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Permit �=�CITY OF TIGARD (.7 COMMUNITY DEVELOPMENT DEPARTMENT 13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 839 -4171 PLUMBING PERMIT PERMIT # ^ PLM95 -0153 639 -4171 DATE ISSUED: 07/31/95 PARCEL: 29103DD -01200 SITE ADDRESS...: 13970 SW PACIFIC HWY SUBDIVISION ZONING: C -G • BLOCK . LOT CLASS OF WORK..: NEW GARBAGE DISPOSALS..: MOBILE HOME SPACES.: TYPE OF USE •COM WASHING MACH - BACKFLOW PREVNTRS..: OCCUPANCY GRP..:B1 FLOOR DRAINS •1 TRAPS • STORIES WATER HEATERS CATCH BASINS FIXTURES - LAUNDRY TRAYS SF RAIN DRAINS..... SINKS URINALS GREASE TRAPS LAVATORIES •1 OTHER FIXTURES TUB /SHOWERS SEWER LINE (ft) • WATER CLOSETS,..:1 WATER LINE (ft' DISHWASHERS RAIN DRAIN (ft) . Remarks: Chevron station and office bldg. PLUMBING. Owner: FEES CAIN PETROLEUM type amount by date recpt 2624 PACIFIC AVENEUE PRMT $ 36.00 B 07/31/95 95- 268681 PLCK $ 5.00 B 07/31/95 95- 268681 FOREST GROVE OR 97116 5PCT $ 1.80 B 07/31/95 95- 268681 Phone #: 357 -9711 Contractor: CAMPBELL PLUMBING & HEATING 14755 SE 232ND DR. BORING OR 97009 - - - - -- Phone #: 46.80 TOTAL Reg #..: 81777 REQUIRED INSPECTIONS - This permit is issued subject to the regulations contained in the Water Line Insp Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Service In applicable laws. All work will be done in accordance with Rough -in Insp approved plans. This permit will expire if work is not started P L M / U n d e r f l o o r within 180 days of issuance, or if work is suspended for more Top-out Insp than 180 days. Storm Drain Insp Rain Drain Insp _ Misc. Inspection Final Inspection _ Permittee Si nat-u_ur 1',�I /. 01 , f ' _ Final Inspection _ Issued By: Call for inspection -- 639 -4175 - City ,pf Tigard ?� - -- PLUMBI t - ERMIT AP - ATION P k/Rec. # 7 i t! ' 13125 SW Hall Blvd 5 • , :(4( p- t, � ermit # / Tigard, OR 9722 01 .� ► 44 .. -_, 16 -760A-r - sidg 9v B 3a 6. (503) 639 -4171 INI .00 PERMIT FEE + ST. SURCHARGE Name q 7 6 � ,........e.9 New Single Family Residences Only Job / / ,� ❑ 1 BATH HOUSE $140.00 ❑ 2 BATH HOUSE $195.00 ❑ 3 BATH HOUSE $225.00 Address aMSate to Fee includes all plumbing fixtures in the dwelling and the first 100 feet of water service, sanitary sewer and storm sewer. See fees below. Name (or name of B as nel ( FIXTURES QTY PRICE AMT CAAAiRde r O `'Q (k PI 7 251 - ' 11 Sink 9.00 Ir- Matt Address P^0 Lavatory / 9.00 Mtgagr 7-102- Pq�� �NiQ e Tub or Tub /Shower Comb. ` 9.00 City/State ZIP Shower Only 9.00 VvYfSk broUe ore ° lirt to Water Closet I 9.00 7 Name (or name a Maness) Dishwasher 9.00 Garbage Disposal 9.00 Occupant maim) Ad,.. Phone Washing Machine 9.00 Floor Drain I " 9.00 q DgylStea ZIO Water Heater 9.00 Laundry Room Tray 9.00 Name Urinal 9.00 O uvi 1 .1' (5 r It..,lM k& J 4 (-1.k • Other Fixtures (Specify) 9.00 Marty Addr 1 -• vnona 9.00 Contractor 1141 5 56 - .2- 9.00 'Shta zio 9.00 4 11111111.11P ,Vvy, � �� '^ (� Ore- /100' Sewer 1st 100' 30.00 State Regelmnon M. _ Gn r c . � 3 . me. Sewer - ea. Addit. 100' 25.00 '1 �7 P6 to 31 J Water Service 1st 100' 30.00 I hereby acknowledge that I have read this application, that the Water Service ea. Addit. 200' 25.00 information given is correct, that I am the owner or authorized agent of the owner, that plans submitted are in compliance with State laws, that Storm & Rain Drain 1st 100' 30.00 I am registered with the Construction Contractor's Board, that the Storm & Rain Drain Addit. 100' 25.00 number given is correct. (If exempt from State registration, please give reason below.) Mobile Home Space 25.00 Back Flow Prevention Device or Anti - Pollution Device 9.00 Signature (meter et agent) Date Any Trap or Waste Not Connected to a Fixture 9.00 Describe work new 0 addition 0 alteration 0 repair 0 Catch Basin 9.00 to be done residential 0 non - residential 0 Insp. of Exist. Plumbing 40.00/hr Specially Requested Inspections 40.00/hr Existing use of building or property Rain Drain, single family dwelling 30.00 Residential backflow prevention devices 15.00 Proposed use of building or property '(Except residential backflow prevention devices) NOTICE 'Minimum Fee $25.00 SUBTOTAL CO 5, PERMITS BECOME VOID IF WORK OR CONSTRUCTION q 6 AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE i ,/ CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED `/ ® � j - - FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS 9 COMMENCED. PLAN REVIEW 25% OF SUBTOTAL ) TOTAL / fp $���/ Special Conditions /� �7� ,� Date issued /.. / ( 4 / 5---- by 1� - 1 " -- CAMPBELL'S PLUMBING & HEATING & GENERAL CONTRACTING "One Call Does It All" 14755 SE 232nd Dr. BORING, OREGON 97009 (503) 651.3137 RECEIVED • March 16, 2000 MAR 2 4 2000 Hap Watkins COMMUNITY DEVELUPMEN1 City of Tigard 13125 SW Hall Blvd. Tigard, Oregon 97223 -8199 • Dear Mr. Watkins: AFFIDAVIT Re: Cain Chevron 13970 SW Pacific Highway Tigard, Oregon 97223 This is my affidavit as to the facts and procedures regarding the plumbing installation at the above facility. All inspections were requested and inspections completed by ..the City of Tigard inspectors. Additionally, all plumbing was installed per the codes in effect at that time. Underground: Water waste and vent passed inspection. 50 pound water test, 10 ft head on waste. Top Out: Water waste and vent passed inspection. 50 pound water test, 'fill system through roof. Final: Set fixture caulk and seal passed inspection. Set water heater at 110 degrees. Approximate date of final inspection was 10/15/95. This is based upon my final billing date. Sinc ly, i/ Date: .2 / 7 ^ 00 Campbell Munn Campbell Plumbing and Heating 14755 SE 232 " Drive Boring, Oregon 97009 Al* •a & r � c �J s P/d p4 �I ° /% i 4 !� Pr� ela yr / 124 . 3 /� ,� Do' -- f STATE OF OREGO FORM No. 23—ACKNOWLEDGMENT. Stevens -Ness Law Publishing ing Co. Co. NL �j SS. Port land, OR 97204 © 1992 County of ... �. BE IT REMEMBERED, That on this 1-2 day of �' before m the u dersigne� a Notary Public in and for the State of Oregon, personally appeared the within . named . M p e11. - -..11 - X11 !1.11 r known to me to be the Aientica individual described in and who executed the within instrument and acknowledged to me that iy ei ./ ll.'i44.4.. executed the same freely and voluntarily. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my official seal the day a d y ar la above written. � ` OFFIC A L LOUISEA SE h' NOTARY PUB OE 7 E2 1 3 1 8 6 ��� ^; LIC - OR Not y Public for Oregon r COMMISSION NO . - c? deg. �, . M?hls! ?- n l kPI REt �F�3 My commission expires ,., 2 001 :wr- 03/30/2000 Activities for Case #: PLM95 -00153 10:12:10 AM Assigned Hold Updated Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes PLMC010 Plan check by 06/30/1995 MS APPR JHF 06/30/1995 PLMC799 Final Inspection . 11/01/1995 MS PART MRS 11/02/1995 req.overflow scuppers on bldg and cannopy PLMC720 PLM /Underfloor 06/30/1995 08/18/1995 MS PASS MRS 08/21/1995 need to insulate abs pipe in concrete PLMC725 Top -out Insp 06/30/1995 09/12/1995 MS APP GES 09/13/1995 TOPOUT OF OFF I CE /STORAGE /RESTRM PLMC730 Storm Drain Insp 06/30/1995 09/12/1995 GS APP GES 09/13/1995 STORM COMPLETE EXCEPT 2 CATCH BASONS UNDER CANOPY PLMC740 Misc. Inspection 06/30/1995 08/24/1995 MS PART MRS 08/24/1995 oil seperator line needs to be ' tested PLMCO50 (F) Ready to issue 07/31/1995 JSD CTR 07/31/1995 PLMC060 (F) Issue permit 07/31/1995 ' BON B 07/31/1995 PLMC740 Misc. Inspection 08/25/1995 TLP PASS TLP 08/28/1995 oil water seperator PLMC800 Case Finaled 11/03/1995 MS PASS MRS 11/03/1995 • Page 1 of 1