Permit IIIIp CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit#: PLM201500107
T f G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/07/2015
Parcel: 2S110AA02800
Jurisdiction: Tigard
Site address: 14055 SW PACIFIC HWY
Project: Elmer's Restaurant Subdivision: CANTERBURY PLACE,AMENDED Lot: 6A
Project Description: Installation of backflow prevention device
Contractor: LBD LANDSCAPING LLC Owner: DANNA BROTHERS PROPERTIES LLC
PO BOX 3189 9800 SE STARK ST
CLACKAMAS, OR 97015 PORTLAND,OR 97216
PHONE: 503-631-8755 PHONE:
FAX: 503-631-8735
FEES
Quantity Description Date Amount
1 ea Backflow Preventer 04/07/2015 $31.27
Specifics:, 1 12%State Surcharge- 04/07/2015 $8.70
Plumbing
Type of Use: COM 41 ea Minimum Fee Adjustment- 04/07/2015 $41.23
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 5503..2o32..1987 or 1.800.332.2344.
Issue By: Q�Y -i Permittee Signatu `° at
r
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Applicat >l}, �,I
Site Utilities �Eii ll��ri
City of Tigard Received
13125 SW Hall Blvd,Tigard,OR 9'710 / 201
Plan Review 7/ Permit No.: /S�b f07
I Plan Re
Phone: 503.718.2439 Fax: 503.598.1960 Date/By. Other Permit No
Inspection Line: 503.639.4175 11 Y of i ii ALiU Date Re /B luris: 0 See Page I G R l) Internet: www.ti ard-or. ov Notified/Method.o ent l Information
+i. FEE' SCHEDULE
For special information use checklist
Description I Qiy. I Ea. I Total
Addition/alteration/replacement ❑Other. New 1-2-family dwellings(includes 100 ft.for each utility connection)
=? CATEGORY OF IIITRUC�kI SFR(1)bath 312.70
❑ 1-and 2-family dwelling I Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler(—sq.ft.) Page 2
JOB SITE II RMATION AND LOCATION Site utilities:
Job site address: /y15-5—,SuJ iT� /VAX
Catch basin or area drain 18.76
City/State/ZIP: ' /. �i Z Drywell,leach line,or trench drain _
l- 1 O� 7 7`-� Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: yr 5 Manufactured home utilities 50.03
Cross street/directions to job site: 7'W Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer / 31.27 3i4/
DESCRIPTION OF WOE Backwater valve 12.51
/�_ _ i Clothes washer 25.02
/ � L /404/ / `Ik/ - A 1& Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Of PROPERTY OWNER { 0 TENANT Expansion tank 12.51
Name: � �
r Fixture/sewer cap
Address: � Floor drain/floor sink/hub
�`f / fiz, Garbage disposal 25.02
City/State/ZIP: 7/1�„f ,1,y /4 q7 Hose bib 25.02
Phone:( ) ^' Fax:( ) Ice maker 12.51
iti APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:
Medical gas(value:$ )
Contact name: pelt/ Primer
N Roof drain(commercial)
Address: "P gni/ 437 Sink/basin/lavatory 25.02
City/State/ZIP: ef�/Iii. at,t0 O4 Ciz',9J� Solar units(potable water) 62.54
Phone:(j )) 6)i-771.3 'C I Fax: :(5 )G���'2/ Tub/shower/shower pan 12.51
✓ / J Urinal 25.02
E-mail: LI//f�/1(�Gi4 f/� c#c 1�`'
—
7 e. � Water closet
CONTRACT4
Water heater
Business name: 145,0 L,4-1,t�V SCA?1//V� L &
L Water piping/DW V
Address: Ao r 3/ Other: 25.02
City/State/ZIP: yr q�'/!-� Subtotal
Phone:(. ) 4)177i3� �C Fax: ) �3i-t,3y� Minimum permit fee: $72.50
CCB Lic.: // /4/!o Plumbing Lic.no.: Plan review (25%of permit fee)
State surcharge(12%of permit fee) WM
Authorized signature: TOTAL PERMIT FEE 7/
IFriit:'Sill" This permit application expires if a permit is not obtained within 180 days
v.. .. 04/ ��/1,7" ater it has been accepted as complete.
•Fee methodology set by Tn-County Building Industry Service Board.
L1 Building\Pennits\PLMU-Per itApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
14055 SW PACIFIC HWY, TIGARD, OR, 97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00107
George Heimos
Violation Summary:
Inspector Contractor