT SERVICES DATE ISSUED: 8/10/2006
- 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 PARCEL: 2S103DD - 00800
SITE ADDRESS: 13815 SW PACIFIC HWY 100 ZONING: C - G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Petrone Deli /Lottery. other 1 mop sink
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: • FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
•
Owner: FEES
D.W. SIVERS COMPANY
4730 SW MACADAM AVE Description Date Amount
#101 [PLUMB] Permit Fee 8/9/2006 . $116.20
PORTLAND„ OR 97201 [PLMPLN] Plan Review 8/9/2006 $29.05
Phone : [TAX] 8% State Surcha 8/9/2006 $9.30
Total $154.55 .
Contractor:
MP (MILWAUKIE) PLUMBING. CO
P.O. BOX 393
CLACKAMAS, OR 97015 . REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 655 -9161
FAX 503- 655 -1726
Reg #: LIC 5002
PLM 3 -17PB
•
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: - , �r" ' �� / pj/f , Permittee Signature: ��_ /,
Call 503 - 639 -4175 by 7:00 a.m. for an .inspection that busine y.
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.
08- 02 -'06 09:47 FROM-MP PLUMBING CO. 5036507050 T -266 P02/03 U -528
4 Plumbin Permit A ' lien ... 1.01z in t F I < 1 .: t : s t.: 0 \ 1 1
City of Tigard Au 2 e / ls� ,
13135 SW Hall Blvd.. Tigard, OR 97223 phone: Permit No.�
G 0� 'P`. 4. i0; 003'716
P 503.639.4171 Pax: 503.598.1960 T s :A: , ; - Plan Review W dp
f ?�b,b0/
24- Hour Inspection Litre 503.639.4175
o r/ OF. .` J I � I Date/By; , Other PermitNo6 '/
Internet: www.ci,tigar d.or.tts B <z f ` Date Ready/By. 7 ' / % S sec Page : for OC
M. �;::, ::Tr.' .c i .t zga r d,; rns 4;�1; a: c: 'c' �r ;p Notified/Method: 7 7 J� smpplemeatal Incormadoa
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❑ New construction ❑ Demolition For special information use checklist
P. i Addition/alteration/replacement 0 Other. Description _Qty. I a. Total
New 1- 2-fa may dwellings (includes 100 R for each utility connection)
(0,0,/,m Yl1 r f-7 'Q cik: Ii i,1.a -1 , r < 4 r ra 1 'o gik ; SFR (1) b ath
s i r l r t.. r{ �� ,�� i , i.• .�:`n� ro y C �N i
t I t ;' r � t'L'
re, 43 to v3 la ztiL �,.4.:s s, I ?� 11 fi,:ttA Pal r , tf�l�:r-1�, S .3 to `i: /H'� i isS r': t l ( ) 249.20
0 1- and 2- family dwelling F4 Commercial/industrial SFR (2) bath 350.00
0 Accessory building Q Multi - family SFR (3) bath 399.00
Q Master builder ❑ Other Each additional bath/kitchen 45.00
iiV ¢rm- ws ?ft' r 'fr t n ' Y {y . l Y,,t Kdl..a '1r'i r°ct, t Fire sprinkler p Page 2
,1 %P#-- i T sd ��` 1 �9¢ ;/ ' I•''.i.� t p 141, 1,15;t111:i 1 -Y'H g41,:F �p�li��t }' i "i' ( sq. ft.) Cti ----t
, .4, �: 4t,: f;dkt; n..AI_LIPa ryr {ji uytCtR�+�'' 'Ab tN. d' -,, gi.i , -.1,r1 t:.... i site atllitie
Job Site addres / fr 1 , / .` Catch basin or area drain 16.60
City/State/ZIP: ,, Ari '7/25 Drywell, leach line, or trench drain 16.60
a r • ldg. /apt. no.: /AO Project name: / . . Footing drain (no, linear ft.: _ ) Page 2 111111.‘ ■ Manufactured home utilities 110.00
Cross street/directions to job site: e....dxg.. IL EI 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 1
• Fixture or item
Tax map/parcel no.:
{ ,tWt f h� IgLC, r :wi n ,! f ^Y^ •,�, :,�.xr� � �•7 ; �,a, Absorption valve 16.60
, lr,i :FN$, ifav� { 6�, 2 ff.N: { 1� ,4 , ggrx,sA' ffiq' i;;;i;.s al,mfrdr 7im"t7
_ i 57A, ;':-. 4: , . :2i) +.i'11.`,ti ci :11`,1 f'�'�C, „ nssi -iii... .6. lh.,i.s biz . �t , nu- XiiilL43`:'.41 ;.�Y..h,t,fiJ acct r •� !-\ �',, Backflow preventer Page 2
.I /} N /� � Backwater valve ■ 16.60
Clothes washer 16.60
, �J Dishwasher 16.60
eta` n ,�lr, - . , ,.i �L'dti ( YS�
: ID!. , ,, . aSj ` l r H , 1 , , i {t yr Sn f i 2 r 9 � y ., 1 0' Fd ii' Drinking lllL[rt 0
��.!Ti,', :441' d r . fr t`� ,, fl... i t , �'ie `p r � ��� a a lt , t t _ �, t g f untain 16.60
t3 xtix e,l ',tgy,j2.t".caaa...� � m� :E 7 1is, 7•�+".l!) 1 C- , . ;
7 r�: h IGI # .1 _ Ji ' �: 53 9 iA
J I Ejectors/sump 16.60
Neme: l iv », 1 if /lM',y Expansion tank 16.60
Address: ■
_ Fixture/sewer cap 16.60
City/ State /ZIP: Floor drain/floor sink/hub A 16.60 /, /_!--•/'
Phone: ( ) p ax: ( ) Garbage disposal 16.60
IlY• F , i, r P" i lh'il. r ; , , • , ' • , t? ;, Hose bib 16.60 .34 ��,.i -.3s�1 „Y ,.'., ln ; V �� 1` s, r ,. '�.'� i �`,�' Td'' a ��;i� N' , n �� S
.�� :n� • .' s, 7ssa3atro >< rr �i Ice maker
16.60
Business name: MP PLUMBING CO. Intcrceptodgreasetrmp 16.60
Contact name: TAMI Medical gas (value: $ ) Page 2
Address: PO BOX 393 _ Primer 16.60
City/State/ZIP: CLACKAMAS OR 97015 Roof drain (commercial) 16.60 • ' r
Phone: (503) 655-9161 Fax: : (503) 650 -7050 Sinlotbssia/lavatory L yragil 16.60 11
E -mail: Tub/shower/shower pan 16.60
Urinal
16.
, "',h'°� "�kFi '_; "? " • ± "z * n - � yr'�w' =,a, a ts,,� ; � ,,. , �..,•,•.��Rr�n� , �i`I" 'K;!sf� :; 16.60
iii � {1 ,', c +i (r3 'Jti , s 7 E ta ! w ,- r e ds f y azifl `iF� G aI �',�' p t' 1 r t �;
„, :;:tLR�i -. K) ..k.� .. J, �t �a �I 1R 1, ,.. �� d A. Yr trti�c ,.. �}} 1 h �r ' c-yy 3∎, r,:'i..d W closet !/ /
rxl s 719.. �:!i'ai'i �.�r�, , •. •h � n.'J::SG..Li 16.60
Business name: MP PLUMBING CO. Water heater 16.60 it P/digi
Address: PO BOX 393 Other. , / / / MII1JULIM
• City/State/ZIP: CLACKAMAS OR 97015
Subtotal !'
Minimum permit fee: $72.50
Phone: (503) 655 -9161 Fax: (503) 650 -7050 Residential backflow minimum permit fee: $36.25_
CCH Lie.; 5002 Plumbing Lic. no.: 3 -17PB 1 0 ' Plan review (25% of permit fee) i '
� ,/ State surcharge (8% of permit fee) , _
Authorized signature: . 4h� TOTAL PERMIT FEE a r
Print name: TAMI GEORGE Date: A , j7 Thi permit application expires if a permit is not obtained wl , In
180 days after it has been accepted as complete.
*Fee methodology sct by Tri- County Building Industry Service Board.
inaeikileaTericits \PLM.Pemilapodoe O6/O 4411.4616T(I0/01/COWWE13)
I CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00370
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/10/2006
Phone: (503) 639 -4171 itnqp
Inspection Requests (24 Hrs.): (503) 639 -4175 , 1 "'I IL
INSPECTION WORKSHEET FOR DATE: 10/5/2006 TIME: 7:00AM PAGE: 69
SITE ADDRESS: 13815 SW PACIFIC HWY 100 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PETRONE DELI /LOTTERY
DESCRIPTION: Petrone Deli /Lottery. other 1 mop sink
OWNER: SIVERS COMPANY, D.W. PHONE #:
CONTRACTOR: MP (MILWAUKIE) PLUMBING CO PHONE #: 503 - 655 - 9161
Inspection Request Scheduled For: Date: 10/5/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 037697 -01 503 - 655.9161 Y
Corrections /Comments /Instructions: 3 (°3
_
1 5
A I
5 o3 T
1
e 6/-z,. /
idgekss ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
O� -9- 4-/-9(
Inspector: 1 1 "v Date: Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION s PERMIT #: PLM2006-00370
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/20066
Phone: (503) 639 - 4171 „ ityi5ill
Inspection Requests (24 Hrs.): (503) 639 -4175 _
INSPECTION WORKSHEET FOR DATE: 8/11/2006 TIME: 7 PAGE: 84
SITE ADDRESS: 13815 SW PACIFIC HWY 100 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PETRONE DELI /LOTTERY
DESCRIPTION: Petrone Deli /Lottery. other 1 mop sink
OWNER: SIVERS COMPANY, D.W. PHONE #:
CONTRACTOR: MP (MILWAUKIE) PLUMBING CO PHONE #: 503655 -9161
Inspection Request Scheduled For: Date: 8/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 034761 -01 503- 789-6177 Y
Corrections /Comments /Instructions:
1 1\11 \
PASS El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ki f Date:gj / / Phone #: (503) 718-