Permit CITY TIGARD PLUMBING PERMIT
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i DEVELOPMENT SERVICES PERMIT #: PLM2006 -00532
- ..� — 13125 SW Hall Blvd., Tigard, OR 97223 503 - 6394171 DATE ISSUED: 11/2/2006
PARCEL: 2S 103DD -00800
SITE ADDRESS: 13815 SW PACIFIC HWY 100 ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Installation of backflow preventer.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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
D.W. SIVERS COMPANY Description Date Amount
4730 SW MACADAM AVE
#101 [TAX] 8% State Surchari 11/2/2006 $5.80
PORTLAND„ OR 97201 [PLUMB] Permit. Fee 11/2/2006 $72.50
Phone : Total $78.30
Contractor:
MP (MILWAUKIE) PLUMBING CO
P.O. BOX 393 REQUIRED ITEMS AND REPORTS
CLACKAMAS, OR 97015
Backflow Test
Contact # : PRI 503 655 - 9161
FAX 503- 650 -7050
Reg #: LIC 5002
PLM 3 -17PB
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 -00! i 1 i rough OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
call' g 503 - 246 -6: • 9 0 332 -2344. S ._
Iss ed By: 1l j _ ' Permittee Signature: , ,,
, _ r 1 4. w
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.
Frbm: a 0 / 1/01/2006 15:42 #058 P.001/003
D I b RECEIVED ,
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Nov 0 - 2006 kt r
Plumbing Permit Annlicatbily QFT1GA' 1 1 ) t 01 I. 1 ()N1,1
City of Tigard BUiLD1NG HIV - 1 Received ;
13I25 SW Hall Blvd., Tigard, OR 97223 I Date/By: Permit No.: (,N l�la e06-3:2. , Plan
Phone: 503.639.4171 Fax: 503.598.1960 :I. t r; ,p... I . 1 Date Ow Other Permit No.:
24 Hour Inspection Line: 503.639.4175 s" Ready/gY ®
r ° ' Sea Page 2 for
Internet: www.ci.tigardor.us "' "� 1
Notified/Method: ii j Supplemental Information
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❑ New construction ❑ Demolition For special Information use checklist
Descri.tion • . Ea. Total
F i Addition/alteration/replacement ❑ Other:
{ I + ((.'', 'FFI r,•r s • I .edit II { .J itl<' ;;!Ciilli� I',' ' ; 'nI' i rr 'I';il' ;i', ;tl ^.,;, I JI'S Y " ? L° fi "i +l i SI 2 =' - I i r �; I � ! . , New 1-2-family dwellings (includes 100 R. for each utility connection)
�11 iV I`3Ll_r, 111 { t I 1 I 01 ft 11141u 11 ti..u., 11. �ti.1 i ill 2{i: i'ir r, I��d131i1 , 1 il L 1, .,I • :,, I4,? l i SFR (1) bath ■ 249.20
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El 1- and 2- family dwelling / � Commercial/ industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family
SFR (3) bath 399.00
❑ Master builder ❑Offer Each additional bath/kitchen 45.00
7 (�� • I �! I 5 I 1 Fire sprinkler ( sq. ft.) Page 2
F'I:1t1III1li fits 111 � lil ` 1I5 P• W �� ;I111Mig- 11''I'.illli In�1111191fbill(lT1,r.I lITl.11{,r i?Ilif d1F:'
:1. Ir- _.c„ .'“Ib Illl Id i..ice,... L_:. si ..hFirral = allki.ir-¢l.:m.:.Jt:ix!Inn t'1' i;;s:.lur11:2I�.1 :rJ1�rf.11 I t 'AI.!I Site utilities
Job site address: �,'�� il/ , Catch basin or area drain 16.60
City/State/ZIP: a,I d /" f / 3 Drywall, leach line, or trench drain 16.60
Suite/bldgJapt. no.: Project name: JF///J 4 - Footing drain (no. linear ft.: ) 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 ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: 1 f Page 2
Fixture or Item
Tax map/parcel no.: -
t c :I;,;� 17,,,' _ ;drf I: jl r'j t`i ;;1; =! F !at ?tl!athr na r:.isa ;rae nsn p5m t 1 -, 5!r 3 [I:'" 'ra ql : ; r ,. , + 1 0rt1 Absorption valve 16.60 �'�'Jh�
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, .' ��f � %% /� . Backwater valve 16.60
ai lid / Clothes washer 16.60
Dishwasher 16.60 '
r; ]:'N •' Ir I ` , I L° 1J4dIP ilia tl f IJr I t I i I - it '9 Z r : I,1 1 r e Id 11 Irll tr .7 i li I I 1 �1 ,hill
f Drinking fountain 16.60
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a•!1l 2 1 . ,i . i n: , to 1a _.11 _ JIII s 1 11∎1.79 ' .n11.'ni ..l �l .l I 81 1 h1.+ 1.l, l 1..;�' (11: ! .n . :1' ,rn ' ,l iI0 IIa: , I :II ,..1. I Ejectorsls 16.60
Name: ��///��
/S� : /i��Jf/ li Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City / State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
In 1 !! ;' 3 ". ; { ii i„ :n,° I! i'`i I (Ili ' 'l ll;'! 's ul I O:9' f l lilt I' I S ` 1 - l� � i. I uw 7: 31 F: jll; a c rtI L ; [� � I I _ ule � i; 1 i; Hose bib 16.60
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. 1111,1 11 II:l,i'.awl,lo o:. 1 .i:L111It ,,i!:Win: hill I iL l: 1.. I III I :Ifi:I1 I11.Ci l - 1.: . UII aI: L1). = 0 Lii IIP " I;I Ice maker 16.60
Business name: MP PLUMBING CO. Interceptor /grease trap 16.60
Contact name: TAMI Medical gas (value: 3 ) Page 2
Address: PO BOX 393 Primer 16.60
City/ State/ZIP: CLACKAMAS OR 97015 Roof drain (commercial) 16.60
Phone: (503) 655 -9161 l Fax: : (503) 650 -7050 Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
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ll fil[31111':nry; pill y 1z +c: ;r .;: ,x.l,•. 't'-n I^ . ;i 1Jnnal 16.60
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Business name: MP PLUMBING CO. Water heater 16.60
Address: PO BOX 393 ' Other: ,i
0. City/ State/ZIP: CLACKAMAS OR 97015 Subtotal (t//-
Minimum permit fee: $72.50
Phone: (503) 655 -9161 Fax: (503) 650 -7050 Residential backflow minimum permit fee: $36.25 f ce. •
CCB Lie.: 5002 SP-00 Plumbing Lic. no.: 3 -17PB .711 la Plan review (25% of permit fee) (O
Authorized signature: a,d/?u Stara surcharge (8% of permit fee)
TOTAL PERMIT FEE 1
I Print name: TAMI GEORGE I Date: //r f .4 This permit application expires If a permit Is not obtained wlthln a()
180 days after it has been accepted as complete. /5.
5.
*Fee methodology set by Tri -County Building Industry Service Board.
1.1 BuldinaiPerndtslPIM- PermitApp.doe sales 440-4616T(10/02/COM/WE8)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006 -00532
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/212006
Phone: (503) 639 -4171 41111-
Inspection Requests (24 Hrs.): (503) 639 -4175 .
INSPECTION WORKSHEET FOR DATE: 11/3/2006 TIME: 7:01AM PAGE: 56
SITE ADDRESS: 13815 SW PACIFIC HWY 100 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PETRONE DELI /LOTTERY
DESCRIPTION: Installation of backflow preventer.
OWNER: SIVERS COMPANY, D.W. PHONE #:
CONTRACTOR: MP (MILWAUKIE) PLUMBING CO PHONE #: 503 - 655 -9161
Inspection Request Scheduled For: Date: 11/3/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 039264 -01 503 - 655°9161 N
Corrections /Comments/ Instructions:
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-
o' ///4Y-
ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
n A Inspector: Dat e: Phone #: 5 718- 2' v3 )
p 116 (>