Permit �. CITY OFTIGARD
DEVELOPMENT SERVICES PLUMBING PERMIT
� u. 1 0 1 - i PERMIT # : PLM97 -0156 6
13125 SW Hall Blvd., Tigard, OR 97223 (503)639 -4171 DATE ISSUED: 05/02/97
PARCEL: 2S110DB -00200
SITE ADDRESS...: 15199 SW ROYALTY PKWY
SUBDIVISION • WILLOWBROOK FARM /ARBOR HEIGHTS ZONING: R -25
BLOCK • LOT •8 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:B 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: Installation of commercial backflow prevention device.
Owner: FEES
SECURITY CAPITAL PACIFIC TRUST type amount by date recpt
SUITE 201 PRMT $ 25.00 DRA 05/02/97 97- 294064
330 112TH AVE., NE 5PCT $ 1.25 DRA 05/02/97 97- 294064
BELLEVUE WA 98004
Phone #: F206- 451 -2692
Contractor
CEDAR LANDSCAPE
14375 SW PATRICIA AVE
HILLSBORO OR 97123
Phone #: 503 - 628 -3411 $ 26.25 TOTAL
Reg #.. 000058
REQUIRED INSPECT IONS
This persit is issued subject to the regulations contained in the RP/Backf low Prey
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
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 sore
than 180 days.
Per ign- - r �G"L"' 1- 1; - "-C- 2 ---_ mitte g u e
Issued ° : ,■,_ ,i,, ..,
Call for inspection — 639 -4175
CITY TIGARD Plumbing Application Rec'd By
7
13125 SW HALL BLVD. Commercial and Residential Date Rec'd 5
TIGARD, OR 97223 Date to P.E. �-
Date to DST ----
(503) 639 -4171 Permit# pu- r4 -OIS6
Print or Type Related SWR #
Incomplete or illegible applications will not be accepted Called
Name of Development/Project FIXTURES (Individual) QTY PRICE AMT
Job AR13012 ,lei q / rs Sink 9.00
Address Street Address A Suite Lavatory 9.00
151 c79 5LoRamay 11< y Tub or Tub /Shower Comb. 9.00
Bldg It City/State Zip Shower Only 9.00
TmA-Lo / 62 9 Tao" / Water Closet 9.00
ame n Dishwasher 9.00
l Ty 0 7 PACs rl 'L
Owner Mailing Address Suite Garbage Disposal 9.00
350 'It 2.!--`41 )2._ A)T■ PCD1 Washing Machine 9.00
City/State Zip Phone Floor Drain 2' 9.00
? 6 1 / L C J M 4 _ WA ? 4 OW -4"5/- 3• 9.00
N me 4• 9.00
Occupant Mailing Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City/State Zip Phone Urinal 9.00
Name
Other Fixtures (Specify) 9.00
CE Wie /4411aLSC PE Zee , 9.00
Contractor Mailing Address . 9.00
'75'
/3 SW PAIr AIDE 9
City/State Zip Phone
N f aQO DAP. m. 21 4,..v?- 34i/ 9.00
Oregon Const. Cont. Board Lic.# Exp. Date 9.00
Attach Copy of , 6 3O--f? 9.00
Current Plumbing Lic. # Exp. Date Sewer - 1st 100' 30.00
Licenses Sewer - each additional 100' 25.00
COT Business Tax or Metro # Exp. Date Water Service - 1st 100' 30.00
Name Water Service - each additional 200' 25.00
Architect Storm 8 Rain Drain - 1st 100' 30.00
Or Mailing Address Suite Storm 8 Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- 25.00 ex
Pollution Device • / .25
Describe work New of Addition 0 Alteration 0 Repair 0 Residential Backflow Prevention Device* 15.00
to be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
Additional description of work Catch Basin 9.00
Insp. of Existing Plumbing 40.00
per/hr
Existing use of - Specially Requested Inspections 40.00
per/hr
building or property Rain Drain, single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property
QUANTITY TOTAL
Are you capping , moving or replacing any fixtures? Yes ❑ No ❑ Isometric or riser diagram is required if Quanity Total is > 9
(If yes see back of form) 'SUBTOTAL 25
I hereby acknowledge that I have read this application, that the information 5 SURCHARGE
given is correct, that I am the owner or authorized agent of the owner, and /
that plans submitted are in compliance with Oregon State Laws.
Signature of Owner /Agent Date PLAN REVIEW 25% OF SUBTOTAL
Required only if torture qty. total is > 9
Dose- (4..)e-• 5 '. - 97 TOTAL 2
Contact Person Name Phone -
� � *Minimum permit fee is 525 + 5% surcharge, except Residential Beddow ‘ ,.¢. �/e 4Na /a t o 70� - .25 Prevention Device, which is $15 + 5% surcharge
' is \dsts\plmapp:doc 8/96
PLEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
. Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
Page No. 1 CASE HISTORY FOR CASE NO.: PLM97 -0156
SECURITY CAPITAL PACIFIC TRUST
15199 SW ROYALTY PKWY
05/08/98
Action Description Reg/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
- - -- - -- -- --- --- - --
PLMC003 Application received / / / / 05/02/97 RECD DRA 05/02/97 CTR
PLMC005 Permit Created / / / / 05/02/97 PASS DRA 05/02/97 CTR
PLMC060 (F) Issue permit / / / / 05/02/97 PASS DRA 05/02/97 CTR
PLMC750 RP /Backflow Preventer 05/02/97 / / 06/16/97 PASS TLP 07/10/97 RB
PLMC799 Final Inspection / / / / 06/16/97 PASS TLP 07/10/97 RB
PLMC800 Case Finaled / / / / 06/16/97 PASS TLP 07/10/97 RB
•
7/27/99 Activities for Case #: PLM97 -00156
1:57:09 PM •
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 APPlication received 5/2/97 DRA . RECD CTR 5/2/97
PLMC005 Permit Created 5/2/97 DRA PASS CTR 5/2/97
PLMC799 Final Inspection 6/16/97 TLP PASS RB 7/10/97
PLMC750 RP /Backflow Preventer 5/2/97 6/16/97 TLP PASS RB 7/10/97 •
PLMC060 (F) Issue permit 5/2/97 DRA PASS CTR 5/2/97
PLMC800 Case Finaled 6/16/97 TLP PASS RB 7/10/97
•
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