Permit . aN OF TIGARD DATE ISSUED: PERMIT
PERMIT # FLM96 -0`30
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PARCEL: 291 10DC -00200
SITE ADDRESS...: 15660 SW PACIFIC HWY #4
SUBDIVISION • WILLOW BROOK FARM ZONING: C - -G
BLOCK • LOT •11
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:B FLOOR DRAINS 2 TRAPS • 0
STORIES • 0 WATER HEATERS • 0 CATCH BASINS 0
FIXTURES LAUNDRY TRAYS 0 SF RAIN DRAINS • 0
SINKS • 3 URINALS • 0 GREASE TRAPS ° 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS 0 SEWER LINE (ft)...: 0
WATER CLOSETS..: 2 WATER LINE (ft)...: 0
DISHWASHERS 0 RAIN DRAIN (ft)...: 0
Remarks: Tenant improvement
Owner: FEES
STERLING DEVELOPMENT CORP type amount by date recpt
LA JOLLA CORPORATE CENTER PRMT $ 63.00 JDA 09/04/96 96- 283592
3252 HOLIDAY CT #225 SPCT $ 3.15 JDA 09/04/96 96- 283592
LA JOLLA CA 92037
Phone #: 619 -546 -8841
Contractor:
MODERN PLUMBING
11120 SW INDUSTRIAL WAY
TUALATIN OR 97062
Phone #: 691 -6166 $ 66.15 TOTAL
Reg #..: 87906
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Rough —in Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Top—out Insp
applicable laws. All work will be done in accordance with Final Inspection
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:/ f ` _
Issued By: ?;01.4
Call for inspection — 639 -4175
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&t,a46( S 'g -°1 o - Y/
City of 'Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # Off_ l (9c
134125 SW Hall Blvd. Permit # ELIWiIv-02,50
Tigard, OR 97223 l 6/4(Llb-
(503) 639 -4171
MINIMUM $25 0 PERMIT FEE + ST. SURCHARGE
,
�j� /n/
Nome of Development New Single Family Residences Only
15-660 V nna C/ . f/?-i7 /i71-e-
��/ ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00
Job ` � ,"5 40_.JYG /T �/ ❑ 3 BATH HOUSE $225.00
Address tsar. Fee includes all plumbing fixtures in the dwelling and the first 100 feet
g ~ f ' 22/ of water service, sanitary sewer and storm sewer. See fees below.
. w I,C/ , ornam.el i / FIXTURES QTY PRICE AMT
N Gt A i Sink 9.00 7
/Ming Address Phan° .r//D Lavatory 9.00
Owner 1 44 ' e4 970 - 2 1 Tub or Tub/Shower Comb. 9.00
lsete Shower Only 9.00
•0',2V j �� � c,, Water Closet 9.00 ) g
Name (or naAe of boU,.s" Dishwasher 9.00
Garbage Disposal 9.00
Occupant New m,,,, Fawn. Washing Machine 9.00
Floor Drain f.,-- 9.00 )
cS ,State np Water Heater 9.00
Laundry Room Tray 9.00
Name
- -.3 Urinal 9.00
46Z6,7/7"4/Ael ! , (p/ Other Fixtures (Specify) 9.00
w Aate.. peen. 9.00
/ Contractor r l -��^^ � ,
-7 �, 6 1 Chiv ^ es'( GJ 9.00
I ea Ditylsate rip 9.00
,�yb - . ,��i 4 _a4_ , 1z J /
State - 9 7762, Sewer 1st 100' 30.00
VJ� ` t ate R.wa�a, No. CO Da. Tao No. Sewer - ea. Addit. 100' 25.00
,<_r7 g(5C0 - - : - 3c-Z -- 0 0 06 Water Service 1st 100' 30.00
Thereby 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 Storm & 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 9.00
entre x « or epe,n , Date Any Trap or Waste Not
7 Connected to a Fixture 9.00
Describe work new Q addition 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 J Y � /'1 Ci 1
building or r property Rain Drain, single family dwelling 30.00
Residential backflow prevention
devices 15.00
Proposed or upr se
of operty l �� t
building / ---P ^ ' �J 5/40t2
ing pr }'r/ --- "N *(Except residential backflow
/ prevention devices)
NOTICE /Q C � �
*Minimum Fee $25.00 SUBTOTAL lA my Ix•D
PERMITS BECOME VOID IF WORK OR CONSTRUCTI v 4 5% SURCHARGE UL
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, Oj.l� 2 ��
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED �J
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL -
TOTAL (10(0,6
Special Conditions
Date issued by
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Page No. 1 CASE HISTORY FOR CASE NO.: PLM96 -0230
NOAH'S BAGELS
15660 SW PACIFIC HWY Unit: 4
09/17/97
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Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
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PIMC003 Application received / / / / 07/30/96 RECD JD 08/08/96 BON
PIMC005 Permit Created / / / / 08/08/96 PEND B 08/08/96 BON
PIMCO50 (F) Ready to issue / / / / 08/08/96 do not issue until SWR96 -0390 is paid. MEMO B 08/08/96 BON
PIMC060 (F) Issue permit / / / / 09/04/96 'PASS JDA 09/04/96 JDA
PIMC725 Top -out Insp 08/08/96 / / 09/09/96 PASS MS 09/09/96 MRS
PIMC800 Case Finaled / / / / 10/11/96 - PASS MS 10/14/96 MRS
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