Permit PLUMBING PERMIT
CITY OF T I GARD PERMIT #
DATE ISSUED: 08/29/96 —k'0J8
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PARCEL: 2S 1 10DB -00600
SITE ADDRESS...: 15348 SW PACIFIC HWY
SUBDIVISION • WILLOW BROOK FARM ZONING: C —G .
BLOCK • LOT •10
CLASS OF WORK.. :NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:B2 FLOOR DRAINS • 3 TRAPS • 0
' STORIES : 0 WATER HEATERS . 1 CATCH BASINS • 1
FIXTURES LAUNDRY TRAYS : 0 SF RAIN DRAINS • 0
SINKS • 2 URINALS . 1 GREASE TRAPS • 0
LAVATORIES • 3 OTHER FIXTURES • 4
TUB /SHOWERS • 0 SEWER LINE (ft)...: 47
WATER CLOSETS..: 3 WATER LINE (ft)...: 148
DISHWASHERS • 0 RAIN DRAIN (ft)...: 421
Remarks: 13,236 sq. ft. retail tire store
Owner-: FEES
LES SCHWAB type amount by date recpt
PO BOX 667 PRMT $ 386.00 DST 08/29/96 96- 283412
PLCK $ 96.50 DST 08/29/96 96-- 283412
PRINEVILLE OR 97754 SPOT $ 19.30 DST 08/29/96 96- 283412
Phone #: 503- 447 -4136
Contractor:
OWNER
1
Phone #: $ 501.80 TOTAL
Reg #..: 99999
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspection .
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Line Insp
applicable laws. All work will be done in accordance with Water Service I n _
approved plans. This permit will expire if work is not started Top—out Insp
within 180 days of issuance, or if work is suspended for more Storm Drain Insp _
than 180 days. Rain Drain Insp
Misc. Inspection ___ _—
Drinking Fountai
9 — / ��� � � RFC /BackflPw Pre
Permittee Si na ture Final Inspection
T s s �_� e d B y: __ � � --
Call for inspection — 639 -4175
1
City of Tigar, PLUMBING PERMIT APPLICATION Planck /Rec. # 03 - / C
13125 SW 14311 Blvd. Perhlit # L-111 Flo -C (o 1
Tig OR c °7223 SwF - l(r o /Zl
(503) 639 -4171
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
Name of Development New Single Family Residences Only
10� <4,42 42 i J re 6
Address ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job
1' 2 , i . -,G C dJ ❑ 3 BATH HOUSE $225.00
Address CityfState zip Fee includes all plumbing fixtures in the dwelling and the first 100 feet
j of water service, sanitary sewer and storm sewer. See fees below.
Na ( name of ELmeaa FIXTURES QTY PRICE AMT
1_0.4 i .111A131)2 " j Cal f rfia Sink O y 9.00 /
Mang Address / Lavatory 3. 9.00 22-
Owner Pa Pg :'; i 1 .1 -g Jo. Tub or Tub /Shower Comb. 7 9.00 �
i f• , LP Shower Only / 9.00
R fY 1 nevi I kj) CK • ..2_z_ W Closet 3 9.00
Name (or name of business) • Dishwasher / 9.00
le/ Garbage Disposal / 9.00
Occupant Mailing Address Phone Washing Machine ,----- 9.00
Floor Drain 3 9.00 2
Cityfst81e z;v Water Heater '� -
/ 9.00
Laundry Room Tray j 9.00
Name Urinal / 9.00 1 G
I Other Fixtures (Specify) - 9.00 1 r
Mailing Address Phone �r/ h
Contractor /�k2 aq#7 • .7 9.00 f i
.tC / 9.00
City/State rm 9.00
Sewer 1st 1 ' 1 ke, . f 7 rr• 30.00 i _ f
State Registration No. Cdy Bus. Tax No. Sewer - ea. Addit. 100' _--- -
25.00 •
Water Service 1st 100' 141 fart A b fT 30.00 2 o
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 1 i 25.00 as'
information given is correct, that I am the owner or authorized agent of t-
the owner, that plans submitted are in compliance with State laws, that torm & Rain Drain t t 1004A l et. 30.00 3Q
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00 2 JQ p
number given is correct. (If exempt from State registration, please - ,-> C`�r_
reason below.) I Mobile Home Space 25.00
,:t....... Back Flow Prevention
-9A, Device or Anti - Pollution Device ( 9.00 GT
Sign re ( r or agent) Date Any Trap or Waste Not
Connected to a Fixture / 9.00
Describe work new (9e 0 alteration 0 repair 0 Catch Basin 9.00
to be done residential 0 non - residential 0 Insp. of Exist. Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of -•
building or property Rain Drain, single family dwelling 30.00
ReoidefitieI- backflow prevention
devices 15.00
Proposed use of )
building or property -
'(Except residential backflow
prevention devices) I
NOTICE 'Minimum Fee $25.00 SUBTOTAL .5WP
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE 19- 30
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL C1(0.59- \
1
i .r OTAL 50I , a"
Special Conditions
Date issued _ by
I_
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Page No. 1 CASE HISTORY FOR CASE NO.: PLM96 -0056
LES SCHWAB TIRE CENTERS INC
15348 SW PACIFIC HWY
•
09/17/97
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
---- - -- ---- -- -- - --
PLMC003 Application received / / / / 03/26/96 RECD JD 04/02/96 BON
PLMC005 Permit Created / / / / 04/02/96 PEND B 04/02/96 BON
PLMC007 Plans routed to Plans Examiner / / / / 04/02/96 PEND B 04/02/96 BON
PLMC008 Plans Checked /Approved by P.E. 04/17/96 / / / / PASS MS 04/17/96 MRS
PLMC015 DST Post Review Complete / / / / 05/08/96 PASS B 08/27/96 JDA
PLMCO50 (F) Ready to issue / / / / 08/27/96 PASS JDA 08/27/96 JDA
PLMC060 (F) Issue permit / / / / 08/29/96 PASS JDA 08/29/96 JDA
PLMC120 Plumbing Undersl 04/17/96 / / 11/22/96 PASS TLP 12/19/96 TLP
PLMC705 Sewer Inspection 04/17/96 / / 11/14/96 tested pass sidewalk PASS MS 11/15/96 MRS
PLMC705 Sewer Inspection / / / / 01/31/97 PASS MS 01/31/97 MRS
PLMC710 Water Line Insp 04/17/96 / / 02/11/97 PASS TLP 02/12/97 TLP
PLMC725 Top-out Insp 04/17/96 / / 02/11/97 PASS TLP 02/12/97 TLP
PLMC735 Rain Drain Insp 04/17/96 / / 01/16/97 PASS TLP 01/24/97 TLP
PLMC750 RP /Backflow Preventer 04/17/96 / / 03/17/97 PASS MS 03/18/97 MRS
PLMC799 Final Inspection / / / / 03/17/97 PASS MS 03/18/97 MRS
PLMC800 Case Finaled / / / / 03/17/97 PASS MS 03/18/97 MRS
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