Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00383
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/30/2008
PARCEL: 2S 102BD -00701
SITE ADDRESS: 12785 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT: 008 JURISDICTION: TIG
PROJECT: BURGERVILLE
Project Description: Plumbing TI - other fixtures: (2) hose bibs.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: A2 FLOOR DRAINS; 11 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: 1 GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 2
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
CATHERINE BENNETH
C/O LAWRENCE K. PETERSON Description Date Amount
8 NORTH STATE ST 301 [PLUMB] Permit Fee 9/29/2008 $348.60
LAKE OSWEGO, OR 97034 [TAX] 12% State Surcha 9/29/2008 $41.83
Phone : 503- 635 -3546 Total $390.43
Contractor:
PMSI LLC
21195 NW EVERGREEN PKWY #204
HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 466 -2222
FAX 503- 466 -2211
Reg #: LIC 158286
PLM 34 -434PB
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 or direct questions
to OUNC by callin• 503.246.6699 or 1.800.332.2344.
Issued B :
C� ✓ —' H Permittee Signature
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.
1
From: . ' 09/26/2008 14:58 #007 P.002/003
Plumbin 1 Permit A 1 l lit .> ' olu' EIVED t-er4 O0 ,(- 4/
Building Fixtures FOR OFFICE C SE O� lit ,, r
" 0, ' w ry 1 n, "v, t , ,1. 6 � 7,' t '2/? ' rl >`
City Tigard SEP 2 6 20 08 Received 9 �G o' � y I 1 �? a1r x 6,°383
Ci of Ti and Permit No.
■ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: • I 1 ' 17a ./By Other Permit No �vB /
ction Line: 503.639.4�,�1,7 ! "'+ 1 IG ne�D v�s�r ��
TIGARD gosi DIVISION NotiRd l e / 4. Supplemental Pentfor
Internet: vvww- tigard -or- ILDIN GDIV Notified/Method. / J Infonnation
TYPE OF WORK FEE* SCHEDULE
® New construction ❑ Demolition For spay information use checklist
Description I Qty I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2-faintly dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
0 1- and 2- family dwelling ® Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ID Multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath /kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Joh site address: 12785 SW Pacific Hwy Catch basin or area drain 16.60
City/State/ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Burgerville #45 Footing drain (no. linear ft.: ) Page 2
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: Lot no.: War service (no. linear R: ) Page 2
Tax map /parcel no_: Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
'numbing - 21 fixtures Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
® PROPERTY OWNER ❑ TENANT
Ejectors/sump 16.60
Name: e 1 0 r L - eV J E/ Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 11 16.60 182 -60
Phone: ( ) Fax: ( ) Gage disposal 16.60
Hose bib 2 16.60 33.20
❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name:
Medical gas (value: $ ) Page 2
---_.-.____-.-_ --
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) p ( ) Sink/basin/lavatory 4 16.60 66.40
Tub /shower /shower can 16.60
E -mail:
Urinal 1 16.60 16.60
CONTRACTOR Water closet 2 16.60 33.20
Business name: PMSI LLC Water heater 1 16.60 16.60
Address: 21195 NW Evergreen Pkwy Suite 204 Other
City/ State/ZIP: Hillsboro, OR 97124 Subtotal t Llil , VC
Minimum permit fee: $72.50
Phone: (503) 466 -2222 Fax: (503) 466 -2211 Residential backflow minimum permit fee: $36.25
;CB i,ic.: 158286 ( Plumbing Lic. no.: 34 -434PB Plan review (25% of permit fee)
. J / (�� State surcharge (12% of permit fee) I, $3
,
Authorized signature: ,,/t/(.66( C {f „
- I TOTAL PERMIT FEE i�4I
Print name: Lanell Robinson Date: 9 /19 /O8 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
F - methodology set by Tri- County Building Industry Service Board.
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liBuilding\Permits1PLMF- PermrtApp dot 12/27/06 440 461 6T(I WO2 /COM/WEB ., 6�
CITY OF TIGARD - -
BUILDING DIVISION PERMIT #: PL M2008-
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/3012008
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 s__ 1:
INSPECTION WORKSHEET FOR DATE: 10/7/2006 TIME: 7 :00AM PAGE: 26
SITE ADDRESS: 12785 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: NO. TIGARDVII.LE ADDITION AMEND LOT #: 008 TYPE OF USE:
PROJECT NAME: DIJRGERVILLE
DESCRIPTION: Plumbing TI - other fixtures: (2) hose bibs.
OWNER: DFNNETH, CATHERINE PHONE #: 503 635 354 6
CONTRACTOR: PMSI LLC PHONE #: 503-466-2222
Inspection Request Scheduled For: Date: 10/7/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
306 Plumbing underslab 076366 -01 603 -209 -4207 Y
Corrections/Comments/Instructions: oG Li3 /tA4.1 v<.
P ro,./ AC. t0 t o 1�) a ft.', u6- 11 ,J Co G ` t-ri"� 4-I- �a,1 -t D I v i c- ✓ ( IQwd I
No e. o A it 0 (-4.a SF 0✓ k oU - P I awi% A-'- ctDJo cfrte,
illy-w. e_ l0 4_ w,e,✓T" ‹ } I✓ k Pb C' i ct/C K l•,-c A4 cnt 1 t) D iA/ ettD,
r ) 3 r Cb e ---i--e A,... LANl.- - -- Cf, ,..re, Co 4, 4 - ..c..,1-.- 1 s peal s t.
c o c a 9fa,p.
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
K FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED I
Inspector: Q \ev % \r•"•— Date: I b Phone #: (503) 718-
i