Permit i
CITY OF TIGARD
I 1, DEVELOPMENT SERVICES PLUMBING PERMIT
PERMIT # • FLM98 -0305
13125 SW Hall Blvd., Tigard, OR 97223(503) 639 -4171 DATE ISSUED: 11/05/98
PARCEL: 2S112DD -00800
SITE ADDRESS...: 15670 SW UPPER BOONES FERRY RD
SUBDIVISION • ZONING: C —G
BLOCK • LOT • 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..:M FLOOR DRAINS • 5 TRAPS • 0
STORIES • 0 WATER HEATERS 0 CATCH BASINS • 2
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS . 0
SINKS • 2 URINALS • 1 GREASE TRAPS • 0
LAVATORIES • 2 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 2 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 1
Remarks: Add plumbing for an existing service station /convience store.
Owner: FEES
CHEVRON USA PRODUCTS CO type amount by date recpt
6001 BOLLINGER CYN RD BLDG L -1114 PRMT $ 181.00 JSD 11/05/98 98- 310584
SAN RAMON CA 94583 PLCK $ 45.25 JSD 11/05/98 98- 310584
5PCT $ 9.05 JSD 11/05/98 98- 310584
Phone #:
Contractor
TWO BROTHERS PLUMBING
TIMOTHY DARREN CRANE
1796 SE DOGWOOD WAY
GRESHAM OR 97080
Phone #: $ 235.30 TOTAL
Reg #..: 131298
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Water Line Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Rough—in Insp
applicable laws. All work will be done in accordance with Underfloor /Under
approved plans. This pereit will expire if work is not started Top—out Insp
within 180 days of issuance, or if work is suspended for Bore Storm Drain Insp
than 180 days. ATTENTION: Oregon law requires you to follow rules Rain Drain Insp
adopted by the Oregon Utility Notification Center. Those rules are Misc. Inspection
set forth in OAR 952 ' -0010 through OAR 952 -0001 -0080. You lay RP /Backflow Prey
obtain copies of these rules or direct questions to OUNC by calling Final Inspection
(503) 246 -1987. Final Inspection
ie
�'
Issued B Permittee Signature: Le P t2A-e-- 4 - - ---
+ + + + + + + + + + + + ++ _ _ ++/++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639-4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
CITY OF TIGARD Plumbing Permit Application Plan Check # cY9 -0 6 C
13125 SW' HALUBLVD. Commercial and Residential Rec'd By G
TIGARD, OR 97223 Date Rec'd ?/o / 9 6
(503) 639 -4171 Date to P.E.
Print or Type Date to DS J,+S' -f1
Incomplete or illegible applications will not be accepted Permit # 6
Related SWR # '! - �✓ �
Called /d 19 9 - "�
Name of Development/Project FIXTURES (individual) QTY:.. PRICE: 'AMTI
Si 9.00
Job � j�l F Cf>'�e7JnbJ 2 - '
Address Street Address (s'-4 70 Suite Lavatory _ 9.00
S. tit) C,k PPM $oo J6 re t i R Tub or Tub /Shower Comb. - 9.00
Bldg # City /State Zi p Shower Only - ' 9.00
Name T Water Closet ,, . 9.00
• fr�6j D SI>ALE Dishwasher _ 9.00
Owner Ma' ing Address Suite Garbage Disposal 9.00
M �� Washing Machine - 9.00
Cit Zip Phone
41tile
)9130VE Floor Drain/Floor Sink 2" y 9.00
Name � 3" / . 9.00
x/1 A -BjIZ- 4" 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
-i° M " I R - 8 406..
Gas piping requires a separate mechanical permit. / '
= ate Zip Phone Laundry Room Tray 9.00
KE fi rinal / , 9.00
Name
Di 7 [ P $ t D • - p I' -r _ es (Specify) 9.00
Contractor Mailing Address Sup( (1/, e % i-`A'A 9.00
t� 9.00
Prior to permit City/State Zip Phone Sewer - 1st 100' 30.00
Issuance, a copy Sewer - each additional 100' 25.00
of all licenses are Oregon Const. Cont. Board Lic.# Exp. Date
required if Water Service - 1st 100' 30.00
expired in COT Plumbing Lic. # Exp. Date Water Service - each additional 200' 25.00
database Storm & Rain Drain - 1st 100' / 30.00
Name Storm & Rain Drain - each additional 100' 25 00 1
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
Describ work to be done: -- restricted energy permit.)
New ' Repair 0 Replace with like kind: Yes No 0 Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0 Catch Basin .2 9.00
Additional description of work:
R.6--- Co Xt rOECT Td fft4u.1 cAr-1 a e y Insp. of Existing Plumbing 40.00
per/hr
CE- PG•RA'D6 Wtrte- C 'T-il-rt61" Specially Requested Inspections 40.00
s ) cr e (C.IZ"S per/hr
Are you capping, moving or replacing any fixtures? • Rain Drain, single family dwelling 30.00
Yes O No O Grease Traps 9.00
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 �"r
I hereby acknowledge that I have read this application, that the information fW given is correct, that I am the owner or authorized agent of the owner, and 5% SURCHARGE q
that plans submitted . ompliance with Oregon State Laws !. t
Signature of Owne Date "PLAN REVIEW 25% OF SUBTOTAL t1�+
eY Q . 7'7. 9 R equired only if fudure qty total is > 9 /1Y�
C, C J G l / TOTAL �� gir
Contact Person Name Phone (�3, y -
J ee `I ' TC Icy bq , r Z q r 'Minimum permit fee is $25 + 5% surcharge, except Residential Backflow
I,�F O Prevention Device, which is $15 + 5% surcharge
**All New Commercial Buildings require plans with isometric or riser diagram
and plan review
I \dsts\plumapp doc 7/2/98
— �—(c,o A_ 5 • 4/
I
PLEASE COMPLETE: 3T6 l i S -
z U A/ 4 /S
Fixture Type Quantity by Work Performed
New Moved . Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet 3
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2" �
3"
4
Water Heater
Laundry Room Tray
Urinal j
Other Fixtures (Specify)
0o2oCW.Lo /461- 5-04>M /a=6 A
•
COMMENTS REGARDING ABOVE:
•
I \dsts'plumapp doc 7/7/98
/� /' Accumulative Sewer Tally
Tenant Name: l� ,t 7 l /SOA /' (�He eo n This SWR# % —� �1
Address: /56'7O ..5 ✓ ,06w_ Soon. -feat t2r j. This PLM#: 9B - 0 30 b
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- JacuzziNVhirlpool 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1 - — " - ( I - I -
Eye Wash 1
Floor Drain/sink - 2 inch 2 / 4 99.' 3 & •
-3inch 5 / ' 5 L 5
- 4 inch 6
- Car Wash Dm 6
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48
Ice Machine/Refrigerator Drains 1
Oil Sep (Gas Station) 6 _
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar/Lavatory 2 „L a • OZ -
- Bradley 5
- Commercial 3 / -3 .2 (, 1
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6 3 /g )d- - / - V
Urinal 6 / g / • le - / - 6
TOTALS I & 1 3 /9
Total fixture values: / / divided by 16 = 1, / 7 EDU = /vv (. y, -A c —
HISTORY p /fir & ,J /i -/ I
PLM# EDU# / SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
i:\dsts‘swrtay.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 Fy g7
BUP C�
Date Requested 3 AM PM L� BLD
Location / &..) Ug21 ��7' l_2& Suite MEC
Contact Person //" Ph S/J c r7 PLM ( Pg 0 33 d Ce
Contractor Ph SWR
UILDING Tenant/Owner ELC
g all ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain c Inspection Notes) 0,-a 6
Slab SIT
Post & Beam 1 (� "n 9 g N 6? / e 7
Ext Sheath /Shear '�M
Int Sheath /Shear
Framing
Insulation U ' ' ) ; } _
Drywall Nailing i /71..g,Cr///Yi _ C0_,
OP
Firewall �/ 1 a —
Fire Sprinkler a -: / / i I /�/ST�(�
Fire Alarm
Susp'd Ceili , _
Roof -
.i )---
( ° ,r iv 1 .
Misc:
• 44I P - : ' 0 FAIL ��
• LUMBIN 0 z
t
• . • : eam
Under Slab 41101
Top Out \
S
Water Service
Sanitary Sewer • `: _Zart
brains M1 -
PART FAIL Mk
■iumor
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL 1
ELECTRICAL • / `>
Service __ _ . l
Rough In ■ (
UG /Slab IIIIIIIMITI 0
Low Voltage Fire Alarm L I J I
1/
• __
Final /
PASS PART FAIL
SITE . /�1 i ()
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin Please call rens ection RE:
Fire Supply Line [ ] Pl ll for i p alif [ ] Unabte to inspect - no access
ADA
Approach /Sidewalk D ate 3 / 9 Ins ector ' Other / p � Ext
Final
PASS PART FAIL . DO NOT REMOVE this inspection record from the job site.
1 7