Permit 'CITY OF TIGARD PLUMBING PERMIT
'a l '" • DEVELOPMENT SERVICES PERMIT #: PLM2000 -00164
'�' L 13125 S W Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 5/22/00
SITE ADDRESS: 13939 SW PACIFIC HWY * ** • PARCEL: 2S103DD -01000
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: M 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
Remarks: Installation of commercial backflow prevention device.
FEES
Owner:
Type By Date Amount Receipt
BC REAL ESTATE INVESTMENTS
PRMT DEB 5/22/00 $50.00 0002341
BC NORTHWEST LP 5PCT DEB 5/22/00 $4.00 0002341
BY BURKE & NICKEL
TULSA, OR 74135 Total $54.00
Phone 1:
Contractor:
CEDAR LANDSCAPE
14145 SW GALBREATH DRIVE
SHERWOOD, OR 97140 REQUIRED INSPECTIONS
Phone 1: 625 -3700 RP /Backflow Preventer
Reg #: LIC 75535 Final Inspection
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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 ma • • - in copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
r
Issue • = y: � � � , � ts� --i Permittee Signature:, JUU"�^� 4 _. 4 r11
I .
Call (50 639 -4175 by 7:00 P.M. for an inspection needed the next bu iness day
CITY OF TIGARD Plumbing Permit Applicak0 Plan Ch
13125 SW HALL BLVD. Commercial and Reside tr' o ® Rec'd B r -
TIGARD, OR 97223 � X 44 Q _ d0 ��� :, 1�� QACA Date to P E. ! __
(503) 639-4 Print or Typ 0 p�v��0 Date to DS
Incomplete or illegible applications will ,,∎ Permit # �c rf /lob'
r• , , ,, Related SWR #
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job k) 1:41 q (-L Y\'S - T 1111 Sink 11.50
Address StreetAddrrs \ o Suite Lavatory 11.50
13S Si. ` Re- Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zi Shower Only 11.50
_ 1 - Te x an l 02.. 9l a a-3
Name Water Closet 11.50
3e- R fraL EsrQ.. t Ji)t rn2F.0t5 Urinal . 11.50
Owner Mailing d ( Address Suite Dishwasher 11.50
' /"a'Q' e 44 707 Garbage Disposal 11.50
1Y 6 City/State Zip Phone Laundry Tray 11.50
f j, c.ks 7u G56 02 7 Ni 3 S
Name Washing Machine /Laundry Tray 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
Gas piping requires a separate mechanical permit.
me J C C MEG Home New Water Service 32.00
Contractor Mailing Address Suite MFG Home New San/Storm Sewer 32.00
1y 1 X15 SIAJ &(r 1? e_. Hose Bibs 11.50
Prior to permit Ci /State Zip Phone �� Roof Drains 11.50
issuance, a copy te . r be g 1140 W 5 370
Drinking Fountain 11.50
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if -r- � S 9/ - - 1 j t V Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database 1j'LZ' Lt" 4S f . ^, " - ,./
Name -hece C -r{°3 t e 4°13 OD
Architect Sewer- 1st 100' 38.00
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 & Rain Drain - 1st 100' 38.00
New Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Reside al 0 Commercia
Additional description of work: Commercial Back Flow Prevention Device 1 32.00
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 •
I hereby acknowledge that I have read this application, that the information 50 ....,---`
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9
that plans submitted are in compliance with Oregon State Laws. *SUBTOTAL
-+
Sig e of Owner /Agent Date 8% SURCHARGE
D ply
n e '. Db
ntact Person Name
**PLAN REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if fixture qty. total Is > 9
2: BATH HOUSE $250.00 • TOTAL , / Dc
3 BATH HOUSE $285.00 �+-
(This fee includes all plumbing fixtures in the dwelling and the first , *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
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.
l:ldstslformstplumapp.doc 11/18/99
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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)
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COMMENTS REGARDING ABOVE:
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1: ldsts1formslplumapp.doc 11/18/99
07/11/2000 Activities for Case #: PLM2000 -00164
2:14:10 PM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received - 05/18/2000 DEB MAIL No Hold DEB 05/22/2000
PLMC005 Permit Created 05/22/2000 DEB DONE No Hold DEB 05/22/2000 Delay in creating due to
understaffing.
PLMC750 RP /Backflow Preventer No Hold DEB 05/22/2000
PLMC799 Final Inspection 07/06/2000 MRS PASS No Hold MRS 07/06/2000
PLMCO50 (F) Issue permit 05/22/2000 DEB DONE No Hold DEB 05/22/2000
PLMC800 Case Finaled 07/06/2000 MRS PASS No Hold MRS 07/06/2000
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