Permit ` CITY OF TIGARD
PLUMBING PERMIT
r4c DEVELOPMENT SERVICES PERMIT #: PLM2006 -10041
"�'� .� ! 1312 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 3/23/2006
PARCEL: 1S136AD-04001
SITE ADDRESS: 11539 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: PACIFIC TERRACE LOT: JURISDICTION: TIG
Project Description: Hook -up mop sink and 3- compartment sink to grease trap.
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: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC TERRACE COMMERCIAL LLC Description Date Amount
833 NW 170TH DR
BEAVERTON, OR 97006 [PLUMB] Permit Fee 4/5/2006 $72.50
[TAX] 8% State Surchari 4/5/2006 $5.80
Phone : Total $78.30
Contractor:
TROUBLE FREE PLUMBING
514 N MOLALLA REQUIRED ITEMS AND REPORTS
MOLALLA, OR 97038
Contact # : PRI 503- 829 -5851
FAX 503- 829 -5851
Reg #: LIC 99318
PLM 3 -238P
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 5(-246, -66 9 r 1- 800 - 332 -2344. �
Issued Permittee Signature. /?
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.
1 JM �oa4/ -
03.23/2006 09:23 FAX 5035981960 s CITY OF TI(ARD X 001
A
Plumbing Permit Application
City of Tigard
l"t,,: c)rrlc 1: i s1: c,�l.\
k°°
1? 125 SW Hall Blvd., Tigard, OR 97223 Date/BY. j 3 d'1 }1 .1..
Perrait No , ./�_/ r • �„
Plan Rehew
Phone: 503.639.4171 Fax: 503.598.1960 ,�,. Oth Pu enit xo
CIS. DRcBY
24-Hour Inspection Line: 503.639.4175 _t 4 'i_ Da te Rcad y/gl - ® r te page 2 ta
Internet: wwW.tigard- or.Rov N otiS e d/Melhod r / /:. S u pplemeetnl Iat ormatioo
__ TYpE of WORK .. FEE* sclal�DVLE • . . '
- ❑ New construction ❑Demolition Forspeclal ittformation use checklist.
Description I Qty. ( Ea. 1 Total
- ffAdditiontalterationlreplac.ement ❑ Other; • New I- 2- family dwellings (includes 100 ft for each utility connection)
. • • : .. , CATEGORY OF CONSTRUCTION . - , SFt (1) bath 249.20 1 •
❑ 1- and 2- family dwelling ❑ Commercial /industrial SF k (2) bath 350.00
❑ Accessory building ❑ Multi - family SF Z (3) bath - 399.00
❑ Master builder ❑ Other: Ea:h additional bath/kitchen 45.00 • - t JOB STFE INFORMATION ARID LOCATION Fire sprinkler ( sq. ft) Page 2
Site utilities •
Job site address: (LL43 9 .5 '? E, _ C � /j�y� 4 Catch basin or area drain 16.60
/ /
City /State/ZIP; '? ar' d o cf- iwell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Fo-rting drain (no. linear R: ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site:
- - Manholes 16.60
„ ,- Rain drain connector 16.60
Sanitary sewer (no. linear It: _) Page 2
Storm Fewer (no. linear ft.: �.) Page 2
Subdivision: Lot no.: Water service (no. linear It: 1 Page 2
- -' Fixture or item
Tax map /parcel no.: -
-
Absorption valve 16.60
s:- ..DFS�CRIPTION OF WORK . .. . ' . • Back Dowprcventer Paget
/7G /C- . . i if • e or / / �A / Backwater valve 16.60 • .
Clothes washer 16.60 •
e
Diihwashe7 16.60
• •ROPERTY OWNER D. TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: + i # r r r '. Expansion task 16.60
Address: ; i I + . L Fi::ture/sewer cap 16.60
City /StateiZIPrb L 3 6 ° 7 - Fluor drain/floor sink/hub 4P` 16,60 /6 _ 61
F ax: ( ) Cr rbage disposal 16.60
Phone: ( ) Hose bib 16.60
' ❑ AreLic m '.. . • ❑ CONTACT PF tSON ' • -
- la: maker 16.60
Business name: Interceptor/grease trap 16.60 _
Contact name; _ M•:dical gas (value: S ) Page 2
Address: Prmcr 16.60
• Ciry /State/ZiP: Rnofdrain (commercial) L6.60
Phone; ( ) ( ) Sink/basin/lavatory 16,60
Fax :: - - Tt.b /shower /shower pan 16.60 /
E-mail: veinal 16.60
• CONTACTOR - . Water closet 16.60
Business name: rU c 4 1 . , - 4/ , Water heater 16.60
Address: � a. Other: / E n C - ��
, City/State/ZIP; D A � Subtotal City/State/ZIP; A O -
` / D C. ' r - Minimum permit fee: 572.50 SO
Phone: ( ) , a - - , Fax: (� ) _ • - Residential backflow minimum permit fee: $36.25
CCB Lie.; • 0 ! Leir Plumbin. Lic.no.: F i - Plan review (25 %of permit fee)
I
„ / // • t G 6 rr _ State surcharge (8% of permit fee) /' • ��
Authorized signature: �/� . A� TOTAL PERMIT FEE ,g . 0
Print name: tv i , .er Amp 0 ,�, Date: 3 2 ,, This permit application expires if a permit is not obtai d r it
180 days after it has been accepted as -complete.
*Fee methodology set by Tri -County Building Industry Service Board.
l amidina\Pemie\PLM- Pern/t&ep.doc 12 .. y -
C 440-4416V NOVCO.YJWl7B) -- _.
CITY OF TIGARD eLtri
BUILDING / 0 ° DIVISION .. ' PERMIT 6 - / 0° (1 l
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: A
Phone: (503) 639 -4171 d
Inspection Requests (24 Hrs.): (503) 639 -4175 i I..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: j 1 5 q'/ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
•
DESCRIPTION:
OWNER: / PHONE #:
CONTRACTOR: /� PHONE #:
ti G�y� ?
Inspection Request Scheduled For: Date: 3 — J 0 - 0 4 Pour Time:
Code # InAectio D escription Confirm # Contact # Message
Corrections /Comments/ Instructions:
___,71 (/P,/ l ` -
e 5 .,7.."2.....„
...." .d ' 4 _ _ _ , ■. . _ : . . , 7 A . , a ■7AA. A . _ a PA 0 0' _ _ _.- /. i. 1 i
/
./ 1-15— ' ) ' --
► / �7
ic9 r
'P ASS [PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: p 0 Date: M / c ? Phone #: (503) 718- i L/
CITY OF TIGARD e L'
BUILDING DIVISION PERMIT #: c:;.0.0 - /0 o �/ Ill
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 /���m
Inspection Requests (24 Hrs.): (503) 639 -4175 "'I?�
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: I ( 53 CLASS OF WORK:
SUBDIVISION: / OT #: TYPE OF USE:
PROJECT NAME: 13 i Li'
DESCRIPTION: L' /'f
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3--.7 c/—d Pour Time -i
ap ,,
Inspection Description Confirm # Contact # Messa • / 1
54L-- 6 - ems /
Corrections /Comments /Instructions: ei
/ V /
- 7 ez
/
L
1 4/
95 ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / r Date: : I Phone #: (503) 718-