Permit 4 CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES �� ' PERMIT #: PLM1999 -00432
= '� 13125 SW Hall Blvd.,.Tigard, OR 97223 (503) 639 -4171 V�' . DATE ISSUED: 12/15/99
SITE ADDRESS: 15570 SW PACIFIC HWY
" Y ' PARCEL: 2S110DC -02200
SUBDIVISION: WILLOW BROOK FARM ZONING: C -G
BLOCK: LOT: 011 RISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
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
Remarks: Install 2 commercial back flow prevention devices in existing commercial building.
FEES
Owner:
Type By Date Amount Receipt
TIGARD CENTER LP PRMT DEB 12/15199 $64.00 99- 320444
9777 WILSHIRE BLVD #609 5PCT DEB 12/15/99 $5.12 99- 320444
BEVERLY HILL, CA 90212
Total $69.12
Phone 1:
Contractor:
MYERS + SONS PLUMBING
6024 SW JEAN RD, BLDG F
LAKE OSWEGO, OR 97035 REQUIRED INSPECTIONS
Phone 1: 684 -6602 RP /Backflow Preventer
Reg #: LIC 00040389 Final Inspection
PLM 26 -305PB
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 181 • - ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
No • "cation Cente . Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
'feu may obtain copie . of these r _les or direct questions to OUNC by calling (503) 246 -1987.
, ,
Is • ed By: , %o � tik.# Permittee Signature: I
- Call (503) 639 75 by 7:00 P.M. for an inspection needed • next bu iness day
ITY OF TIGARD Plumbing Application Recd By St9
3125 SW HALL BLVD. Commercial and Residential Date ReCd 57 1
'IGARD, OR 97223 owe to P.E.
5031639-4171 Date to DST
Permit: ftivi, 99 - O t) 02-
Print or Type Related SWR s
Incomplete or illegible applications will not be accepted Called
Name of DevelopmenuProject F!xty $/30 000 414101te31110 4 .tp,1E. . IOWA
Job Sint` 9.00
Address Street Address ,• _ Suite 9.00
/5 S ri PAci F , 4. j / Ilu y Tub or Tub /Shower Comb. 9.00
Bag 5 ty /State Zip Shower Only 9.00
1&4r2 6 9 7Z2-3 Water Closet 9.00
Name Tt e. rd` Ce c4c Dishwasher
9.00
Owner Mailing Address ' ' ■ ' Suite Garbage Disposal 9.00
9 t41,51 tr¢, 41 J ho' Washing Machine 9.00
& l j it (13 n l, - � 7o2►2_ Phone Floor r Drain r
I J 9.00
Name
£AFtL..)A .�73,Pe.� 4' 9.00
Occupant "ailing Address Suite Water Heater 9.00
Laundry Room Tray 9.00
Clty/State Zip Phone Urinal 9.00
_ Name - Other Fixtures (Specify) 9.00 -
MI YE AS C is AukiRag 9.00
Contractor suite 9.00 .
_ la,) J.EAA/ el
9.00
( appl cant must Jj f) � 7 035 '� 640 9.00
provide all Oregon ccppn�stst.. Cont. Board Lac.* Exp. Dater - 9.00
contractors ' 1\11
9.00
information Pturnbu ,�o5 /08 7 311 oo O ' Sewer- 1st too 25.00
Sewer -each additional tar 23.00
f database).
for COT COT B :j � or Metro s Exp. Date
dat Water Service -1st tar 30.00
•
Name Water Service - each additional 200' 25.00
Architect Storm & Rain Drain - 1st tar . 30.00
Or Mailing Address Suite Storm a Rain Drain - each additional tar 25.00
Mobile Home Space 25.00
Engineer City/State Zip Phone Commercial Back Flow Prevention Device or Anti- .2&1115
• Pollution Device A 32-- lEce-yi%3
esaibe work New 0 Addition 0 Alteration 0 Repair O Residential Badlow Prevention Device' 15.00
be done: Residential 0 Non - residential 0 Any Trap or Waste Not Connected to a Fixture 9.00
:ditionat description of work
lN,s•7 t c Q P V /C6 S Pte' e. y &A Chu'" 9.00
T71, 4L . 0 iAi $3 r- Insp. of existing Phumtuing V _ 40.00
per/hr
sting use of /� Specially Requested Inspections 40.00
per/Fir ,
riding r property &2066. v .S o ,C_L Rain Drain, single family dwelling 30.00
oposed use of Grease Traps 9.00
.udding or property
QUANTITY TOTAL . p. Are you capping moving or replacing any fixtures? Yes 0 No V) Ism or riser man m
is misted it Ouana : y Total is 3 • 9 - ■ .:.:.f. a =. - + a
a
If yes see back of form) *SUBTOTAL -- .,_ ••• ,� _ b
hereby acknowledge that I have read this application, that the information
wen is correct, that I am the owner or authorized agent of the owner. and 81% SURCHARGE . •, 5 , t t/
at plans submitted are in compliance with Oregon State Laws.
'denature of rlAgent Date PLAN REVIEW 25% OF SUBTOTAL - 7 . 7 .: - s
'/ 9
P hone Reamed only f fixture sty. total it r, 9 A,. v
1 • �T `� TOTAL '< - y - 6- r0 (C I 1
1.'? 4,otr�a Pers �J'I
'•'
/�U , / 'Minimum permit fee is 525.5% surcharge. except Residential Ba ow
My . (p r7 -44, _ Prevention Device. which is 515.5% surcharge
I:lplmapp.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)
1/21/00 Activities for Case #: PLM1999 -00432
4:28:36 PM •
Assigned Hold Updated
Activity Description Date I Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC005 Permit Created. 12/15/99 KJP DONE No Hold KJP 12/15/99
PLMC003 Application received 12/15/99 KJP RECD No Hold KJP 12/15/99
PLMC750 RP /Backflow Preventer 12/15/99 12/15/99 No Hold KJP 12/15/99
PLMC799 Final Inspection 12/15/99 12/15/99 12/27/99 MRS PASS No Hold • AKJ 12/27/99 '
PLMCO50 (F) Issue permit 12/15/99 DEB DONE No Hold DEB 12/15/99
PLMC800 Case Finaled 12/27/99 AKJ DONE No Hold AKJ 12/27/99
•
•
•
•
•
•
Page 1 of 1
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested c /�7 / ' 7 / / PM BLD
Location /55 5,u) ate., P., G f ( 1 Suite MEC
Contact Person / f t S ' t5 P,c -, Ph (tike t p (o a.)-- PLM (? 3�
Contractor 00 Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain - SGN
Crawl Drain Inspection Note . � C° � J
Slab SIT
Post & Beam
Ext Sheath /Shear CA— ( Cahn - = (.. akCoT K 3(07
Ina Sheath/Shear
Framing ming + S d W/ US ` � f ' d- fors 194_,2t.
'r'ce.l
Insulation
Drywall Nailing 1 57 c Coo
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
AILFAIP j` ASRT FAIL ce ar,
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
rains
PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL •
ELECTRICAL
Service -
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
f ` Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access 1-1 ADA /
Otheoach /Sidewalk Date /a ' '2 / Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. . •