Permit A b,.. CITY OF TIGARD
PLUMBING PERMIT
% DEVELOPMENT SERVICES DATE ISSUED: 01/28/98 • 8 -0026
LM9
PARCEL: 1S135DD -03301
SITE ADDRESS...: 11945 SW PACIFIC HWY #250
SUBDIVISION • HOFFARBER TRACTS N0.1 ZONING: C —G
BLOCK • LOT •002 JURISDICTION: TIG
CLASS OF WORK..:ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE •COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 1
OCCUPANCY GRP..:B FLOOR DRAINS • 0 TRAPS : 0
STORIES • 0 WATER HEATERS • 0 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS • 0 SF RAIN DRAINS • 0
SINKS • 0 URINALS • 0 GREASE TRAPS • 0
LAVATORIES • 0 OTHER FIXTURES • 0
TUB /SHOWERS...: 0 SEWER LINE (ft)...: 0
WATER CLOSETS.: 0 WATER LINE (ft)...: 0
DISHWASHERS • 0 RAIN DRAIN (ft)...: 0
Remarks: Safeway — Install backflow prevention device.
Owner: FEES
TIGARD PROPERTIES type amount by date recpt
2106 SE OCHOCO ST PRMT $ 25.00 DRA 01/28/98 98- 302852
MILWAUKIE OR 97222 5PCT $ 1.25 DRA 01/28/98 98- 302852
Phone #:
Contractor
MYERS & SONS PLUMBING
6024 SW JEAN RD, BLDG F
LAKE OSWEGO OR 97035
Phone #: 684 -6602 $ 26.25 TOTAL
Reg #..: 000403
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the RP /Backf low Prey
Tigard Municipal Code, State of Ore. Specialty Codes and all other Final Inspection
applicable laws. All work will be done in accordance with
approved plans. This permit will expire if work is not started
within 188 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 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Issued •y: 6 Permittee Signature: , _ .7i OA
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
TY OF TIGA.RD Plumbing Application Reed �3
125 SW BLVD. Commercial and Residential Date Reed / - gig - /
GARD, OR 97223 Date to P.E.
Date to DST
'03) 639 -4171 Pandit s 1 9 it af
Print or Type Related SWR e
Incomplete or illegible applications will not be accepted Called
/1 4V 4669SZ) - _
-
Name of Development/Project , FucTURES, Qndividwl) 0101104911M3111§ k 4 4AmTit
snit 9.00
Job
5AriE\N Ai hA.ce ... ' Lavatory - • 9.00
Address Suite
2. 50 j 1( /§ e i PLA ?A _ Tub or Tub/Shower Comb. 9.00
Bldg s I y City � / Zip Shower Only 9.00
1 aosita) Gil in Water Closet 9.00
7 2,0 lic : / A.< . , Dishwasher ,
9.00
Owner Mailing Address Suite Garba Dis 9.00
•D/C& g9 to it ' vT , Pone Machine 9.00
r YI 1.wRa 6/, f 6. / Z IS g' Y - Floor Drain r 9.00
Name
- 4 ' 9.00
7cc upant Maigng Address Suite Water Heater 9.00
Laundry Room Tray 9.00
City/State Zip Phone Urinal - 9.00
Name Other Fixtures (Specify) 9.00 .
M`I EQ.S E & OS loix nn8),J6 . 9.00
Contractor Madrng Address suits - 9.00
(co ,24 Sid Jam/ 9.00
„Prior to issuance /State _ Zip
applicant ust KE, lW U/tth 0 -17 (b S�'l - ipir O ? 9.00
m
provide all Oregon Cans Cont. Board Lice Exp. Date 9.00
contractors - 4D t )1-10 -Q g ' 9.00
license Plumbing tjc. a M Exp. Date - Sewer - let 100' . 50,00
information , - 3DS l 3 1 - 31 q b d Sewer - each additional 100' 25.00
for COT COT Business T or Metro I Exp. Date
database). 3 /.:3 g . 4- 1- 9 Water Service -1st 100' 30.00
Name Water Service - each additional 200' 25.00
Architect Storm a Rain Dram - let tar • 30.00
Or Malting Address Suite Storm a Rain Drain - each additional 100' 25.00
Mobile Home Space 25.00
Engineer caristate Zip Phone P �t Flow Prevention Device or Arai- I 25.00
• Describe work New 0 Addition 0 Alteration , O Repair g Residential Baddlow Prevention Device* 15.00
7 be done: Residential 0 Non- residential lyE / Any Trap or Waste Not Connected to a Fixture 9.00
,+editions description of worts
Catch Basin 9.00
Insp. of Existing Plumbing . 40.00
per/ hr
aisting use of (y / Specially Requested Inspections 40.00
pedhr
wilding or property l ,0 n1 i�1 ( A . lA 1. GI2Oe ° n j t
Rain Dram, single family dwelling 30.00
Proposed use of Grease Traps 9.00
building or property
QUANTITY TOTAL w - - ; 1 f --.
Are you capping , moving or replacing any fbcRUes? Yes CI No p Isomeric or riser diagram is reputed a Quality Total is 9 • j s s f '
(If yea see back of form) 'SUBTOTAL . - a :. - - -. `. /�
• i hereby acknowledge that I have read this application, that the information 1 - �(
liven is correct. that I am the owner or authorized agent of the owner. and 5% SURCHARGE ,; 1 n 5
at Clans submitted are in compliance with Oregon State laws. :r ~= . 1 •
gh d
Signature of NAge Date PLAN REVIEW 25% OF SUBTOTAL - _ , i
P `[ I�O I�Fi� `Y Q1 /L� �28/28/9e, f rostra Repuie0 only ply. total is ; 9
TOTAL 2, /
acuttlat Person Name Phone
•MInknum permit fee is 525 . 5% surcharge. except Residential Beddow -
(y 8.9-660- Prevention Device. which is 515 + 5% surcharge
I: \plmapp.doc 12/96 (dst)
'LEASE COMPLETE AS APPROPRIATE TO PROJECT:
Fixtures to be capped, moved or replaced Qty ..:
Sink
Lavatory
Tub or Tub /Shower Combination -
Shower Only
Water Closet _
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain 2" - _..:
3" - - .
.. . 4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify) -
:OMMENTS REGARDING ABOVE:
I:\plmapp.doc 12/96 (dst)
Page No. 1 CASE HISTORY FOR CASE NO.: PLM98 -0026
TIGARD PROPERTIES
•
11945 SW PACIFIC HWY Unit: 250
11/18/98
Action Description Req/ Schd/ End/ Action Notes Disp By Update Upd
Code Sent Done Done Date By
PLMC003 Application received / / / / 01/28/98 RECD DRA 01/28/98 DST
PLMC005 Permit Created / / / / 01/28/98 DONE DRA 01/28/98 DST
PLMCO50 (F) Issue permit / / / / 01/28/98 DONE DRA 01/28/98 DST
PLMC750 RP /Backflow Preventer 01/28/98 / / 04/01/98 Reduced Pressure Device Okay PASS WA 04/02/98'J *H
PLMC799 Final Inspection / / / / 04/01/98 PASS WA 04/02/98 J *H
PLMC800 Case Finaled / / / / 04/01/98 PASS WA 04/02/98 J *H
•
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3l0
3 -3 /
CITY OF TIGARD BUILDING INSPECTION DIVISION
• 24 -Hour Inspection Line: 639 -4175 Business Phone: 639 -4171
Date Requested: 4 ^ / — ! ti A.M. P.M. MST:
Location: // 9 4 .-/S (7 A 6 BUP:
Tenant: T / : F6- J ( QLD) Suite: 2 5 MEC:
03 9 — Lis 71 — dog
Contractor: le, _74/ A.. t . 4 % Phone: f �e PLM
Owner: , r . d _� �� L // Or ' o - : 4 r0 0 -6 LC:
( [ J '/-67 zejteji ELR:
/ //L
..- SIT:
BUILDING BLDG (con't / ss„ 11 13 I ` ) MECHANICAL ELECTRICAL SITE
Site Post/Beam Post/Beam Post/Beam Cover /Service Sewer /Storm
Footing Roof UndFl/Slab Rough -In Ceiling Water Line
Slab Framing Top Out Gas Line Rough -In UG Sprinkler
Foundation Insulation Sewer Hood/Duct Reconnect Vault
Bsmt Damp Drywall Storm Furnace Temp Service MISC.
Masonry Ceiling Rain Drain A/C UG Slab
Shear /Sheath Fire Spklr /Alm Crawl/Found Dr Heat Pump Low Volt 0 / / /'
Approved rove Approved Approved : Tpr....
Appr /Sdwlk Not Approved Not A proved Not Approved Not Approved No • pproved
FINAL k N r FINAL FINAL FINAL
Aft ' igO ck IELv14J j aei5 L/ppit o'' (' C
1
O Call for re' o O Reinspection fee of $ next inspection O Unable to inspect
Inspector: //� Date: /71irepefore
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