Permit (23) , .
C ITY OF TIGARD PLUMBING PERMIT
J �
� �� PERMIT #: PLM2003 -00333
DEVELOPMENT SERVICES DATE ISSUED: 8/11/03
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 16200 SW PACIFIC HY A PARCEL: 2S115A6 -01900
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SUBDIVISION: TIGARD TOWNE SQUARE ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: FLOOR DRAINS; 12 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: 2 GREASE TRAPS:
LAVATORIES: 5 OTHER FIXTURES: 5
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 6 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Other fixtures: 1- expansion tank, 1 -ice machine, 3 grease traps. Plumbing work to convert day care facility to
buffet restaurant.
FEES
Owner:
Description Date Amount
BIT HOLDINGS LTD PARTNERSHIP
BY FORUM PROPERTIES INC [PLUMB] Permit Fee 8/11/03 $577.60
FIVE CENTERPOINTE DR STE 290 [PLMPLN] Plan Review 8/11/03 $144.40
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 8/11/03 $46.23
Phone : Total $768.23
Contractor:
BUMBLE BEE PLUMBING
PO BOX 373
TROUTDALE, OR 97060 REQUIRED INSPECTIONS
Water Line Insp
Phone : 503 - 618 - 8978 Top -out Insp
Reg #: LIC 113297 Final Inspection
PLM 26 -590PB
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
Issued By: `� / , .411P � / Permittee Signature: ,` / /_
Call (503) 639 -4175 by 7:00 P.M. for an inspection neede • o e next business day
07/08/2003 18:23 FAX 12122748889 6. ,D —eo I05?
A - - • Plumbing Permit Application
Date received 7 F 1 Permit no.• ura27,5.do333 , ; - I City of Tigard s ewer permit no.: Bui ding permit no.: a
Address: 13125 SW Hall Blvd. Ti OR,.. Z2�
City of Tigard Phone: (503)639 -4171 1 v E Projecvappl.no.: Expire dare:
Fax: (503) 598 -1960 Date issued: By: I apt no.:
Land use approval: ,uIL 0 n 40 it 3 Case file no.: Payment type
1 \ t ' s. . 01 P i. It 111 1
O 1 & 2 family dwelling or accessory O Co th r O Multi - family KTenant improvement
O New construction O Addition /alteration/replacement U Food service O Other
.10It tiI I t_ I \I 011\1 \ I I0\ 11..1. s( III 111 I 1 Our Special tuturu list rltc.l.li.i r
Job address: f .ioo Sin Pajj 'St man Qty. Fee(ea.) Total
New 1- and 2- family dwell only: F
Bldg. no.: Suite no.: (Includes 100 ft. for ends way eoeseetioa)
Tax map /tax lot/account no.: SFR (I) bath
Lot: Block: I Subdivision: SFR (2) bath
Project name: -fllJ T& gagleT SFR (3) bath ,
City /county: T rpl I ZIP: Each additional bath/ itches _
4
I Description loci(ioo of workgP premises: She utiltie e
mo , 4y no it-Iii.. — CoVe. ►' 4'D Q} s.µ y k. Catch basin/area drain _----
•
Est. date of completion/inspection: Drywalls/leach line/trench drain
Footing drain (no. lin. ft.) As
Manufactured home utilities
Business name: u. ,Bed. ,i,,,, i Manholes
Address: (o e a A 37 3 Rain drain connector
City: ; ,...,,t 1. , I State: d& I ZIP: 1 9 7D to o Sanitary sewer (no. lin. R)
Phone:bo /g c - V) 7 if l Fax: I E- mail:: Storm sewer (no. tin. ft.)
CCB no.: fi 3,4 I Plumb. bus. reg. no:. , - Water service (no. lin. ft.)
Fixture or item:
City /metro lie. no.: -6 -p5 q -;a—G `/ Absorption valve
Conhactot•s representative signature: Back flow preventer I 44 , . 5k7C
Print name: Date: Backwater valve ,
Basins/lavatory .Aev S' /leiv 533.w
Name: Clothes washer
� (.sue -+ `'� _ Dishwasher f /1014 W)
Address: Drinking fountain(s)
City: ha State: A A , ZIP: OB>DZ- ectors/sump n'
Phone: 1J- a, 8833 FaxAZ. A 6 . E -mail: r , t:l6La " pension tank /. I Gs., l a 4
MI \ 1. R Fixture /sewer cap
- 0
Floor drains /floor sinks/hub r nuII i MB;l.�
Name (print): - -,. Garbage disposal - ----- - - -- - -----
r
Mailing address: .2. 2 3 . cE g.2 i - 1241 / - 4 - 1-- Hose bibb
City: g g) s. _ ( State: QKI ZIP: la ••R 3 ice maker r /` , (, , . too 1 la l#0 Phone: a( ) 1*J933 Fax:all E -mail ` Interceptor /grease trap _ 3 r t'?
Owner installation/residential maintenance only: The actual installation Primers)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s) tet^A A (19 .14) 20,11/:
Owner's signature: Date: _ -- Sump
t \ (:I \ t L R Tubs/shower /shower pan
-. Urinal 1, . , / . •
Name:
_ • lS / SD /_ - _ ` ater closet - / lv c ',.•
Address: 9 i - ' '; ,.e -- water heater ' _ / • s�
City: I State: ZIP: /000 L Other -
Phone: , 1),_6 1s . Fax: >i). .� „I -mail: Total 3 t
Minimum fee S 5 470
Na' p all jurtedtcrwte accept credit cads. *We ca jurgdicn Ca mine inm
cn Notice: This permit application Plan review (eta 7 %) $ / 4 `/J
P IA= 3 MasterCard /i / " expires if a permit is Dot State surcharge (8 %) .... $ _ d 3 Credit card 'lumber: O u 3 + / within 180 days after it has be
i 0 — - Expires TOTAL $ '7 Gob <•
accepted as complete.
ame u , c . �. e'• n I Aces; an - • it •
• Mi. a. t� - t Amount , 4104616 160000OMl
07/16/2003 13:51 FAX 12122748889 Iaj03
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
/ BUP
Received 4 0 5-1° Date Reques ed 4 7-0 CAM PM BUP
Location /e L Suite 1 MEC
Contact Person Ph ) .3 3 D- ,563 • 3 - 3 ,3 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL_
PLUMBING � e /
Post & Beam
Under Slab
Rough -In
Water Service �! - �' .
Sanitary Sewer /` !MEOW"
Rain Drains / -
Catch Basin / Manhole
Storm Drain
Shower Pan
ILES A - FAIL
7-47 • AL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA n p�
Approach/Sidewalk Date [/ Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL