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Permit Er CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00302 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/13/2007 PARCEL: 1S136CD-02200 SITE ADDRESS: 07850 SW DARTMOUTH ST ZONING: C -G SUBDIVISION: LOT: JURISDICTION: TIG PROJECT: COSTCO WHOLESALE Project Description: Replace existing commercial backflow device above food court. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1 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 COSTCO WHOLESALE CORPORATION ATTN: EXCISE TAX DEPT 111 Description Date Amount 999 LAKE DR [PLUMB] Permit Fee 7/13/2007 $72.50 ISSAQUAH, WA 98027 [TAX] 8% State Surcha 7/13/2007 $5.80 Phone : Total $78.30 Contractor: WOLCOTT PLUMBING CONTRACTORS PO BOX 20698 PORTLAND, OR 97294 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 235 -8784 FAX 503- 491 -2932 Reg #: LIC 23847 PLM 26 -208PB 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 rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: /_/ 0� Permittee Signature: 4d/a/962i Call 503.639.4175 by 7:00 a.m. for an inspection that business 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. ' "PluM bing Permit Application FOR OFFICE USE ONLY City of Tigard 1z«e; ea °. 13125 SW Hall Blvd , Tigard. 0— 3 DatetC3y, Q Permit Na ' pLM2f�•� -��Z I ^. Phone, 503 639.4171 Fax 503.531 2.601 3 2007 Date/i3y, Other Pcrmlt Na.; TIGARD Inspection Line: 503.639,4175 Date Rena /B �/� I nternet: www tigard or,gov a Y y ' t 6 l0 Sec Page 2 fnr tl 31•x,! . 1 . NA110.dimethod; " Supplemental lnfprmatinn TYPE OF Stri- giNta°''..'. DRAWN FEE" SCHEDULE ❑ New construction El Demolition For special information use effecklist { Addition/alteration /replacement I:] Other _Description Qty, j Ea, Total New 1- 2- family dwellings (includes 100 ft. for each utility connection) J CATEGORY OF CONSTRUCTION SFR (i) bath — 249,20 ID 1- and 2- family dwelling 11 Commercial /industrial SFR (2) bath 350.00 IIN ❑ Accessory building El Multi-family SFR (3) bath 399.00 El Master builder Each additional bath /kitchen 45,00 ❑ Other; JOB SITE INFORMATION AND' LOCATION " Fire sprinkler (_ sq, R.) Page 2 Site utilities Job site address: — 40 i) Catch basin or area drain 16 60 City /State/ZiP: A t�-.�/ i 9 Ti 2:7_ Drywcll, leach line, or trench drain 16,60 Suite /bldg, /apt, no,: Project name: ae-T(-L VV .,Lnd Footing drain (no linear ft : ) OM Page 2 ME Cross street /direct ions to job site: ' Manufactured home utilities } 10 Manholes 16.60 60 Rain drain connector 16.60 Sanitary sewer (no. linear ft,: j` Page 2 Storm sewer (no. linear rt.' _ _ Page 2 Subdivision: Lot no . Water service (no. linear ft,: ) — Page 2 Tax map/parcel no.; Fixture or item Absorption valve 1660" di 'DESCRIPTION OF WORK /, ' B aekflow preventer 11.111 Page 2 ! r ; 0 \ ' 0L I 7 � Backwater valve 16.6(1 V t- % j . &) . Q • Clnfhcs washer 16,60 - . E . 0:1 N /1+4 ezzA ivi - , Dishwasher 16.60 it 'PROPERTY 'OWNER.:..., ".'. ' Drinking fountain I6.6 0 :TENANT; i Name' D J I I D t t^ 1 , Cjectors /sump 16.60 _ ' LL. Expansion tank 16.60 Address: I P ,/V ,n �/� 1114. �7 � I� l ,Xturo/scwcr cap 1 G,oi) City /State/ZIP: 16i, I` dip /L - ! L Floor drain /floor sink/huh iiM Phone: • I . '''4111...- Q fax; ( ) Garbage disposal 16 60 16.60 N. APPLICANT ' , ' .... Hoc bib _ CONTACT 1'>NRS ©iV' 16,60 ME Business name: WOLCOTT dba JACK NOWT( a Ice maker 16 ,�j. ` _ interceptor/grease trap 16,60 Contact name: r V � yV,0 t/A Medical gas (value. $ ) Y Page 0 Address: P.O. SOX 20698 Primer 16.60 City /State /ZiP: PORTLAND OREGON 9724 Roof drain (commercial) w 16,60 — Phone: (503) 235 -8784 Fax' : (503) 491 -2932 Sink/basinllavatnry 16.60 Tub /shower /shower pan 16.60 f -mall; 1 Urinal 16.60 . CONTRACTOR r 16,60 LL-- o: , Xi W ater closet Business name: WOLCOTT dha JACK 1H1OWi( „ � r Water heater 16.60 — Address; P.O. BOX 20693 at ji Other: City /State /ZIP: PORTLAND, OREGON 97294 p Subtotal A Phone: 403 2 35 $784 j Minimum permit fee: $72.50 7 r ) 0.,; l- ) - Fax: (503) 23.5 -8784 Residential backliow minimum permit fee: 136,25 G- CC/3 Lie.: 23847 J - I Plumbing Lie. no.' 26 -20RPR Plan review (25 "/" of permit fee) Authorized si suture: / / IME State surcharge (8% of permit fee) • A �� t _ l TOTAL. PERMIT FEE P r Print nam 47T , kh/bVii Date:' ) fa V his permit application expires if permit is not obtained it/ II • 180 days after it has been accepted as complete. *Pee methodology set by Tri- County Building Industry Service Board, "n FAX BACK TO JACK HOWK n, (5O3) 491 ,2932. CITY OF TIGARD BUILDING DIVISION PERMIT #: PLIv12007- 00:102 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/13/2007 Phone: (503) 639 -4171 �� INn�ii � Inspection Requests (24 Hrs.): (503) 639 -4175 _. " :_.. INSPECTION WORKSHEET FOR DATE: 7/19/2007 TIME: 7:03AM PAGE: 40 SITE ADDRESS: 07850 SW DARTMOUTH ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: COSTCO WHOLESALE DESCRIPTION: Replace existing commercial backflow device above food court. OWNER: COSTCO WHOLESALE CORPORATION, PHONE #: CONTRACTOR: WOLCOTT PLUMBING CONTRACTORS PHONE #: 503 - 236.87044 Inspection Request Scheduled For: Date: 7/19/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 396 Misc. inspection 052352 -01 503. 235.878 Y Corrections /Comments /Instructions: 4 I (&, � �, �t � �t {-� I A- eo.st P -f p-2..fa cc `. c ru 1 fir w' a -k✓ P"'-`J o% Cek rt ci0.4„.lam' 94.) Pi F -w t PASS I PARTIAL APPROVAL 7 CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED Inspector: L) � 1 ""^ — Date: /19 )O7 Phone #: (503) 718-