Permit ' , CITY OF T PLUMBING PERMIT
��� A\ DEVELOPMENT SERVICES PERMIT # - PLM98 -0.19
�'� DATE I SSUED : 09/ 1 1 / 98
�+� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639
PARCEL: 1S134BC -00300
SITE ADDRESS...: 12266 SW SCHOLLS FERRY RD
SUBDIVISION • ZONING: C —G PD
BLOCK • LOT JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE °COM WASHING MACH • 0 BACKFL_OW PREVNTRS..: 0
OCCUPANCY GRP..:B FLOOR DRAINS • 3 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 - 2 OTHER FIXTURES • 1
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: _ 1 WATER LINE (ft) ...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Plumbing for a commercial tenant improvement.
Owner: FEES
OREGON RESTAURANT SERVICES INC type amount by date recpt
PO BOX 4726 PRMT $ 63.00 DEB 09/11/98 98- 309065'
PORTLAND OR 97208 SPCT $ 3.15 DEB 09/11/98 98- 309065
Phone #: PGR /870 -5441
Contract or
MICHAEL it CO PLUMBING
P 0 BOX 23008
TIGARD OR 97281 -- --
Phone #: 639 -3189 $ 66.15 TOTAL
Reg #..: 000678
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Final Inspection
Tigard Municipal Code, State of Ore. 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 -m10 through OAR 952- 0001 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued y: Permittee Signature:
c�17 vgA pi.„�a
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OP I IGARD Plumbing Permit Application Plan Check -
13125 SW HALL BLVD. Commercial and Residential Rec'd By
TIGARD, OR 97223 Date Rec'd q -
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
• Incomplete or illegible applications will not be accepted Permit #OG/
Related SWR # / - (5 . 23 3
Called
Name of Development/Project FIXTURES (individual) QTY : PRICE- -AMT
Job -PQT`C`( Sink 9.00
Address Street Address LU.W..s...S Suite Lavatory 7 9.00
1 0 Sal) -co._ Qd Tub or Tub /Shower Comb. 9.00
Bldg # City /State Zip Shower Only 9.00
Ti,� f 3 Pa 3 Water Closet 1 9.00
m
ae
L1 g"
", L " Dishwasher 9.00
Owner Mailing .W ng Address Suite Garbage Disposal 9.00
- At 13n . '-Cie_ I wv P kkro Washing Machine 9.00
City/State .�ZZip Phone
^\ Floor Drain/Floor Sink 2" � 9.00
1 'Z t: O2 tt .
N ame
ol 3" 9.00
4" 9.00
Occupant Mailing dtl
Aress ,/ Vi Suite Water Heater 0 conversion 0 like kind 9.00
12 `-''°I�
sw Sr CtIt , Ilo1 g- Q Gas piping requires a separate mechanical permit.
City/State te Zip Phone Laundry Room Tray 9.00
11U�- Urinal 9.00
Name ;7 O ther Fixtures a
wv_h{i0� Co 131 u (Specify) i fy) 9.00
Contractor ailin Address Suite /G{ i%I ` 9.00
c . 0 . 1, 2 O U 9.00
Prior to permit City /State Zip Phone Sewer - 1st 100' 30.00
issuance, a copy "II & AC q'12?j' b ?� SW-1
Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if t'1 2,11 Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database 2 , -133 Yb Storm & Rain Drain - 1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect Mobile Home Space 25.00
Or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
Pollution Device
Engineer City /State Zip Phone Residential Backflow Prevention Device' 15.00
(Irrigation timing devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0 Catch Basin 9.00
Additional description of work: Insp. of Existing Plumbing 40.00
-"\--10!--1/141T-- 2 P(1�vt 4t��� per/hr
Specially Requested Inspections 40.00
per/hr
Rain Drain, single family dwelling 30.00
Are yoy capping, moving or repl ing any fixtures? Grease Traps 9.00
Yes 0 No
If yes, see back of form to indicate work performed by '
fixture. FAILURE TO ACCURATELY REPORT FIXTURE QUANTITY TOTAL
Isometric or riser diagram is required if Quantity Total is > 9
WORK COULD RESULT IN INCREASED SEWER FEES. *SUBTOTAL
I hereby acknowledge that I have read this application, that the information 0.
given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE
that plans submitted are in compliance with Oregon State Laws. 3
SI nature of Own er /Agent Date **PLAN REVIEW 25% OF SUBTOTAL
KZ ' ^ �� , --. Q t6 Required only if fixture qty. total is > 9 V/S
� Qe h I TOTAL .
Contact Person �
n Nam Phone
�� "o di -�-� ` � k WI 3) Ica) .Min permit fee is $25 + 5% surcharge, except Residential Backflow
lu N l Prevention Device, which is $15 + 5% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram
/1 �y //� P .f /,{a -( /� and plan review
I:tdstslplumapp.doc 72/98 / l t/1 C. 7 /i "l (Ori / i /-
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•
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New ` >::: Moved Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I:'dstslplumapp.doc 7/7/98
•
03/03 /2000 Activities for Case #: PLM98 -00319
8:35:38 AM
• Assigned Hold • Updated
Activity - Description Date 1 Date 2 Date 3 To Done By . Disp. Level By Updated Notes
PLMC003 Application received - 09/04/1998 BON RECD GES 11/05/1998
PLMC005 Permit Created 09/10/1998 GEO DONE . GEO 09/10/1998
PLMCO50 (F) Issue permit 09/11/1998 DEB DONE DST 09/11/1998
PLMC720 Underfloor /Underslab 09/16/1998 09/23/1998 DD - FAIL J *H 09/25/1998 1. DWV undersiab water test
could not be verified - end line
• - hose bibb had no water.
PLMC799 Final Inspection 09/16/1998 10/05/1998 TLP PASS . J *H 10/06/1998
PLMC800 Case Finaled 10/06/1998 RLP PASS J'H 10/06/1998
PLMC725 Top -out Insp - 09/28/1998 TLP PASS GES 10/08/1998
PLMC720 Underfloor /Underslab 11/05/1998 TLP PASS GES 11/05/1998 entered by GS done by tip
•
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Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
A 18 2 �� pp� BUP
30 Date /R�egq 11 to r S - l AM PM BLD
L cation f c2 - & (i(
�1 Suite MEC
Contact Person C-i;bidi V Ph 3-O ' a-- h 4 1 - 1 9 L t 'Q _3/ q
Contractor Ph SWR
BUILDING Tenant/Owner { 3NS ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
P T FAIL
4PLUM
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
i! /' FAIL
—LP
Rough In
Gas Line
• Dampers
- ASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ I Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire [ ] Please call for reinspection RE: III [ ] Unable to inspect - no access
Supply Line
ADA —� ay ,
Approach/Sidewalk ��
Other Dat f Inspector � Ext
Final
PASS PART FAIL . DO NOT REMOVE this inspection record from the job site.