Permit (122) CITY OF TIGARD � PLUMBING PERMIT
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, , DEVELOPMENT SERVI � `
PERMIT # 999
PLM -
00228
s , 4. A �' DATE ISSUED: 7/27/99
13125 SW Hall Blvd., Tigard, OR 9723 639 -4171
SITE ADDRESS: 16200 SW PACIFIC HY Z PARCEL: 2S115BA -00100
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SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ADD GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: ,BACKFLOW PREVNTRS: •
OCCUPANCY GRP: M FLOOR DRAINS;. TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 100 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: 100 ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: 100 ft
Remarks: Addition of domestic water line, fire line, storm drain lines and sewer line. Other fixture is fire line main.
FEES
Owner:
Type By Date Amount Receipt
ALBERTSON'S PRMT DEB 7/27/99 $152.00 99- 317169
250 PARK CENTER BLVD 5PCT DEB 7/27/99 $10.64 99- 317169
BOISE, ID 83726
Total $162.64
Phone 1: 208 - 395 -6283 •
Contractor:
KEEFER PLUMBING INCORPORATED .
52300 SW SOUTH RD .
GASTON, OR 97119 REQUIRED INSPECTIONS
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Phone 1: 503 - 640 -7451 Sewer Inspection •
Reg #: L IC 065481 Water Line Insp
$ Fire Supply Line -FPS
PLM 34 -94pb Storm Drain Insp
Final Inspection
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 •
Notific. '• • Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0080.
Y• may obtain • • pies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Is ed By: / i , - / Permittee Signature ii
Call (503) 6 9-4175 by 7:00 P.M. for an inspection needed the next business day
CITY OF-TIGARD Plumbing Permit Application •
Plan eck
13125 SW HALL BLVD. Commercial and Residential Recd y�
TIGARD, OR 97223 Date Rec'd (7-P-7 -2-9
(503) 639 -4171 Date to P.E.
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Print or Type Date to DSjT -
Incomplete or illegible applications will not be accepted Permit # /;M 699- 1 8'
///�y� 2 Related SWR #
/ P / 0 3 - Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job 4 /b-e -r / ,6-.'-i-, i$ Sink 11.50
Address Street Address n 1 Suite Lavatory 11.50
�/&7.. /7d 5 w / Pic-/X) ' Tub or Tub /Shower Comb. 11.50
Bldg # City /State Zip
7 (�� OR 9 -7 Shower Only 11.50
N9 me
✓ A b t Water Closet/Urinal (Specify) 11.50
°Z" tf'QOtb y 41.-3L/275G C,, Dishwasher 11.50
Owner Maili !ddr ss P*Tg Acct „� S uite fNC Garbage Disposal 11.50
��N `-0R �O ,, - washin Machine/Laundry Tray Zip 3 Phone
00/5g- iD � 9 ry Y (Specify) 11.50
Floor Drain /Floor Sink 2" 11.50
Name 3" 11.50
4" 11.50
Occupant Mailing Address Suite Water Heater 0 conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
City/State Zip Phone MFG Home New Water Service 28.00
MFG Home New San/Storm Sewer 28.00
Nam e _ Hose Bibs 11.50
Contractor iling Add less L S�rlte Rain Drains 11.50
rrO ' 15 a7( 5 4 • Z Drinking Fountain 11.50
Prior to permit City/pate Zip Phone ,..,, Other Fixtures (Specify) 15.00
issuance, a copy �l ((5 IGI[ q, 9 1 7 (2- 6 `'lyr (� I
of all licenses are Ore on Const. o t. Board Lic.# Exp. ate
required if (.P 5-C-r26 r S ZJ.p /DO
expired in COT Plu g Lip. # q e / r8 �Dat Date
Name (�, ((/ ! I Ff /t .L L t -1: L "Ai* / r
3/'' 3P "
Sewer - 1st 100' / 38.00 v
Architect Sewer - each additional 100' 32.00
or Mailing Address Suite Water Service - 1st 100' / 38.00 3 ■
Engineer City /State Zip Phone Water Service - each additional 200' 32.00
Storm & Rain Drain - 1st 100' / 38.00 3, i
Describe work to be done: Storm & Rain Drain - each additional 100' l 32.00
New 0 Repair 0 Replace with like kind: Ye ? No 0 Commercial Back Flow Prevention Device 32.00
Residential 0 Commercial Residential Backflow Prevention Device' 19.00
e. r- d S -, L V 1(14 j-, /l yC, �/� , Catch Basin 11.50
1 � � APAJAi? D jr!iteJ 4.- f' • Insp. of Existing Plumbing 50.00
Are you capping, moving or replacing any fixtures? per/hr
Yes 0 No yie Specially Requested Inspections 50.00
If yes, see back of form to indicate work performed by per /hr
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Rain Drain, single family dwelling 45.00
WORK COULD RESULT IN INCREASED SEWER FEES. Grease Traps 11.50
I hereby acknowledge that I have read this application, that the information QUANTITY TOTAL .
given is correct, that I am the owner or authorized agent of the owner, and Isometric or riser diagram is required if Quantity Total is > 9
that .tans submitted are in compliance with Oregon State Laws. "SUBTOTAL
• � a of Owner A • ent _ ( DV 7 i
i _/Ai 11 ' •� 7% SURCHARGE 0
ntact Pere n Na e Phone /
(� � 0 (1)0.7c1 Cf **PLAN REVIEW 25% OF SUBTOTAL
1 BATH H USE 178.00 Required only if fixture qty. total is > 9 O
2 BATH HOUSE $250.00 TOTAL // °-
3 BATH HOUSE $285.00 ((�/
(This fee Includes all plumbing fixtures in the dwelling and the firs
100 feet of sanitary sewer storm sewer and water service) 'Minimum permit fee is $50 + 7% surcharge, except Residential Backflow Prevention
- - - -- Device, which is $25 + 7% surcharge
"All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
I:tdststformstplumapp.doc 7/19/99
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
Sink
Lavatory
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Tub or Tub /Shower Combination
Shower Only
Water Closet
Dishwasher
Garbage Disposal
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Laundry Room Tray
Urinal
Other Fixtures (Specify)
COMMENTS REGARDING ABOVE:
1:1dsIsVormslplumapp - dot 7/19/99
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04/17/2000 Activities for Case #: PLM1999 -00228
9:15:55 AM
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Assigned Hold Updated
Activity Description Date 1 Date 2 Date 3 To Done By Disp. Level By Updated Notes
PLMC003 Application received 07/27/1999 DEB DONE No Hold DEB 07/27/1999
PLMC005 Permit Created 07/27/1999 DEB DONE No Hold DEB 07/27/1999
PLMC705 Sewer Inspection 07/27/1999 07/27/1999 08/10/1999 TLP FAIL No Hold AKJ 08/10/1999 no work being done
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PLMC710 Water Line Insp 07/27/1999 07/27/1999 07/28/1999 TLP PASS No Hold AKJ 07/28/1999
PLMC712 Fire Supply Line -FPS 07/27/1999 07/27/1999 07/28/1999 TLP PASS No Hold AKJ 07/28/1999 •
PLMC730 Storm Drain Insp 07/27/1999 07/27/1999 08/11/1999 TLP PASS No Hold AKJ 08/12/1999 new relocated line at canopy
front of store to pickup 4"
downspout
PLMC799 Final Inspection 07/27/1999 07/27/1999 02/23/2000 TLP PASS No Hold AKJ 03/02/2000
PLMCO50 (F) Issue permit 07/27/1999 DEB DONE No Hold DEB 07/27/1999
PLMC711 Water Service Insp 08/02/1999 08/02/1999 07/30/1999 GS PART No Hold AKJ 08/02/1999 8" from riser to main
6" from riser to fdc
4" fdc from main to new utility m
6" main fire line to shops note'
test on 6" main line pressure
low, retest
all other pipes and tests ok
PLMC712 Fire Supply Line -FPS 08/03/1999 08/03/1999 08/03/1999 TLP PASS No Hold AKJ 08/03/1999 6" to utility 200# test
PLMC800 Case Finaled 03/02/2000 AKJ DONE No Hold AKJ 03/02/2000
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