Permit '.. _CITY OFTIGARD
COMMUNITY DEVELOPMENT DEPARTMENT
13125 SW Hall Blvd. Tigard, Oregon 97223.8199 (503) 639 -4171 PLUMBING PERMIT
PERMIT # • PLM95 -0193
639 -4171 DATE ISSUED: 10/16/95
' PARCEL: 2S110DC -00100
SITE ADDRESS...: 15570 SW PACIFIC HWY
SUBDIVISION ° WILLOW BROOK FARM ZONING: C -G
BLOCK • LOT •11
CLASS OF WORK..:NEW GARBAGE DISPOSALS..:1 MOBILE HOME SPACES.:
TYPE OF USE -COM WASHING MACH BACKFLOW PREVNTRS..:4
OCCUPANCY GRP..:B2 FLOOR DRAINS .9 TRAPS
STORIES • WATER HEATERS •3 CATCH BASINS •
FIXTURES LAUNDRY TRAYS SF RAIN DRAINS •
SINKS •14 URINALS •2 GREASE TRAPS
LAVATORIES •7 OTHER FIXTURES •80
TUB /SHOWERS • SEWER LINE (ft) °1
WATER CLOSETS..:7 WATER LINE (ft) •1
DISHWASHERS •1 RAIN DRAIN (ft)
Remarks: 54,142 sq. ft. single story grocery store
Owner: -• FEES
STERLING DEVELOPMENT CORPORATION type amount by date recpt
LA JOLLA CORPORATE CENTER PRMT $ 1212.00 B 10/16/95 95- 271662
3252 HOLIDAY COURT, SUITE 225 PLCK $ 303.00 B 10/16/95 95- 271662
LA JOLLA CA 92037 5PCT $ 60.60 B 10/16/95 95- 271662
Phone #: 619 -546 -8841
Contractor:
MSI PLUMBING
PO BOX 7035
BEAVERTON OR 97007
Phone #: 642- 1234 $ 1575.60 TOTAL
Reg #..: 51823
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Sewer Inspection
Tigard Municipal Code, State of Ore. Specialty Codes and all other Water Line Insp
applicable laws. All work will be done in accordance with Water Service I n
approved plans. This permit will expire if work is not started PLM /Underfloor
within 180 days of issuance, or if work is suspended for more Top -out Insp
than 180 days. Storm Drain Insp
Rain Drain Insp
1 Misc. Inspection
`\�� RP /Backflow Prey _
Permittee Si. at�_ire I u f �l f Final Inspect ion
Issued By: . IA2 4..■ / // l'\..-/ -
Call for inspection - 639 -4175
City of Tigard PLUMBING PERMIT APPLICATION Planck/Rec. # 7- 3 C
131 SW. Hall 3lvd. j d fr\J!. S. SS - -- Permit # 7 /74 - oT
;"Tigard, OR 97223 y ,u(L -o �c
(503) 639 -4171
4Aww) 31h B MINIMUM $25.00 PERMIT FEE + ST. SURCHARGE
a New Single Family Residences Only
ml -TO 1 b e, Je 0 1 BATH HO USE 5740.00 ❑ 2 BATH HOUSE 5195.00
Job ❑ 3 BATH HOUSE $225.00
Address w O m Fee includes all plumbing lboctures in the dwelling and the first 100 feet
of water service, sanitary sewer and storm sewer. See fees below.
"� �° FIXTURES GTY • PRICE AMT
k ;# e - Sink Mak 9.00 I
(1� b19 » 1 Lavatory 9.00 ?? V
Owner 1 24 , --V1.- Ol v � C ` . '� =_ Tub or Tub/Shower Comb. 9.00
I�, Shower Only 9.00
I t la , el23O 1 water Closet
7 9.00 V
a /
" 9.00 9
Occupant t A Garbage Disposal 9.00 / Washing 1 � y u '41� rain 7, 9.0o g /
�� Water Heater ? 9.00 g
G ' . � 0 % �1 Laundry Room Tray J 9.00
Urinal A 9.00 /
]'v . MS I NAM n iCQJI l ` F'a S °-iM4 + Other tures (Specify) I 9.00
oo i -CM $ ti /0 9.00 GA
Contractor
4 )(16 - 5 ..cA) 6 .21-cAAJ \ \V C-A . S- E.iOD re s e `tr47)$ _3 9.00 7
WI :° case c .�r- lr� s- 6/ 9.00 S ll9 i
Q` Of `� 7 � Sewer 1st 100' / 30.00 d
m° R., ..om - car 9a Tat N,. Sewer - ea. AddiL 100' 25.00
Water Service 1st 100' J 30.00 3 0
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 Mobile Home Space 25.00
give reason below.)
iyVz Badc Flow Prevention
Device or Anti - Pollution Device 9.00 6
. a... ° own A l / D My Trap or Waste Not
// ire / _ 4 o� 7. is 9 , F Connected to a Fixture 9.00
• : work n , addition 0 alteration 0 pair 0 Catch Basin 9.00
to be done ' • - ntial 0 non - residential 0 Insp. of Exist Plumbing 40.00/hr
Specially Requested Inspections 40.00/hr
Existing use of ^
building or property i 42 4 d I Rain Drain, single family dwelling 30.00
Residential back low prevention
devices 15.00
Proposed use of :7.. ^ Q 0 i Pta (/1 _5 q 4/5
building or property r'�C C•I
'(Except residential backllow
OC�, f 1 V.:
prevention devices) ��
NOTICE 'Minimum Fee $25.00 SUBTOTAL /
PERMITS BECOME VOID IF WORK OR CONSTRUCTION 0 a
AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF 5% SURCHARGE IIWW / /)
CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED p
FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS �
COMMENCED. PLAN REVIEW 25% OF SUBTOTAL VJ
a
TOTAL
Special Conditions
Date issued by i r75 , l/ V T1
1/21/00 Activities for Case #: PLM95- 00193
4:28:55 PM
Assigned Hold Updated •
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC007 Application received 7/28/95 JD PEND B 8/8/95
PLMC010 Plan check by 10/6/95 MS PASS MRS 10/6/95
PLMC799 Final Inspection 4/2/96 TLP PASS TLP 4/2/96 .
PLMC120 Plumbing Undersl - 10/6/95 10/17/95 MS PASS • MRS 10/17/95 public toilet rm ok partial call
back on remaining
PLMC711 Water Service Insp 10/6/95 10/20/95 TLP PASS TLP 10/20/95
PLMC725 Top -out lnsp 10/6/95 1/24/96 MS PASS - MRS 1/25/96 water ok around bldg toilet rm
nw corner ok
PLMC730 Storm Drain Insp 10/6/95 2/8/96 TLP PASS TLP 2/12/96 •
PLMC735 Rain Drain Insp 10/6/95 2/8/96 TLP PASS . TLP 2/12/96
. PLMC750 RP /Backflow Preventer 10/6/95 " 3/29/96 TLP PASS TLP 4/2/96
PLMCO50 (F) Ready to issue 10/6/95 JDA PASS JDA 10/6/95
PLMC060 (F) Issue permit 10/16/95 BON PASS B 10/16/95
PLMC120 Plumbing Undersl 10/20/95 TLP PASS TLP 10/20/95
PLMA130 Plumbing Undersl • 10/24/95 TLP PASS TLP 10/25/95 •
PLMC120 Plumbing Undersl 10/25/95 TLP PASS TLP 10/25/95
PLMC120 Plumbing Undersl 11/2/95 MS PASS MRS 11/2/95 case drains east side
PLMC120 Plumbing Undersl 11/7/95 MS PASS MRS 11/7/95 grease traps
PLMC120 Plumbing Undersl 11/14/95 TLP PASS . TLP 11/15/95
PLMC120 Plumbing Undersl 11/17/95 • TLP PASS TLP 11/17/95
PLMC120 Plumbing Undersl 1/30/96 1/29/96 MS PASS MRS 1/30/96 delhi bakery ok
PLMC725 Top -out Insp 2/8/96 2/7/96 TLP PASS TLP 2/8/96
•
PLMC735 Rain Drain Insp 2/15/96 2/14/96 TLP PASS TLP 2/15/96
PLMC735 Rain Drain lnsp • 2/21/96 2/21/96 TLP PASS TLP 2/21/96
PLMC800 Case Finaled • - 4/2/96 TLP PASS TLP 4/2/96
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