Permit re,
�._ v� CITY OF TI
PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00404
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/15/2008
PARCEL: 1 S135DD -03301
SITE ADDRESS: 11945 SW PACIFIC HWY 202 ZONING: C -G
SUBDIVISION: TIGARD PLAZA LOT: 002 JURISDICTION: TIG
PROJECT: LUCKY DELI
Project Description: Interior plumbing.
•
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: 1 WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TIGARD PROPERTIES INC
2106 SE OCHOCO ST Description Date Amount
MILWAUKIE, OR 97222 [PLUMB] Permit Fee 10/15/200€ $72.50
[TAX] 12% State Surch 10/15/200€ $8.70
Phone : Total $81.20
Contractor:
RAYBORN'S PLUMBING INC
19990 SW CIPOLE RD
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS •
Contact # : PRI 503- 692 -4139
FAX 503- 691 -2328
Reg #: 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
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these r s or direct que t••ns to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu By: ' / t Lh / i / Permittee Signature: SCL
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.
5 91 2 Ra lumbing 09:10:52 a.m. 10-15-2008 1 /341.......
i
: - � ' Plumbing Permit Application N` ' � I )13571 1 �� . - ■ �y
Building Fixtures - �� FO (11: Fl( 1. 1 , ..E ()N I.)
City of Tigard ��0 Received iv is Us , dry Permit No.: pi p / ) ""(� _ / cV (_
I II 13125 SW Hall Blvd, Tigard, OR 9 J y: r N
Phone: 503.639.4171 Fax: 503.598.19600 • Other Penult No. 4 A -� d
Inspection
Line: 503.639.4175
I Ili:\ I: I > w GG'� C \, Rcady/By: >um 0 See' _e
Internet: ww.tigard or.gov OT N 1J Notified/Method • suppkm Inm.mauon
. . TYPE OF WORK t1 L,`' �,% FEE* SCHEDULE
l New construction ❑ Deatron For special information use checklist
Description I Qty. I Ea. I Total
® Addition /alteration/replacement ❑ Other New 1- 2 -family dwelfings (includes 100 fL for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 350.00
El Accessory building El Multi-family SFR (3) bath 399.00
El Master builder El Other Each additional bath/kitchen 45.00
Fire sprinkler (_ sq. R.) Page 2
JOB SITE INFORMATION AND LOCATION Site atildes
Job site address: 11945 SW PACIFIC HWY. Catch basin or area drain 16.60
City /State/ZIP: TIGARD, OREGON DrywedL leach line, or trench drain 16.60
Suite/bldg./apt. no.: 202 ' Project name: LUCKY DELI Footing drain (no. linear IL: _) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: ,{/�lt WI)
Manholes 16.60
)E.f/' a Rain drain connector 16.60
(J' Sanitary sewer (no. linear fl: ) Page 2
Stern sewer (no. linear R: ) Page 2
Subdivision:
Water service (no. linear R: _) Page 2
Fixture or Meta
Tax map/parcel no.: @ c(.---.41151-*41"--°Pi .
I Lot no.:
Absorption valve 16.60
DESCRIPTION OF WORK B go. preveater Page 2
INSTALL 3 SINK AND FAUCETS Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER 1 ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City / State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) I Fax ( ) Garbage disposal 16.60
® APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: RAY BORN'S PLUMBING
interceptor/grease trap 16.60
Contact name: RANDY DEADMOND Medial gas (value: S ) Page 2
Address: 19990 SW CIPOLE RD Primer 16.60
City/State/ZIP: TUALATIN, OREGON 97062 Roof drain (commercial) 16.60
Phone: (503) 692.4139 Fax: : (503) 691 -2328 Sink/basin/lavatory 3 16.60 49.80
Tub/shower/shower pan 16.60
E -mail: randy @rayhxs>coal
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: RAYBORN'S PLUMBING Water heater 16.60
Address: 19990 SW CIPOLE RD Other: •
City / State/ZIP: TUALATIN, OREGON 97062 Subtotal 49.80
Minimum permit fee: S72.50 72,50
Phone: (503) 692 -4139 Fax: (503) 691 -2328 Residential baddlow minimum permit fee: $36.25
CCB Lic.: 87852 Plumbing Lic. no.: 34 -166PB Plan review (25% of permit fee)
f /' � State surcharge of permit fee) 8.70
Authorized signature: / f //
TOTAL PERMIT FEE 81.20
Print name: Randy Deadmond Date: 10/15!08 This penult application expires if a permit b not obtained within
IRO days after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008 -00404
13125 SW Hall Blvd., Tigard, OR 97223 c DATE ISSUED: 10116/2008
Phone: (503) 639 -4171 V �I Inspection Requests (24 Hrs.): (503) 639 -4175 �: _..
INSPECTION WORKSHEET FOR DATE: 11/5/2008 TIME: 7 :01AM PAGE: 3
SITE ADDRESS: 11946 SW PACIFIC HWY 202 CLASS OF WORK:
SUBDIVISION: TIGARD PLAZA LOT #: 002 TYPE OF USE:
PROJECT NAME: LUCKY DELI
DESCRIPTION: Interior plumbing.
OWNER: TIGARD PROPERTIES INC, PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 -697-4139
Inspection Request Scheduled For: Date: 11/5.5/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 077694 -01 971 -506 -6414 N
Corrections /Comments / Instructions:
G -r'e- Cd wt--ei '4,-
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (3iNieq,, rj \ \s.._1 Date: I' \ S f 0 1) Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: PLM200B -00404
13125 SW Hall Blvd., Tigard, OR 97223 ,� DATE ISSUED: 10i 15/2008
Phone: (503) 639 -4171y
Inspection Requests (24 Hrs.): (503) 639 -4175 `'I J�
INSPECTION WORKSHEET FOR DATE: 10/29/2008 TIME: 7: 00AM PAGE: 1
SITE ADDRESS: 11945 SW PACIFIC t-IWY 202 CLASS OF WORK:
SUBDIVISION: TIGARD PLAZA LOT #: 002 TYPE OF USE:
PROJECT NAME: LUCKY DELI
DESCRIPTION: Interior plumbing.
OWNER: TIGARD PROPERTIES INC, PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 5A3697 4139
Inspection Request Scheduled For: Date: 10/29/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 077336-01 503- 692 -4139 N
Corrections /Comments/ Instructions:
D bo✓ Lac . ckk A- -c kit:. PLie, pi.,..,b..i 4vaS LA, Le -.
. 3C. 9- L113 9 P 1,,,1.;1,. Co `!
P b vo M A &Lj -- ■ c- ►.-/c-A-= 11-e-r1, w ► I t eizi Cam bo,. o4ov) -el,
4, (. `C p l w 412iV a c,.,t_ -1 P ■ w,...L-i \- e pievi....,` -r "f e "ri t11re.-e-. d--
Peo vi ok t Co v - 1:e.- - r 2 cam' A-- Q?1b &14--e. ( R, P, I De,v1 c.e.) IL :rave tu,ti1; n.
Fay CZ c,�clp hA-A
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
1AFAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (TdLv A_ JS - V\ DA _. Date: hi) q I DR') Phone #: (503) 718-
CITY OF TIGARD , `
BUILDING DIVISION PERMIT #: PLM200B -00404
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/16/2008
Phone: (503) 639-4171 iso., I� •
Inspection Requests (24 Hrs.): (503) 639 -4175 AL
INSPECTION WORKSHEET FOR DATE: 10/3017008 TIME: 7:00AM PAGE: 3
SITE ADDRESS: 11945 SW PACIFIC HWY 202 CLASS OF WORK:
SUBDIVISION: TIGARD PLAZA LOT #: 002 TYPE OF USE:
PROJECT NAME: LUCKY DE_I-I
DESCRIPTION: Interior plumbing.
OWNER: TIGARD PROPERTIES INC, PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503-692-4139
Inspection Request Scheduled For: Date: 10130/2008 Pour Ti • e:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 077411 -01 503-692-4139 Y
Corrections /Comments/ Instructions:
❑ PASS ❑ PARTIAL APPROVAL [CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718-
TIGARD .. , A.A.,, ...,
,
i DIVISION PERMIT #: m ^ �Lf�JF��h,�,�
'all Blvd., Tigard, OR 97223 i _ DATE ISSUED: ,i, i5 2fli,'i
..e3) 639 -4171 i i a,11 'i l
Ii Requests (24 Hrs.): (503) 639 -4175 F.
r
CTION WORKSHEET FOR DATE: io134]6 006 TIME: d :iltlA?VI PAGE: •1
/
` SITE ADDRESS: 11946 SW PAc li - .IC i }WY ':'02 CLASS OF WORK:
SUBDIVISION: °I 10ARD PLAZA LOT #: 002 TYPE OF USE:
PROJECT NAME: LUcKX t> - ..
DESCRIPTION: intslior plrJrnbit4i.
OWNER: Ti CARD PROPER) IFS it %ii., -. PHONE #:
CONTRACTOR: Rfrymo N'S I`I UMLINe, IN( PHONE #: 60 6:;2-1111q1
Inspection Request Scheduled For: Date: •ilj U/ OB Pour Time:
Code # Inspection Description Confirm # Contact # Message
393 Plumbing final 077411 01 6O3•092#13E Y
Corrections /Comments / CI:4/k r, tt ✓( )14.0%)
J
•
r V • . , r- ,. - -
.
i 1. : / r. - ._ V
❑ PA ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL 7C, ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718 -
1
I
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008-00401
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/155/2008
Phone: (503) 639- 4171'tli �i
Inspection Requests (24 Hrs.): (503) 639 -4175 "� I..
INSPECTION WORKSHEET FOR DATE 10131/ 2008 TIME: 7 :00AM PAGE: 46
SITE ADDRESS 11945 OF WORK:
SUBDIVISION: 11945 SW PACIFIC HWY 202 TIGARD PLAZA 002 LOT #: TYPE OF USE:
PROJECT NAME:
LUCKY DELI
DESCRIPTION: Interior plumbing.
OWNER: TIGARD PROPERTIES INC, PHONE #:
CONTRACTOR: RAY BORN'S PLUMBING INC PHONE #: 503.692 -4 l39
Inspection Request Scheduled For: D ate: 1Q/31/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 077419 -01 971 - 506.6414 Y
Corrections/Comments/Instructions:
to — _ .. �i. - • t•■) cv 1/l • F k,o Otc:
ew k i- (AAA ,...- q i -1" C , ,4-,...„-A-- LA..) i -Mx (-,J G, \ \ .
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S l r (-AK-4 J , e r, u,eIr . ` .1 t / J C1 W ai. k, 1,
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _11 \s`...._. Date: 1 1,3 •D h) Phone #: (503) 718-
,
CITY OF TIGARD ; ._:L
BUILDING DIVISION PERMIT #: PLM200B -00404
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/15/2008
Phone: (503) 639 -4171 r�qp i I
Inspection Requests (24 Hrs.): (503) 639 -4175 ``'f��
INSPECTION WORKSHEET FOR DATE: 10/21/2008 TIME: 7:00AM PAGE: 25
SITE ADDRESS: 11946 SW PACIFIC HWY 202 CLASS OF WORK:
SUBDIVISION: TIGARD PLAZA LOT #: 002 TYPE OF USE:
PROJECT NAME: LUCKY DELI
DESCRIPTION: Interior plumbing.
OWNER: TIGARD PROPERTIES INC, PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 -692 -4139
Inspection Request Scheduled For: Date: 10/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 076972 -01 503-692-4139 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Ca Wi ■A-i NSLN-'j: Date: IQ, 1'2_ \1 cl 41 Phone #: (503) 718-