Permit -CITY CITY OF TIGARD PERM I PL UMBING # PERMIT
• PLM96 -0063
COMMUNITY DEVELOPMENT DEPARTMENT DATE ISSUED: 04/05/96
13125 SW HaII Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171
PARCEL: 251 10DC -00100
SITE ADDRESS...: 15570 SW PACIFIC HWY
SUBDIVISION • WILLOW BROOK FARM ZONING: C —G
BLOCK • LOT •11
CLASS OF WORK..:NEW GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE °COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 2
OCCUPANCY GRP..:B2 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: 1)BACKFLOW PROTECTION DEVICE AT 3 COMPARTMENT SINK IN MEAT DEPT.
2)BACKFLOW PROTECTION DEVICE AT MOP SINK (ONLY ONE IN STORE)
Owner: FEES
STERLING DEVELOPMENT CORPORATION type amount by date recpt
LA JOLLA CORPORATE CENTER PRMT $ 25.00 JMH 04/05/96 96- 277895
3252 HOLIDAY COURT, SUITE 225 5PCT $ 1.25 JMH 04/05/96 96- 277895
LA JOLLA CA 92037
Phone #: 619 -546 -8841
Contractor:
MYERS & SONS PLUMBING, INC.
6024 SW JEAN RD., BLDG. F, SUITE 170
LAKE OSWEGO OR 97035
Phone #: 684 -6602 $ 26.25 TOTAL
Reg #..: 040389
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP/Back f1ow Prey
Tigard Municipal Code, State of Ore. Specialty Codes and all other RP /Backflow Prey
applicable laws. All work will be done in accordance with Final Inspect ion
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.
/
Permittee Signature: /J EIi
Issued By: 411 , 1 1) 4 .0
Call for inspection — 639 -4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # ih 6 - 6663
13125 SW Hall Blvd. Permit #
Tigard, OR 97223 - (�� �. j _ , 514(k (503) 639 -4171 r
MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
N1Ae °' °ieeBower& New Single Family Residences Only
1O '" e 0 1 BATH HOUSE 3140.00 0 2 BATH HOUSE $195.00
Job /557o dal AAC /A /e /-/W y 0 3 BATH HOUSE $225.00
Address orosuw. rb Fee includes all plumbing fixtures in the dwelling and the first 100 feet
j ]6-A=QQ 0 972 3 of water service, sanitary sewer and storm sewer. See fees below.
Name (dr sae e' m'°) FIXTURES QTY PRICE AMT
.'ArE GvJg y ..C=/ E-F_C Sink 9.00
hewing Andreas Phone Lavatory 9.00
Owner Tub or Tub/Shower Comb. 9.00
°j"Sli0e rip Shower Only 9.00
Water Closet 9.00
Name (et u, s) Dishwasher 9.00
Occupant Garbage Disposal 9.00
„wing '°dr"'
Phone Washing Machine 9.00
Floor Drain 9.00
MOM. ao Water Heater 9.00
Laundry Room Tray 9.00
Name Urinal 9.00
/l4 yE,e 5 s'6, X'Azip)-264,06 Other Fixtures (Specify) 9.00
Mang Address wwr 9.00
Contractor
I!o0J 4 J t eog kr A-) / ,14 . 9.00
ms 's e no ' 9.00
( ��4..2 40,t-- ' 7a55 Sewer 1st 100' 30.00
State Re{pe'eoe N'. Oa ®'• T•' No. Sewer - ea. Addit. 100' 25.00
_ X0381 / .3g' Water Service 1st 100' 30.00
I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00
information given is correct, that I am the owner or authorized agent of
the owner, that plans submitted are in compliance with State laws, that Stour) & Rain Drain 1st 100' 30.00
I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00
number given is correct (If exempt from State registration, please
give reason below.) Mobile Home Space 25.00
Back Flow Prevention
Device or Anti- Pollution Device 2- 9.00 /
Siamese (owner or 'pan) ° Any Trap or Waste Not
d / -9 -4 - Cie Connected to a Fixture 9.00
e tribe work new add' 0 alteration 0 repair 0 Catch Basin 9.00
to e done resid n a l Q on- 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
Residential backflow prevention
devices 15.00
Proposed use of
building or property
'(Except residential backtlow
prevention devices)
NOTICE 'Minimum Fee $25.00 SUBTOTAL - oo
o7s
PERMITS BECOME VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE / v �
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
TOTAL 2v J5
Special Conditions
Date issued by
1/21/00 Activities for Case #: PLM96 -00063
4:29:13 PM
Assigned Hold Updated
9 P
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC067 Issue plumbing signature form 4/5/96 JMH J *H 4/5/96
PLMC750 RP /Backflow Preventer 4/5/96 JMH #1 J'H 4/5/96 YEARLY INSPECTIONS
REQUIRED
PLMC750 RP /Backflow Preventer 4/5/96 JMH #2 J'H 4/5/96 YEARLY INSPECTIONS
REQUIRED
PLMC060 (F) Issue permit 4/5/96 JMH PAID J *H 4/5/96
PLMC067 Issue plumbing signature form 4/5/96 JMH PAID J *H 4/5/96
PLMC800 Case Finaled 4/11/96 MS PASS MRS 4/11/96
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