Permit r
• CITY OF TIGARD
PLUMBING PERMIT
4 v4)PeI k DEVELOPMENT SERVICES PERMIT #: PLM2003 -00530
.,� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/16/03
SITE ADDRESS: 11945 SW PACIFIC HWY 100 PARCEL: 1S135DD -03301
W
SUBDIVISION: HOFFARBER TRACTS NO.1 ZONING: C -G
BLOCK: LOT: 002 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B FLOOR DRAINS; 2 TRAPS:
STORIES: WATER HEATERS: 1 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
Remarks: Fixtures: (1) backflow, (2) 2" floor drains, (2) sinks, and (1) water heater.
FEES
Owner:
Description Date Amount
BREWED AWAKENINGS
11945 SW PACIFIC HWY. [PLUMB] Permit Fee 10/6/03 $129.40
TIGARD, OR 97223 [TAX] 8% State Tax 10/6/03 $10.36
Total $139.76
Phone : 360 - 225 - 6826
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 503 Rough -in Insp
Top -out Insp
Reg #: MET 00001806 Final Inspection
LIC 87852
PLM 34 -166PB
•
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
Issued By: Permittee Signature 72td ,/
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busines day
Oct (,,2 -03 11:05A Rayborn's Plumbing, Inc. 15036912328 P.01
• FOR OFFICE USE ONLY
Building Fixtures
Received /0 � Plumbing
Plumbing Permit ApplicrIi EIVED Date /8y : Permit n►o 4 / -00530 f
Cit of Tigard Plan11eQ Approval
Permit No oo 3
Hate / By ; 6u R�ov 3 - 7
13125 SW HaII Blvd OCT 2 1003 Plan Review Other W
Tigard, OR 97223 l /By : Peel* No. :
Phone : 503 639 -4171 Fax 503 598 -1960 Post - Review Land use
Inspection line - 503 639 -4175 CITY OF TIGARD Date / By Case No.: n l/A
BUILDING DIVISION Contact Jurisdiction• (`
:.:%•,. t r -..... :f !ou.: ix . ` "
,
:>.-.,: : _ ,. ,.,.:... �� Descrl Ion � 1
- `. Each '; ; :;; T otal
❑ Demolition . _ 1,:,., :,:: a
❑ • New Construction .:�,., �#� r � ;;; .��. ► `
01 Repair n Others : SFR (1) bath .
n addition/Alteration /Reply o Other : ' " '1 k s `" ```
cement :•S;�:�1N�''t�i4�!�,F;- .,. ` � a....... . ;� ;
: :.... ...::.:,:.::. r :. �. 7 . :• • . ., ::: x : , s;'y ..i $3 $000
. « '`r. ; ,...s.; ; .!::p ; ;: ::yyi > •!:: SFR (2) bath
y i s i % ::.;!':': : :![': w:. .,•,: '..:, ..: ..y .. .4i:Y•F: v i:• }:��j:�•vrri : }�': %�!ti:
-. .. Two f •, r. {••...
❑ One & Two Family Dwelling ❑ Commercial / Industrial SFR (3) bath $375.00 $0.00
❑ Accessory Building n Multi- Family Units ❑ Each additional bath / kitchen $155.00 , $0.00 Li f
a Master Builder n Others : Fire sprinkler - S Ft : _ 2
_ +
Job site address: 11945 SW Pacific Highway Catch basin or area drain $16.60 I $0.00 4
Suite : 100 I Bldg / Apt # Drywell, leach line, or trench drain $16.60 $0.00
Project Name : Brewery Awakening / Can Footing drain (no. Linear Ft : ) ' Page 2 $0.00 f tl .
Cross street / Direction to Job : Manufactured home utilities (each) $110.00 $0.00
' Manhole $16.60 $0.00 cs-
Subdivision: ILot no.: Rain drain connector $18.60 , $0.00
Tax map/lot/account ( parcel It ) : Sanitary sewer ( no linear R : __)' Page 2 $0.00 ...:\
: ... sewer (no linear ft : )' Page 2 $0.00
Tenant Improvement Water heater + hub drain + floor sink + 4 comet. Water service (no linear ft : )' : Page 2 $0.00 ' : 1
Absorption valve
sink + mop sink + RP for expresso :: `.::: �:. � ,• .
....
.: ::!;r % - •; ;:!;.. �,y B ac k flow preventer ` / 1 ` $� 16.60;: >..; f
` � Is �
Name : Bac valve $16.60 $0.00
Address : Clothes Washer $16.60 $0.00
City / State / Zip: Dishwasher $16.60 $0.00
Phone : ax: : Drinking fountain $16.60 $0.00
: >:<.;< >:.,:::... ,:: >; $16.60 $0 00
Drin n
';t • �:< ......#0. . Ejectors / sump
Name : Expansion tank $16.60 $0.00 4 .._ - k , \
Address : Fbdure / sewer cap $16.60 $0.00 Ir
:try / State / Zip: Floor drain / floor sink / hub a2 a 2 1 $16.60 $33.20. ''-
Garbage disposal $16.60 $0.00
Phone +. :. >:: Fax:. s:, ,;f -; >:« ;: Hose Bibb $15.00 $0.00
rd::
LIr L:.tigp <j "y'vl+' �Sj] i%t {[+ :`t'((:' +'. f ,r
:
Business name : RAYBORN'S PLUMBING Ice Maker $16.60 $0.00
Address : P. O. BOX 69 Interceptor / grease trap $16.60 $0.00
City/ State/ Zip : TUALATIN, OR 97062 Medical gas (value : $_J .. Page 2 $0.00
Phone : 503 692 -4139 ex : 503 691-2328 Primer $16.60 $0.00
CCB Uc : 87852 Exp: 12/03 Metro tic : 01806 Exp : 7/04 drain ( commercial ) $16.60 $0.00
Authorized CAL/6 Sink / basin / lavatory a . X. . $16.60 $33.20 J/,,Li0
Signature : JP LJc : 4075JP Exp: M 06 Sic
shower / shower pan $16.60 $0.00
Print name : Wayne Sleboid bate : 10/2103 Urinal $16.60 $0.00
Water closet $16.60 $0.00
Water heater 1 1 $16.60 $16.60 /(, . Go
Others : $16.60 $0.00 ,
Notice : This permit application expires of a permit Is not obtained within ,
Others : $16.60 $0.00
180 days after It has been accepted as complete. � / ,:
i:F .(.Y. {: :' "P' X:•i % : l4i:y Ylnr:,.: iifi:fr
Permit Subtotal : $85.00 1
Minimum permit fee $72.50 / Res Backflow $36.25: •
Commercial Plan Review (25% of permit fee) :
State Surcharge (8% of permit fee) : $6.80 /0. a&
Total Permit Fee : ,59{� /
1513C1,1-6
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received - Date Requested 11 /Z4/0 AM PM BUP
Location //q4/5 OGL.Ci tigluite / D MEC
Contact Person Ph ( -- i'�� 2 q/39 111Do 3-00 5:36
Contractor • & ■■ • J•• ' .��'� • Ph ( ) SWR
BUILDING ' Tenant/Owner ELC
Footing ELC
Foundation
Access'
Ftg Drain moo ELR
Crawl Drain /C,
Slab Inspect! o es: SIT
Post & Beam /
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
R Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING — /2
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
4
PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ❑ Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA
Approach/Sidewalk Date v Inspector Ext
Other:
Final DO N • REMOVE this inspection record from the job site.
PASS PART FAIL