Permit (147) CITY TIGARD PLUMBING PERMIT
w l�
DEVELOPMENT SERVICES PERMIT #: PLM1999 -00237
r �� II .13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/19/99
SITE ADDRESS: 16200 SW PACIFIC HWY Z PARCEL: 2S115BA -00100
SUBDIVISION: O R I G l A ZONING: C -G
BLOCK: LOT: ORIGINAL, TIG
CLASS OF WORK: ADD GARBAGE DISPOSALS: 1 MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; 66 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 8 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing work for expansion and remodel. Other fixtures: 1 drinking fountain, 1 eyewash.
FEES
Owner:
Type By Date Amount Receipt
IBJ SCHODER BANK & TRUST PRMT DEB 8/19/99 $935.00 99- 317787
BY ALBERTSONS INC #565 5PCT DEB 8/19/99 $65.45 99- 317787
ATTN: CORP ACCT DEPT PLCK DEB 8/19/99 $233.75 99- 317787
BOISE, ID 83726
Phone 1: Total $1,234.20
Contractor:
KEEFER PLUMBING INCORPORATED
52300 SW SOUTH RD
GASTON, OR 97119 REQUIRED INSPECTIONS
Phone 1: 503 - 640 -7451 Water Line Insp
Underfloor /Underslab
Reg #: LIC 065481
P Top -out Insp
LM 34 -94pb
RP /Backflow Preventer
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
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 -0010 through OAR 952 - 0001 -0080.
You obtain pies of these rules or direct questions to OUNC by callin• (503) 246 -1987.
Issu By: / 4 i Permittee Signature: 4 /, /
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF TIGARD Plumbing Permit Application • Plan Check# -6 ci C.
13125 SW HALL BLVD. Commercial and Residential Recd By Pff
TIGARD, OR 97223 Date Rec'd . P3 7'�
(503) 639 -4171 g ° 1 6 uL. P 99 -000 3D-- Date to P.E. - -9
•
Print or Type Date to D
Incomplete or illegible applications will not be accepted Permit # t 1 7
Related SWR # A 9 (a
Called `77 - 1 . 7
( NName of Development/Project FIXTURES (individual) QjFY PRICE AMT
Job TI L eDC.Ie-1 5 Noj t 3 Sink 1/% 11.50 G/7i
Address Stroet Address Q, t Suite Lavatory 1 /2.., 11.50
l
ZOO J AL+ Tub or Tub /Shower Comb. 11.50 z�
Bldg # CL ,State Zip -
Ty r(/ & try (412 Z3 Shower Only 11.5
Na e Q / WaterCloset/Urinal (Specify) 1 }'� 11.50 'L
' `c0Q,y .15 PpC') CALASV Dishwasher 11.50
Owner Mailing Address Suite Garbage Disposal ✓ 11.50
11,210D5C) P AC. }l«► ( t
W as hi ng M achine /Laundry Tray (Specify) 11.50
'Ft fate 1 CI 3 Phone Floor Drain/Floor Sink 2" to (Q 11.50 7
c illt4 Na �,," 3" 11.50
5 A /'- 4" 11.50 -
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
City/State Zip Phone MFG Home New Water Service 28.00
MFG Home New San/Storm Sewer 28.00
N t P\IICA 1 /0 Hose Bibs 11.50
Contractor ing Ad ess _ Suite Rain Drains 11.50
r (7.). , ? Drinking Fountain 4
I 11.50 r)
Prior to permit City(tat Zi Phone `may Other Fixtures (Specify) 15.00 .
issuance, a copy. 1.4 ( r�'e r0 9 7 G 1 40
745 1
of all licenses are OregoP C C nt. Licit Exp. Date �€_��O'(' t +t u . / 1g.
required if (Q
expired in COT Plumbing Lic. # �Q Exp. Date
database `3 4 -q lLI Py
Name
U s ��`� � % Sewer - 1st 100' 38.00
Architect i Azili Sewer - each additional 100' 32.00
Or � M L ailingAddress - Suite Water Service - 1st 100' 38.00
( / S OV `�`" ^k Water Service - each additional 200' 32.00
Engineer State
C / Zip Phone
' O g37tc- r- ag_wLt_0 Storm & Rain Drain - 1st 100' 38.00
Describe work to be done: O , 1 Storm & Rain Drain - each additional 100' 32.00
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Commercial Back Flow Prevention Device 32.00
Residential 0 Commercial Residential Backflow Prevention Device' 19.00
Additional description of work:
Catch Basin 11.50
Insp. of Existing Plumbing 50.00
Are you capping, moving or replacing any fixtures? per/hr
Yes _ No 0 Specially Requested Inspections 50.00
If yes, see back of form to indicate work performed by per/hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45.00
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL Cr\ .
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9 :COL
that fans submitt d are in compliance with Oregon State Laws.
*SUBTOTAL Q0
r of O r/A p
I 0 7% SURCHARGE �
Contact Person Name riii-z2/49
3o T. IKEE CQgO * REVIEW 25% OF SUBTOTAL
1 BATH HOUSE $178.00 Required only if fixture qty. total is > 9
2 BATH HOUSE $250.00 • TOTAL
3 BATH HOUSE $285.00 Z ( 0
(This fee includes all plumbing fixtures in the dwelling and the first
100 feet•of sanitary sewer storm sewer and water service) 'Minimum permit fee is $50 + 7 % surcharge, except Residential Backflow Prevention
Device, which is $25 + 7% surcharge
�
'
**All New Commercial Buildings require plans with isometric or riser diagram and
` n 1 j 0 - t] plan review.
Ia \"
dstsVornstplumapp.tloc 7 /19/99 VV n l Ltl
•
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
Sink
Lavatory 2,
Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2" 2 "` ,,. : �:
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
I: ldstalormslplumapp.doc 7/19/99
04/17/2000 Activities for Case #: PLM1999 -00237 •
9:16:09 AM
Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes .
PLMC003 Application received 07/23/1999 DHL RECD No Hold DST 08/03/1999
PLMC005 Permit Created 08/02/1999 DEB DONE No Hold DST 08/03/1999
PLMC007 Plans routed to Plans Examiner 08/03/1999 DST DONE No Hold DST 08/03/1999
PLMC000 Commercial Menu 08/10/1999 • MRS , No Hold MRS 08/10/1999
PLMC008 Plans Approved /Routed to DST 08/10/1999 08/10/1999 08/10/1999 MS SENT No Hold MRS 08/10/1999 '
PLMC010 Plan check by 08/10/1999 08/10/1999 08/10/1999 MS PASS Hold MRS 08/10/1999
PLMC120 Plumbing Undersl 08/10/1999 08/10/1999 08/20/1999 . MS PASS No Hold AKJ 08/22/1999 partial undersl plm to case -
•
drains
PLMC710 Water Line Insp 08/10/1999 08/10/1999 No Hold MRS 08/10/1999 .
PLMC720 Underfloor /Underslab 08/10/1999 08/10/1999 08/31/1999 TLP PASS No Hold AKJ 08/31/1999
PLMC725 Top -out Insp 08/10/1999 08/10/1999 10/25/1999 TLP DONE No Hold TLP 10/25/1999
PLMC750 RP /Backflow Preventer 08/10/1999 08/10/1999 No Hold MRS 08/10/1999
PLMC799 Final Inspection 08/10/1999 08/10/1999 02/23/2000 TLP PASS No Hold AKJ 03/02/2000 •
PLMC015 DST Post Review Complete 08/17/1999 BON DONE No Hold BON 08/17/1999
•
PLMC.040 (F) Ready to issue 08/17/1999 BON DONE No Hold BON .08/17/1999 Do not issue until
SWR1999- 000162 is paid.
PLMCO50 (F) Issue permit 08/19/1999 DEB DONE No Hold DEB 08/19/1999
PLMC120 Plumbing Undersl 09/14/1999 09/14/1999 09/14/1999 MS " PASS No Hold • AKJ 09/14/1999 8" raindrain ,
PLMC120 Plumbing Undersl 09/22/1999 09/22/1999 09/22/1999 TLP PASS No Hold AKJ 09/22/1999 extended one drain at produce,
main condensate drain and
- lateral lines produce section
PLMC120 Plumbing Undersl 10/10/1999 10/10/1999 10/08/1999 TLP PASS No Hold AKJ 10/10/1999
PLMC120 Plumbing Undersl 10/15/1999 10/15/1999 10/14/1999 TLP PASS No Hold DLH 10/15/1999
PLMC720 Underfloor /Underslab . 10/20/1999 10/20/1999 10/20/1999 MRS PASS No Hold JS 10/20/1999
PLMC120 Plumbing Undersl 11/01/1999 11/01/1999 10/29/1999 MS FAIL No Hold MRS 11/01/1999 Need to see pictures plumbing
poured in concrete
PLMC120 Plumbing Undersl 12/23/1999 12/23/1999 12/23/1999 TLP PASS No Hold TLP 12/23/1999
PLMC720 Underfloor /Underslab 01/13/2000 01/13/2000 01/13/2000 - TLP. PASS No Hold AKJ 01/13/2000
PLMC725 Top -out Insp 01/24/2000 01/24/2000 01/24/2000 MRS FAIL No Hold AKJ 01/24/2000 not ready
PLMC725 Top -out Insp 01/25/2000 01/25/2000 01/25/2000 MRS PASS No Hold AKJ 01/25/2000
PLMC800 Case Finaled • 03/02/2000 AKJ DONE No Hold AKJ 03/02/2000
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested �� / AM PM )< BLD
Location I ( 2-00 l' .2L. Suite Z MEC
Contact Person 16-eAl Ph (0 ?�S PLM 1 99 ° 1'-2 7
Contractor Ph SWR
BUILDING er Owner 3t5)) c 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
PASS PART FAIL •
am
er
Top Out
Water Service
Sanitary Sewer
Rain Drains
Fin.
PART FAIL
- • NICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
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 for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA z
Approach /Sidewalk Date J / 7InsPector 1 Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.