Permit rl� q CITY O F TIGARD PLUMBING PERMIT
a l` CONINI TY DEVELOPMENT PERMIT #: PLM2007 - 00367
O 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
DATE ISSUED: 8/14/2007
PARCEL: 1 S136DB -00201
SITE ADDRESS: 11565 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FRED MEYER LOT: JURISDICTION: TIG
PROJECT: FRED MEYER
Project Description: Installation of backflow preventor for dairy case.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WILMINGTON TRUST CO, TRUSTEE
BY FRED MEYER, INC Description Date Amount
3800 SE 22ND AVE [PLUMB] Permit Fee 8/14/2007 $72.50
PORTLAND, OR 97242
[TAX] 8% State Surcha 8/14/2007 $5.80
Phone : Total $78.30
Contractor:
PORTLAND MECHANICAL CONTRACTOR
2000 SE HANNA HARVESTER DR
MILWAUKIE, OR 97222 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 656 -7400
FAX 503- 655 -0620
Reg #: LIC 151807
PLM 3 -425PB
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 -0100. You may obtain copies of
these rule irec • . - stions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu d By: ,� / Permittee Signat ��/ADP
Call 503.639.4175 by 7:00 a.m. for an inspection that bu •fib s day.
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 Application FOR OFFICE USE ONLY
City of Tigard Date/By: 1 0 7 Permit No.: , ( ez7.-dd3Co7
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit No.:
TI GA RD Inspection Line: 503.639.4175 Date Ready /By: lur ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: rl ICj Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description Qty. Ea. I Total
54 Addition /alteration /replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ 1- and 2- family dwelling .Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath /kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: t C c , e - S ` . .. ‘ w ,, Catch basin or area drain 16.60
City/State /ZIP: -- \C‘ (, I N LC i ls.8. C:)\ Drywell, leach line, or trench dram 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: _) Page 2
�'� r ��� Manufactured home utilities 1 10.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer 1 Page 2
� \5� .R'',-CA "-,A c, C d Backwater valve 16.60
(L \ JE'\ 0 t C .mot ..ls_ � Clothes washer 16.60
} Dishwasher 16.60
Drinking fountain 16.60
PROPERTY OWNER ❑ TENANT
Ejectors /sump 16.60
Name: � ... M,,,-.y Expansion tank 16.60
Address: '� � S� ns. 1., . ,6 Fixture /sewer cap ■ 16.60
City/State /ZIP - � 1 c a , ( . c ., A . \ CG \,ZAP Floor drain /floorsink/hub 16.60
Phone: ("c11 ) z.--67__ c1.51+1t! Fax: ( )
Garbage disposal 16.60
51.. APPLICANT 54,CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business nam ::i l , s h r ^LA, ty\Ghl., CnA1 t rld\ L t .5 Interceptor /grease trap 16.60
Contact name: .. r,. v - e k.: Medical gas (value: $ ) ■ Page 2
Address: 2fic:,0 Ss. !l\ctr1.\t1/4.v,R- (Wes1 1:2r Primer 16.60
City/State /ZIP: p/ \ \) � \ � , U , 41.±1 ,( 1 1,..k. � \`\ �� L Roof drain (commercial) 16.60
Phone: Fax: : Sink/basin/lavatory 16.60
� �S� � _ (301) d Tub /shower /shower pan 16.60
E-mail : 1tA --Z 1 °y1 •� t i N t t C.\*4- (AL. CtlnrN. Urinal 16.60
CONTRACTOR Water closet 16.60
Business name 7--- 00.- -- ‘_N - t. 1\4\ C.A4 I` \N(,/sV C01∎1Z bNLX (2.S. Water heater 16.60
1 Other:
Address: ZoC
C =- \��1�\ I ., lJ1 \-ki< \)t,: '5 12. ~y _-
A Subtotal
City/State /ZIP:
r�� \� ��,� \x5 1 La •G`�I..\ C -1 - Z..Z Minimum permit fee: $72.50 ' tZ 0
me: (!_(:17 ) (,. . ( 1 t‘■ t Fax: tt. ) ( �.(, .t t-N Residential backflow minimum permit fee: $36.25
I CCB Lic.: \�. \C -- - ' um.. g Lic. no.: ��� Plan review (25% of permit fee)
�� 3 - 4 --L6$ State surcharge (8% of permit fee) S
Authorized sig :ture: / 7 1 4'( it' _ TOTAL PERMIT FEE 7g , $D
Print name: ♦.‘ ' L�\ e c � N l Date: (s-tAt-n1 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I:\ Building \Permits \PLM- PcmtitApp.doc 06/26/06 440- 4616T(10/02 /COM/WEB)
CIT ■ OF TIGARD • j`w •`
BUILDING DIVISION A PERMIT #: PE.M2007 -00367
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: f3/14/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .1 L.
INSPECTION WORKSHEET FOR DATE: 4117/2008 TIME: 1:02AM PAGE: 24
SITE ADDRESS: 11666 SW PACIFIC: HW' CLASS OF WORK:
SUBDIVISION: FRED MEYER LOT #: TYPE OF USE:
PROJECT NAME: FRED MEYER
DESCRIPTION: Ind allation of b; ckflow preventor for daily/ case.
OWNER: WILMINGTON TRUST CO, TRUSTEE, PHONE #:
CONTRACTOR: PORTLAND MECHANICAL CONTRACTOR PHONE #: 503.656- 7400
Inspection Request Scheduled For: Date: 4/17/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
99 Plumbing final 060517-01 503 -969 -4380
Corrections /Comments /Instructions:
( c .e I 0- t-1- A • • 1/4 ;4 l cc t./36.-- 0 ;5-4
Cep r{. 91--)
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1 FAIL 1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (3wA4.Jf' nib._- Date: LA \ \T \o ZZ Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00361
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/14/2Q07
Phone: (503) 639 -4171 ''
Inspection Requests (24 Hrs.): (503) 639 -4175 ,L.F��'_�
INSPECTION WORKSHEET FOR DATE: 9/13/2007 TIME: 7:01AM PAGE: 43
SITE ADDRESS: 115E+5 SW PACIFIC HVYY CLASS OF WORK:
SUBDIVISION: FRED MEYER LOT #: TYPE OF USE:
PROJECT NAME: FRED MEYER
DESCRIPTION: Installation of bac :Iflow preventor for dairy case.
OWNER: WILMINGTON TRUST CO, TRUSTEE, PHONE #:
CONTRACTOR: PORTLAND MECHANICAL CONTRACTOR PHONE #: 503. 656.7400
Inspection Request Scheduled For: Date: 9/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 055642 -01 503 - 969 -4380 N
Corrections /Comments/ Instructions:
t. i ` \ \ 3 M° ( - ., � z � �� - - lc_
D.e o i c t '- -t - - t-z1 74a la �� U� l c � c,1s D r
PASS U PARTIAL APPROVAL I I CANCEL 1 I NO ACCESS
FAIL 1 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector, r ""'W - Date: C 1 13 )0 `7 Phone #: (503) 718-
, .
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RP /1S- O0812T
ti lt > _.
is i- r-,esii rd d (a = .
Pressure Vacuum reake ° (-�—
Sizes: % ", lh", 3 /4" and 1" _, -- t,
Function: To protect the potable water supply against I:- ,..—
backflow from a nonpotablo source due to
negative supply prim ' - r� Watts OII811Tfi
Protection: Against backsiphonage 6 y „. !„
Installation Requirements: µ 7
1. Install 1"above Hood level of fixture Nfactory deck mounted " PlIbmtti 5125429
or 6" if general plumbing field application.
2. Install bonnet side up and allow for accessibility for
testing/service.
3. Do not ursdersize supply or oversize the valve in relation
to demand. - �" -- .1 Watts 0I18OOT
4. Do not instal where baekpressure can occur. _ , ..,..) v,", t"
8. Protect from freezing.
Note: Use I." suffix for left -hand outlet, r_ Afi
Recommended Service: tg l ,j f O
Test periodically as requii i by local jur fictional authorities. - L ' _+ . . ,� ,
Replace internal components every five years ". J "
Pressure _ Temperature '._ °, t
Working Temp: 33 °F -18fl F - f
�
Max. Plssssure 150 P59 ._c ?►
&'lug. pressure: 8 PSI I l , - - 4' __`1
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