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Permit CITY TIGARD PLUMBING PERMIT I� DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00520 +L "'� - `t ' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/27/2006 PARCEL: 2S 102 B D -01900 SITE ADDRESS: 12920 SW PACIFIC HWY ZONING: C -G SUBDIVISION: HUDSON PLAZA LOT: OOD JURISDICTION: TIG Project Description: Plumbing fixtures for new restroom /equipment structure. Other fixtures: (2) hose bibs. CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS: OCCUPANCY GRP: F2 FLOOR DRAINS; 2 TRAPS: STORIES: WATER HEATERS: 1 CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: 1 URINALS: GREASE TRAPS: LAVATORIES: 1 OTHER FIXTURES: 2 TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: 1 WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES HENDERSON, MARILYN DOROTHEA - JENSEN HUDSON TRUSTEE Description Date Amount 11795 SW KATHERINE ST [PLUMB] Permit Fee 10/27/200( $149.40 TIGARD, OR 97224 [TAX] 8% State Surcha 10/27/200€ $11.95 Phone : Total $161.35 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 r s or dir t questio • OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344. ` / Issu C. 'J J Permittee Signature: L� , 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. r 7 r , ..•.q fluilding Fixtures � 9U .1 _ Plumbing Permit Application ;} j r �� 7''14, i ' i (0 I" . Sl ( ;1 ' k " ` " "" c4:::: Vr ; 'I .. w� 4. -: '` "" b r�"w r !! } �, w" :, : r ). .1 L �, I `�k^�,dPm t'I'1, µ ''v � + City Of Tigard " Y Received 10 9;7 ()(L' Permit No.: IL-iY b9tH "t:'r/ 5 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ` ®, p, Phone: 503.639.4171 Fax: 503.598.1960 Date By Other Permit No.: ' "� Inspection Line: 503.639.4175 T 1 G / 12 D! Date Ready/By: / ` ® See Page 2 for , , - , . Internet: www.tigard or.gov Notified/Method: I I , Supplemental Information a t t ; b:u r -- . r r � a ; T > 4 '� x ,:,, ,, S •o A l " s ii 1 r. C'T titx' ' -?. t.,,,- u ' , , r ' _ r'_, jr *'' : ' .'tf:I3 -47j T �r'e' :7: ;� ="S " �, •.:u .vrz rt. ? N:'3,,„,S v 's u�:^..d.'.. . C.-. , . .-4,1 r At .t +r- yr' 6 '• , ,n n .x y 'y6 1 .. }, ,. �rM ( °! . t,.y.. , 4. .fi +* �.ari .' 1, h� .-,fi *�7 ,,, - .. f �i4r. 1 . Yt-= 'S• i N' ?. t J + 7.*'../ C t."'K ate*/ w• �r.;�,(� i ✓''; c ''' ` T. - ',; +( t s b' "{ Rt .+..., �3 1 ❑ New construction ❑ Demolition For special information use checklis �.. c-..,.. u: L: rn: ..:...,- .::.�:.LL «tc:,3�aJ7.:a::..• ..x'�'"..Y"t «'tw�."1 zc'SLmn'J.�. �c nY. Y. ti v. �r Fa7 'iTcriv�:.2ttUi,BY.ia"C:y'.�� r,L Jy� , + � ... - �f A. i A ^kf 'N ....�'a�:a�"t t _ __ Description 1 Qty. 1 Ea. 1 Total II Addition/alteration/replacement ❑ Other: New. 1- 2- family dwellings (includes 100 ft. for each utility connectior µ r ;l3r tom' p ,,"c . ti'p 4p a u t CA © .�5 v'� 1 + , A l SFR 1 bath 249.20 iy..S•,a-:...,..ti :..2x..3rt,. _t .surt r. -. 4 .. z rie...:e 75s�,.. 3.177, 3'v� 1,w ..}?F„_t __.4;...y • , ...a ■ - ❑ 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 ,. ;,, --5 i q � Fire sprinkler ( sq. ft.) I I Page 2 - ."�`' rtr .Kt4 S . ta' �"'�}' '•? t $1' F 0 /`5°'�:� U () 0 � t v �'t- �'f�'r ;- ^��'L ,, lz3zi_: 'r;:�u iVri.,.. P�__. 4 :41<•.r.. nao. :t _ k?: _ 4 .P..4it. :,. 6'fr:' 'tc's,'AV:' Site utilities - - Jo b site address: /,�+g � Ci t _r 4 �� Catch basin or area drain 16.60 City / State/ZIP: ; i • 00 / . Drywell, leach line, or trench drain 16.60 _ __ Suite/bldg. /apt, no J T Project name : ck p -C Footing drain (no. linear ft.: ) Page 2 to '` Manufactured home utilities 110.00 Cross street/directions to job site: Manholes 16.60 - Rain drain connector 16.60 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2 Tax map/parcel no.: . Future or item n a - v �4 , T , s r� `( y r ., r h Absorption valve ' I 16.60 rfs :ar 6341; ,�, - Z i4 ;P:ir�1 , :i g .'R+ tkItTI ,. A v t j 1Zgiii " ''FJ� : ... 2 • a r � F; ;• Backflow.preventer Page 2 Y i ) _ 11 'icy f 4 / /y�C �T�� I C'% LL �' Backw ater valve 16.60 Clothes washer ' L. 16.60 ] f p , / Dishwasher 16.60 ?� t>.. r �x�'Yt't"c'r"- f ? "'x "'��'S z-ct3 `'c?S '`ai•tf `i"CT�3 h7'�;' Drinking fountain 16.60 1 s`I'..111.i.. 3 .,..5.,',.,.. k..1 ?•.1 ilia -.zt S , �,r , ..7,4rc•i.= .,�ta.J ft5il. 1 4'..' ej 'l`. -,.`, ,.; �a 5*d,; �: � P Ejectors/sump 16.60 Name: t`l fJ k_1<- R-,..)' _ , ,o,or Expansion tank 16.60 Address: Fixture/sewer cap 16.60 City/ State/ZIP: Floor drain/floor sink/hub '.. 16.60 33,77(`. Phone: ( ) Fax ( ) Garbage disposal 16.60 t 1 . 5 ;'14Zi rtr ��,I, , F.4'2-!.fW. 2 L4'7 ,r+,, l � . i r6 � ,,. _ Hose bib ,D 16.60 33, T ;' i:,:,Y.r'...,tu'r .. ,,...ti:'st -z Ti �� .., afr'. i.P-,.d.rw: t , Q }^, 4,77.- a4f..T.'z.zw., .3t � ice maker 16.60 Business name: Interceptor /grease trap 16.60 Contact name: Medical gas (value: $ ) Page 2 Address: Primer 16.60 ' . f drain (co • • ercial) 16.60 City/ State/ZIP: vato . 16.60 • Phone: ( ) I Fax: : ( ) alt7t�$' J1 3.• - lb/show= ower pan 16.60 E-mail: Urinal 16.60 nti :'YL 1 r H t% 2r�, LS 1 �! V. V'1 � ST} X. -t + .. ? ', t L' - i- s. f- -r.7w .0 f S lfri o e-( �' �Y v t r'''it '. ?Ja2 y r ! ...�:J,.a _P.::::4,..',, “t ::r M �JI iY : - LA., ni ?l ;2..,ALI 7.is"u wxZ1 yr2..t r.;.Z. , Water closet i� 16.60 11 Business name:A/4r ^, � . / Ii c /A/c. Water heater I 16.60 )' . ( Address :q /,0 S/n/7 6/9 / 0/a/ Other: Subtotal City /State/ZIP: 776 4'4 04 9 AV Minimum permit fee: $72.50 Phone: (S ) 43� . 4 Fax: (�D) ) ‘8Y ^9Qfs Residential backflow minimum permit fee: $36.25 / c 31479 Plumbing Lic. no.:3t29,�' Plan review (25 %ofpexmit fee) CCB Lic.: State surcharge (8% of permit fee) f /, Cfr j . Authorized signature: dam` ... TOTAL PERMIT FEB f �l� Cj Print name: •rte Ark.. ," 1 Dateg0 ( This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri-County Building Industry Service Board 1:\ Building \Permits\Pr W4'amitApp.doc 04/06/06. 6 \/ 44(W616T(1 W02/COM/WEa) V1 X Accumulative Sewer Tally Parcel # 25102BD 01900 Tenant`Name : Hudson :Plaza - This SWR# N/A . , SiteAddress:12920SW Hudson Plaza This PLM #.2006x00,520 , Fixture Value Previous Previous Credits Capped Fixture Fixture New New # value capped off value added added total total count off #s count # value #s values Baptisery/Font 4 0 0 0 0 0 Bath - Tub /Shower 4 :-::(. 0 0 0 0 0 - Jacuzzi/Whirlpool 4 0 0 0 0 0 Car Wash - Each Stall 6 ,' . 0 0 0 0 0 - Drive through 16 0 0 0 0 0 Cuspidor/Water Aspirator 1 0 °, 0 0 0 0 Dishwasher - Commercial 4 :{ 0 0 0 0 0 - Domestic 2 0 0 0 0 0 Drinking Fountain 1 0 0 0 0 0 Eye Wash 1 .. .ti'. 0 ;, , 0 ;L, 0 0 0 Floor Drain /Sink - 2 inch 2 , _,; , 0 s ti; 0 -2 ,, 4 2 4 - 3 inch 5 0 0 0 0 0 - 4 inch 6 k,„ v 0 0 0 0 0 - Car Wash Drr 6 g Ai. `:i 0 0 0 Garbage Disposal - Domestic (to 3/4 HP) 16 f , „i $ '4,; 0 ,; n 0 ' . : ;;„4 ,1 ;i:,-,-...:;. ,- ; 0 0 0 - Commercial (to 5 HP) 32 � _,.. 0 0 0 0 0 - Industrial (over 5 HP) 42 0 0 0 0 0 Ice Machine /Refrigerator Drain 1 0 0 0 0 0 Oil Sep (Gas Station) 6 0 0 0 0 0 Rec. Vehicle Dump station 16 „,= 0 . #, 0 , , ,, < 0 0 0 Shower - Gang (per head) 1 0 0 0 0 0 - Stall 2- s 4 0 0 > Y , 0 0 0 Sink - Bar /Lavatory 2 t' 0 4„ . . 0 1' 2 1 2 - Bradley 5 Y ' .:;:;::$P,..::.,2 0 0 ,.iV x. , 0 0 0 - Commercial 3 ,, 0 . 0 0 0 0 - Service 3 0 0 i1 3 1 3 Swimming Pool Filter 1 ,� 0 . ;,; 0 � / �= 0 0 o Washer - Clothes 6 " " 0 , <T. ,' 0 1' su 6 1 6 Water Extractor 6 ,. . 0 ' 0 sxK, , 0 0 0 r�s Water Closet - Toilet 6 4 tt , :. 0 , , ,, ,, . , 0 F , 0 0 0 Urinal 6 >i ' 0 T041 ' 0 0 0 0 Previous EDU Count :: 0 0 t Capped EDU Credit 3: 48 TOTALS 0 0 0 0 5 15 5 -33 Current Fixture Value -33 divided by 16 = -2.1 Current EDU 1 EDU = $ 2,700 Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU Change -33 divided by 16 = -2.1 over (under) $ (5,670.00) Enter EDU Change Here -21 Notes: CREDITS FROM DEMO: BUP2006 -00269 Authorized Name /Signature: :Debbie Adamski Date: 10/27/2006 Building Division Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be submitted to the City of Tigard Building Division to redeem credits towards future system development charges. is \Building \Sewer Tally \SewerTallySheet.xls 7/1106 Crie OF TIGARD SUIT. ING DIVISION PERMIT #: PLM2t10 .006241 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/27/2006 Phone: (503) 639 -4171 ICI Inspection Requests (24 Hrs.): (503) 639 -4175 .. " _.. INSPECTION WORKSHEET FOR DATE: 4/27/2007 TIME: 7:OOAM PAGE: 77 SITE ADDRESS: 12920 SW PACIFIC HHWY CLASS OF WORK: SUBDIVISION: HUDSON PLAZA LOT #: 00D TYPE OF USE: PROJECT NAME: HUDSON PLAZA DESCRIPTION: Plumbing fixtures for new restroom /equipment structure. Other fixtures: (2) hose bibs. OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 503 - 639 -5296 Inspection Request Scheduled For: Date: 4/27/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbing final e ivi 047219 -01 503-639-5296 N Corrections /Comments /Instructions: el l,•t., i o..._ A i- 6 id I 2 c - u - r_ - a r-c..ev( ___) Z t i - - ,,,,,_2.3 --iv-A-7- ,,, . ,ki-vue_,,&___ Iv -1--Ake () 41....e-ae of- C be- r-r-e-e 4-t-A: ( L 4 ' S N v../ Aidz: /4-D A 1.4■■tti ...=....----- ./ 1 U'■ D- 26 .st , ,e 4 1. L i5 L (/ ) .1.2.,,,,A, 4-4 1---k, 6/4,,,,-e . ` ■2 PASS n PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS ❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: e/ " 4/ Date: 14 v 0 Z{ Phone #: (503) 718- 2,•.1 CITY OFTIGa4R® • el/H/2406 - 00 67/o BUILDING DIVISION PERMIT #: 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 41— INSPECTION WORKSHEET FOR DATE: \ /t.)s/o 1 TIME: PAGE: SITE ADDRESS: \ 7 O Ya C CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # 1 n Message 1 -7 A " ww� ` �wt- \, LeN\ C�/.e .2 lam' 4s. Corrections /Commen /Instructions: • • PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED 1 � l, � Inspector: r Date: /07 Phone #: (503) 718 - f Z - �� . . CITY QF ��nn m m��u� um�� / ^ I BUILDING DIVISION i ~°~°""~~~""°~� ~°"""~,",=,~ ~ ^ PERMIT #: PLIvI200600620 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/2772005 Phone: (503) 639-4171 |napechonRequea��Hroj � �}3)830��175 .�8W� v * INSPECTION WORKSHEET FOR DATE: 10/30{2008 TIME: 7:05AM PAGE: 67 SITE ADDRESS: 1292OSVV PACIFIC MVYY CLASS OF WORK: SUBDIVISION: HUDSON PLAZA LOT #: DDD TYPE OF USE: PROJECT NAME: HUDSON PLAZA DESCRIPTION: Plumbing fixtures for new reei/nwnVequip/nerd structure. Other fixtures: (2) hose bibs. OWNER: HENDERSON, MARILYN DOROTHEA, PHONE #: CONTRACTOR: WESTERN PLUMBING PHONE #: 503-839-5296 c Inspection Request Scheduled For: Date: • 10f30/2000 Pour Time: Code # Inspection Description Confirm # Contact # Message 520 Plumbing/oughin 038972-01 503-639-6296 N Corrections/Comments/Instructions: . ALPASS . H | PARTIAL APPROVAL El CANCEL El NO ACCESS FAIL | | CALL FOR INSPECTION | | ADDITIONAL FEES ASSESSED /� ' � � |nepactofit / �� - L� Oo�e� ' �r Phone #� ��O3) 718- -:? * `�� . #: `- ' / .