Permit (71) ip p �� ® ® PLUMBING PERMIT
i '' ° ` COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00171
DATE ISSUED: 4/27/2007
TI D
AR 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S136DD -04100
SITE ADDRESS: 11850 SW 67TH AVE 100 ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT: 007 JURISDICTION: TIG
PROJECT: AMERICAN FAMILY INSURANCE
Project Description: New fixtures. Other fixture: drain.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC NW PROPERTIES
6600 SW 105TH SUITE 175 Description Date Amount
BEAVERTON, OR 97005 [PLUMB] Permit Fee 4/27/2007 $72.50
[TAX] 8% State Surcha 4/27/2007 $5.80
Phone : 503- 626 -3500 Total $78.30
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 639 -5296
FAX 503- 684 -9015
Reg #: LIC 2439
PLM 34 -29PB
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 Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules o :' - : - estions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued =y: , �, �� I Permittee Signat� 0*e , ( . i
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
WESTERN PLUMBING 5036849015 03/24/96 12:26am P. 001
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Plumbing Ire :� O �i1. . �, 05� /mo
i n Permit Application
g FOR OFFICE USE ONLY
City of Tigard �iPR 2 2001 Received
Uatefuv Pennit� �1,, n� 4 �y
v 223 13125 SW Hall Blvd., Tigard, OR 9 y' /v/ t / /
Phone: 503.639.4171 Fax: 503i5.91Y'9,fi0 Plan Rev w
y o D Other Permit �, �p _�/�
Inspection Line: 503.639.4175 - ' L 1 '.3 �y y a"r'� •[.�'J/ 0�
TIGARD DateReady/By: 1 1 0 SeePa e2far
Internet: www.tigard -or.go . 1 T 17 1 ?i 0 f71 T r f.( r ? Notifiedimethod:
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❑ New construction ❑ Dem olition _ For special information use checklist
placement ❑ Other:
� Addition /alteration /re
, • , •. . , New -amity dwellings ( eludes 100 for I each utility
Description Qty. ] Total
its � , i , � ,., ti ,, , ,: N 1- 2 f connection)
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i r1 "ru, st ;r " y 5 �:�: (ilk 1 ;fLl• , . 4 15I`,1 N ,..:flg4l�s 3il,� 1il!t i!mi.tt , SFR (1) bath 249.20
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+.. _.. &
❑ 1- and 2- family dwelling Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
t m ::. �' ti -_! ar r" r ,•,• in;ei ;:: 1 . Fire sprinkler ( sq. ft.) Page 2
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s_,., ss
Job site address: ,1ck�C) Ct o � ! ,,, Catch basin or area drain 16.60
City/State/ZIP: \'� ( C\ l Cjt� Dr y
Cit y well, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: ( O Project name? o Footing drain (no. linear ft.: ) Page 2
' «r O �° Manufactured home utilities 110.00
Cross strcet/directions to job site: k " -'' -' 0'""- _, •I , Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear 1t.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: _) Page 2
Fixture or item
- fax map /parcel no.:
r:: -C a +; . l . z; : 5nlr t' t:= xi;;: ar '•r ::v:rur�,:r: , :r- ;eo : ; :y :_ :ugi4ift ?� _ n :,:.; _ Absorption valve 16.60
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s 0
i ' " i !' r.! . ! iTitis l " It s¢i , -� r , eihi m,`' !.L.4r! ? :,tail., ? , az; Backflow preventer Page 2
Backwater valve 16.60
111.` - ' Ilk < t . Clothes washer 16.60
■ Dishwasher 16.60
;!,:� 'r• , a,:; �;r.::s;:: ;!', �;�:: sii ;�y. . =, „� �x:
Drinking fountain 16.60
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Ejectors /sump 16.60
Name: Expansion tank 1660
Address: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain /floor sink/hub 16.60 .
Phone: ( ) Fax: ( ) Garbage disposal 16.60
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Ice maker I 16.60 ftt �O
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ -) Page 2
Address: Primer 16.60
City /State/ZIY: Roof drain (commercial) 16.60
Sink/basin /lavatory (0 16.60 •`)loll
Phone: ( ) Fax:: ( ) Tub /shower /shower pan 16.60
E-mail:
�� Urinal 16.60
C.: : I " 1 : " p L i 4, 1 e" tirk r r ,� jri•I t f r rht :s , l Gr 1 n ,'• o o " 1 " 1 "
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_ ii i4.,.I ; ••i.c!.-r...s i :. ,, .. ,..,42 si s , ...z.. , -rr, .._ ..ti.: 1 ,, . r,,.. s , ..y., i ! r �l Water closet 16.60
Business name: f;0 Iimbfno , Water heater 16.60
Other:
Address:
AS 0 `i),:) i IC lk \10 „ �tl 1.\t,11-) Subtotal eici,cin
City /state /z_1:P: - a n.,%. 0,. (.�-' - ?�
> Minimum permit fee: $72.50
Phone: ( r ) r S .. - Fax: (' ) r �t,� - lE 0 R esidential backflow minimum permit fee: $36.25 D _
CCB Lic.: (..04 Plumping Lic. no. :N, Plan review (25% of permit fee)
)
Authorized signature: ' State surcharge (1l% of permit fee) a8a
TOTAL PERMIT FEE D ,a)
Print nam .1 . 11' i � � may. - ,� Date:4_ _51„ 'fills permit application expires if a permit is not obtained within
n - � ��� 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1:10011 <IingWermit\PL -M- Permit App dm: a6/26J06 441- 461 1'(10 /02/COM/WEB)
.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00171
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 . ' .
INSPECTION WORKSHEET FOR DATE: 8/24/2007 TIME: 7:00AM PAGE: 67
SITE ADDRESS: 11850 SW 67TH AVE 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: New fixtures. Other fixture: drain.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503-626.3500
CONTRACTOR: WESTERN PLUMBING PHONE #: 503-639-5296
Inspection Request Scheduled For: Date: 8/24/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 054584 -01 503 - 572 -7305 N
Corrections /Comments /Instructions:
(-- il,rt. 'F" ‘,./ p4,,i 4 .
•
PASS n PARTIAL APPROVAL ❑ CANCEL NO ACCESS
n FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 111-4.`'5 1 9 $'"''.— Date: it i2-4 (a 7 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00171
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/2007
Phone: (503) 639 -4171 +�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/5/2007 TIME: 7:01AM PAGE: 73
SITE ADDRESS: 11850 SW 67TH AVE 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: New fixtures. Other fixture: drain.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503.62&3500
CONTRACTOR: WESTERN PLUMBING PHONE #: 501639-5296
5296
Inspection Request Scheduled For: Date: 6/5/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 049583 -01 503-639-5296 Y
Corrections /Comments /Instructions:
s2 2 7 3 01 &alf‘, cl)
b 'elt/
N , PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /I/ (`��/ Date / Phone #: (503) 718-
CITY OF TIGARD ,
BUILDING DIVISION : - - .., PERMIT #: PLM2007 -00171
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/2007
Phone: (503) 639 -4171 AT ' Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/4/2007 TIME: 7:00AM PAGE: 32
SITE ADDRESS: 11850 SW 67TH AVE 100 CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS - 1 LOT #: 007:7 . TYPE OF USE:
PROJECT NAME: AMERICAN FAMILY INSURANCE
DESCRIPTION: New fixtures. Other fixture: drain.
OWNER: PACIFIC NW PROPERTIES, ,_. PHONE #: 503. 626-3500
CONTRACTOR: WESTERN PLUMBING - • PHONE #: 503-639-5296
Inspection Request Scheduled For: Date: 5/4/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 047647 -01 503- 639.5296 N
Corrections /Comments /Instructions:
ePAR'f i AL : S I! ( 4,. / Z c-c +rv%4 .
❑ PASS PARTIAL APPROVAL ❑ . CANCEL fJ NO ACCESS
❑ FAIL 1 ] CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v'B Date: r ' li . Vi Phone #: (503) 718- 2 c