Permit 3 CITY OFTIGARD
' A, DEVELOPMENT SERVICES PLUMBING PERMIT
__ !+L `'L L 1 3125 SW HaII Blvd., Tigard, OR 97223 (503) 639 -4171 PERMIT # PLM98 -0452
DATE ISSUED: 12/10/98
PARCEL: 25112DD -01300
SITE ADDRESS...: 15650 SW UPPER BOONES FERRY RD
SUBDIVISION • ZONING: C —G
BLOCK • LOT • JURISDICTION: TIG
CLASS OF WORK..: ALT GARBAGE DISPOSALS.: 0 MOBILE HOME SPACES.: 0
TYPE OF USE -COM WASHING MACH • 0 BACKFLOW PREVNTRS..: 0
OCCUPANCY GRP..:M FLOOR DRAINS - 0 TRAPS : 0
STORIES • 0 WATER HEATERS . 0 CATCH BASINS • 0
FIXTURES LAUNDRY TRAYS - 0 SF RAIN DRAINS • 0
SINKS 3 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: Burgerville TI — relocate existing espresso area.
Owner: FEES
THE HOLLAND INC type amount by date recpt
109 W 17TH ST PRMT $ 27.00 GEO 12/10/98 98- 311444
VANCOUVER WA 98660 5PCT $ 1.35 GEO 12/10/98 98- 311444
Phone #:
Cont ract or
RALPH KUNSELMAN PLUMBING
15121 NE CLACKAMAS ST
PORTLAND OR 97230
Phone #: 704 -0378 $ 28.35 TOTAL
Reg #..: 127326
REQUIRED INSPECTIONS
This permit is issued subject to the regulations contained in the Rough —in Insp
Tigard Municipal Code, State of Ore. Specialty Codes and all other Underfloor /Under
applicable laws. All work will be done in accordance with Top—out Insp
approved plans. This permit will expire if work is not started Final Inspection
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- 0001 -0010 through OAR 952-0001 -0080. You may
obtain copies of these rules or direct questions to OUNC by calling
(503)246 -1987.
Alli
A A����
Issued By: Permittee Signatur :` ATAA �
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
Call 639 -4175 by 7:00 p.m. for an inspection needed the next business day
+++++++++++++++++++++++++++++++++++++++++++++++ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + ++
11/ ;0/98 MON 11:09 FAX 503 598 1960 CITY OF TIGARD Ij ooi
CITY OF: TIGARD Plumbing Permit Application ter, Check* /,V -/7 t'
1 13125 SW HALL BLVD. . Commercial and Residential Rid By
TIGARD, OR 97223 Date Redd iZ /�f9cP
(503) 639 -4171 Date to P.E.
Print or Type �/C Date to DST
Incomplete or illegible applications will not be accepted Parma* Pi'' u5/c
Related Si/ SSA `ig 0 3 3y
Caned / Z19 Af.0
Name of Development/Project = . r:, - .E= fi �R - _ ---. •
.t.,•-i v0'.',=•, = ,�''i:r_•,?�: '� -. - . .ixF k'` :. e
Job Burgerville #40 Remodel Sink triT
Address Street Address ( Suite Lavatory 9.00
15650 S.W. UBF Road I \ Tub or Tub/Shower Comb. 9.00
Bldg h1 I City /State Zip Shower Only 9.00
Lake0swego,OR 97035
Name Water Closet 9,00
The Holland, Inc. Dishwasher 9.00
Owner Mailing Address Suite Garbage Disposal 9.00
109 W. 17th St. Washing Machine 9.00
V a City/State nc o Z Ph Floor Drain/Floor Sink 2' 9.00
Vaouver,WA 8660 36 -443
Name 3' 9.00
•
Burgerville 4" 9.00
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 9.00
Same as Owner Gas piping requires a separate mechanical permit.
City /State Zip Phone - Laundry Room Tray 9.00 _
Urinal 9.00
Name
Ralph Kunselman Plumbino OtlherFixtures (spedfy) 9.00
Contractor Mailing Address Suite 9.00
15121 NE Clackamas St. _ 9.00
Prior to permit City/State Zip Phone Sewer - 1st 100' 30.00
issuance, a copy Portland, OR 97230 503/704 -037E Sewer - each additional 100' 25.00
of all licenses are Oregon Const Cont. Board tic.* Exp. Date
required if 127326 12/24/98 Water Service - 1st 100' 30.00
expired In COT Plumbl Uc. C ate Water Service - each additional 200' 25.00
database 26 - 2/28/99 Storm 8, Rain Drain -1st 100' 30.00
Name Storm & Rain Drain - each additional 100' 25.00
Architect Architects Associative, Inc. Mobile Home Space • 25.00
or Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 25.00
8515 -b NE HazelDell Avenue Pollution Device
Engineer Va / cou ver , WA 9 36 -7019 Residential devivicesrequirree Device* arate 15.00
Describe work to be done: restricted energy permit)
New 0 Repair 0 Replace with like kind: Yes XDX No O Any Trap or Waste Not Connected to a Fixture 9.00
Residential 0 Commercial 0.S Catch Basin 8.00
Additional description of work: Insp. of Existing Plumbing 40.00
Relocate existing espresso area. per/hr
Specially Requested Inspections 40.00
per/hr
Are you capping, moving or replacing any fixtures? Rain Drain, single family dwelling 30.00
Yes A No O Grease Traps 8,00
If yes, see back of form to indicate work performed by QUANTITY TOTAL ' T - - - ''
fixture. FAILURE TO ACCURATELY REPORT FIXTURE
Isometric or riser diagram Is required g Quantity Total Is > 9 �: _ __: ,0_::-:
WORK COULD RESULT IN INCREASED SEWER FEES SUBTOTAL �� =. _; s• -=
.
I hereby a • • • - dge . I have read this application, that the information _ i! �•�: •, _! W iii •R
given Is • • _ - f • : I the • r or authorized agent of the owner, and 5% SURCHARGE U - ? ` t! " °! F -1 j
that plans = itted - .:hlr• m 2 nce with Ore. on State Laws. !.e1.- fix __ l � 7
Stg natu • / Date = "'PLAN REVIEW 26% OF SUBTOTAL :_,'. ° �''`k ' ' � Or Mo. Required o K fixture qty. total is > e 3:__
---T2/4/98 f2/4/98 only TOTAL =�"� =A:': °;r-= - :1;.�(6 d
Co ,. et Person Name Phone ' . ry �`= • , t 1'• :_
Timothy R. Brunner 360/574 -7019 'Minimum permit fee is $25 + 5% surcharge. except Residential Backfiow
Prevention Device, which Is $15 + 5% surcharge
"All New Commercial Buildings require plans with Isometric or riser diagram
and plan review
tldatsvortuMphm,app.aoc 11l3olae
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t , 11/1/98 MON 11:10 FAX 503. 598 1960 CITY OF TIGARD fJ 002
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PLEASE COMPLETE:
•
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°•,°, if is 301: S. ^• <ao .cS aA :c6� Eio:e :r. �o off' •• ; w a t"r' tics ro.ui.° asc n.3
U ' +.$ . $. �g oiw °. •�. �� 'Y ss varao. ,aa$.3 i �'� < c�� ^ '�G o M i
bro oxaorro" Y i RS;n:m�o 6pr .ro o or x� Q � o.aat a ... L, r ao y7.�•7� �.�4�. .� ¢: � :" ,...� °:,, o .. i"� `{.'.
Sink
�i.L�A"�D.R,,. •.......- ..�. #... A:'L:.A'% .. .,V'Y ,.. ro�X.s a:[:'+r °'°r R"i,YO�a rS�a;•�o o:oos.o ; nn�ro ; ec, au+o� ar�>.° u
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2 1
Lavatory
Tub or Tub /Shower Combination
Shower Only •
•Water Closet
Dishwasher
Garbage Disposal
Washing Machine •
Floor Drain /Floor Sink 2"
3 "
n
• Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
•
•
•
COMMENTS REGARDING ABOVE:
•
Relocating an existing handsink and adding two bar sinks. iT
•
•
•
betsuivormalpNmapp.doc 11130186
•
•
� 1 Accumulative Sewer Tally ._ , �; c�
\ J 1 - r' 1 This SWR# " r : -- -
Tenant Name: .
Address: i e" .) � ;`r - �r ( 1-z- e•''�s F ( -7 This PLM #: ! 'L°^ � S - c-v
Fixture Value Previous Previous Credits Capped Fixtures Fixtures New total New
# Value Capped off value added # added #s total
Count off #s count value values
Baptistry/Font 4
Bath - Tub /Shower 4
- JacuzziNVhirlpool 4
Car Wash - Each Stall 6
- Drive Through 16
Cuspidor/Water Aspirator 1
Dishwasher - Commercial 4
- Domestic 2
Drinking Fountain 1
Eye Wash 1
Floor Drain /sink - 2 inch 2
- 3 inch 5
- 4 inch 6
- Car Wash Dm 6
Garbage Disposal 16
- Domestic (to 3/4 HP)
- Commercial (to 5 HP) 32
- Industrial (over 5 HP) 48
Ice Machine /Refrigerator Drains 1
Oil Sep (Gas Station) 6
Rec. Vehicle Dump Station 16
Shower - Gang (Per Head) 1
- Stall 2
Sink - Bar/Lavatory 2
- Bradley 5
- Commercial 3 / 3
- Service 3
Swimming Pool Filter 1
Washer - Clothes 6
Water Extractor 6
Water Closet - Toilet 6
Urinal 6 ,
/7.62/ C_:-c--
TOTALS ,
Total fixture values: i divided by 16 = 3•ti : - EDU
HISTORY
PLM# 5 Y-o75' (7) EDU# - 3 SWR# '%e-7- o :T5'z PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
PLM# EDU# SWR# PLM# EDU# SWR#
i:\dsts\swrtaly.doc
CITY OF TIGARD BUILDING INSPECTION DIVISION MST c/
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
11 BUP
D 7 e , ryl Date Requested 1 L GI l AM PM BLD
Location iN. • Suite MEC
Contact Person l � az_.e y , � a Ph 70 Y --p37 8 PLM
Contractor Ph SWR
BUILDING Tenant/Owner n ELC
Retaining Wall ELR
Footing n
Foundation Access: -- 0`7) L.J, FPS
Ftg Drain SGN
Crawl Drain Inspection Notes: n /�
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling •
Roof ( 5 . q L
2--
Misc: 1 ,
Final
PAS FAIL
Under Slab
Top Out r
Water Service
Sanitary Sewer
Rain Drains
OP , PART FAIL
ICAL
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
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
ADA
Approach /Sidewalk
Other D a t e (-1,/i9fInspector !i E x t
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.