Permit c 6. -4 7 1 0:74.41)14, . j_ -
n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00196
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/16/2007
PARCEL: C28113401000
SITE ADDRESS: 16570 SW 72ND AVE B9 ZONING: I -
SUBDIVISION: OREGON BUSINESS PARK I LOT: OOC JURISDICTION: TIG
PROJECT: SERVICE MASTERS
Project Description: TI - Cap: (3) lays, (2) sinks, (1) washer, (3) water closets. Add: (1) sink & (1) washer.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 3 URINALS: GREASE TRAPS:
LAVATORIES: 3 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC REALTY ASSOCIATES
15350 SW SEQUOIA PKWY #300 -WMI Description Date Amount
PORTLAND, OR 97224 [PLUMB] Permit Fee 5/16/2007 $166.00
[TAX] 8% State Surcha 5/16/2007 $13.28
Phone : Total $179.28
Contractor:
ADDISON PLUMBING
1407 HOMESTEAD PLACE
MOLALLA, OR 97038 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 785 -1840
FAX 503- 829 -9701
Reg #: LIC 151754
PLM 3 -449PB
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 rule t questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
•
Iss d By: Permittee Signatur iL1(
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.
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Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard DateBy 5/' o 7 / PermitNo.: r ,zl0-7 60/96
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit No.:
T I G ARD Inspection Line: 503.639.4175 Date Ready /By: �p See Page 2 for
Internet: www.tigard - or.gov Notified/Method: �l c Supple mental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special informations use checklist
Description 1 Qty. 1 Ea. 1 Total
X Addition/alteration /replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling Ar Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath /kitchen 45.00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / 570 7 a A ti Catch basin or area drain 16.60
City/State /ZIP: � 6 Drywell, leach line, or trench drain 16.60
� ./� r Footing drain (no. linear ft.: ) Page 2
Suite/�d� /apt. n .-/-01f; L Project name: s e r ✓ /._ •Y(
•YI
��// Manufactured home utilities 110.00
Cross street/directions to job site:
C � ' Manholes 16.60
k &in9.1C /.s 6,4_ X! 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
113 4 b _ o t?0/ Absorption item
Tax map /parcel no.:
A v
n valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
A _ � �-� �/ 4- l Backwater valve 16.60
c
� , d i _ y ,� A ------ ���PP��I Clothes washer 1 16.60
���J/l��pp� �� Dishwasher 16.60
14 PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Nante 7 c,rr ( `� Expansion tank 16.60
Address: ` • �. _ _ • . • _ Fixture /sewer cap 16.60
City/State /ZIP:TR r / 1 Y` . Floor drain/floor sink/hub 16.60
Phone: (C ) 6 a .- s 3 6 V Fax: (93 ) 6 41..- F. ?.5-s- Garba disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: 5 - le, d e... . a ,K Medical gas (value: $ ) Page 2
D l Q 5' Primer 16.60
City/State /ZIP: o / e '7 2 re) Roof drain (commercial) 16.60
Phone: 03 ) - 5(6 / Fax:: ( 3)42 (1- 74 f 7 Sink /basi a S J? L- 3 16.60
3a� Tub /shower /shower an 16.60
E -mail: / / P
4iIA. ad, i GdY1/ Urinal 16.60
CONTRACTOR Water closet 3 16.60
Business name: &4 Z. ,I ` �� _ s SeN . t Water heater 16.60
Address: ,/,' j • • ' 4 •1 577: I i' . z147-.5 f.(3ewrtirLreR,IL AD Other:
Subtotal
City/State /ZIP: vaCvvni ' op_ 7b Minimum permit fee: $72.50 , a;
Phone: (ra3 ) 63 2 - /(,S7 \ Fax: ( )4,3z _ /14.9 Residential backflow minimum permit fee: $36.25 I (049.
Plan review (25% of permit fee)
CCB Lic.: ,r, 7S"4 Plumbing Lic. no.: 7 - e B State surcharge (8% of permit fee) / 3. ag
Authorized signature: in g ° TOTAL PERMIT FEE I'l L .A8
Print name: Jpm 4d .et Date: 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.
I:\ Building \Penults\PLM- PermitApp.doc 06/26/06 440- 4616T(10/02/COM /WEB)
I nulative Sewer Tally Parcel # 2S113AB -01201
Tenant Name: Service N. aster This SWR# N/A
Site Address: 16570 SW 72nd Ave This PLM# 2007 -00196
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 0 0 0 0 0
Floor Drain/Sink - 2 inch 2 0 0 0 0 0
- 3inch 5 0 0 0 0 0
- 4 inch 6 0 0 0 0 0
-Car Wash Drn 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 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 0 0 0 0 0
Sink- Bar /Lavatory 2 0 3 6 0 -3 -6
- Bradley 5 0 0 0 0 0
- Commercial 3 0 2 6 1 3 -1 -3
- Service 3 0 1 3 0 -1 -3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 1 6 1 6 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 3 18 0 -3 -18
U 6 0 0 0 0 0
Previous EDU Count 0 0
Gapped EDU Credit 0
TOTALS 0 0 10 39 2 _ 9 -8 -30
Current Fixture Value -30 divided by 16 = -1.9 Current EDU 1 EDU = $ 2,700
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -30 divided by 16 = -1.9 over (under) $ (5,130.00)
Enter EDU Change Here -1.9
Notes:
Authorized Name /Signature: Debbie Adamski Date: 5/16/2007
Building Division
Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this docurnent will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\ Building \Forms \SewerTallySheet.xls 02/02/07
CITY OFTIGARD �
BUILDING DIVISION PERMIT #: PLM2007 -00196
13125 SW Hall Blvd., Tigrd, OR 97223 I DATE ISSUED: 5/16/2007
Phone: (503) 639 - 4171''(' f fl,
Inspection Requests (24 Hrs.): (503) 639 -4175 I I.. ' V
INSPECTION WORKSHEET FOR DATE: 7/24/2007 TIME: 7 :OOAM PAGE: 4
SITE ADDRESS: 16570 SW 72ND AVE B9 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: OOC TYPE OF USE:
PROJECT NAME: SERVICE MASTERS
DESCRIPTION: TI - Cap: (3) lays, (2) sinks, (1) washer, (3) water closets. Add: (1) sink & (1) washer.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 503- 785.1840
Inspection Request Scheduled For: Date: 7/2Q12007 0.011— Pour Time: •X -CUP-
Code # Inspection Description Confirm # Contact # Mes- . -
(r
399 Plumbing final 052619-01 503-320-8601
Corrections /Comments/ Instructions:
(-/I '
J
, ( .
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: (�✓ Date: �/ v ". ' a Phone #: (503) 718 2 '1 i1/4/
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -0019G
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/16/2.007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/11/2007 TIME: 7:Q1AM PAGE: 11
SITE ADDRESS: 16570 SW 72ND AVE B9 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 00C TYPE OF USE:
PROJECT NAME: SERVICE MASTERS
DESCRIPTION: TI - Cap: (3) Iays, (2) sinks, (1) washer, (3) water closets. Add: (1) sink & (1) washer.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 503- 785 -1840
Inspection Request Scheduled For: Date: 7/11/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plurnbing rough -in 051824 -01 503 - 320.8601 N
Corrections /Comments / Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED e--- )/Vt. , 47
Inspector: Date: Phone #: (503) 718-
CITY OF TIGARD •
BUILDING DIVISION • PERMIT #: PLM2007 -00196
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/16/2007
Phone: (503) 639 -4171 � Insp ection Requests (24 Hrs.): (503) 639 -4175 .
INSPECTION WORKSHEET FOR DATE: 7/6/2007 TIME: 7:06AM PAGE: 4
SITE ADDRESS: 16570 SW 72ND AVE B9 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: OOC TYPE OF USE:
PROJECT NAME: SERVICE MASTERS
DESCRIPTION: TI - Cap: (3) Iays, (2) sinks, (1) washer, (3) water closets. Add: (1) sink & (1) washer.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 503 -7085 -1840
Inspection Request Scheduled For: Date: 7/6/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 051564 -01 503 - 320"8601 Y
Corrections /Comments/ Instructions:
g PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: l ��'"� Date: 11 Io inr7 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: PLM2007 -00196
•
' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/16/2007
Phone: (503) 639 -4171 !Aggi�l
Inspection Requests (24 Hrs.): (503) 639 -4175 r -_..
INSPECTION WORKSHEET FOR DATE: 5/29/2007 TIME: 7:02AM PAGE: 64
SITE ADDRESS: 16570 SW 72ND AVE B9 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: OOC TYPE OF USE:
PROJECT NAME: SERVICE MASTERS
DESCRIPTION: TI - Cap: (3) lays, (2) sinks, (1) washer, (3) water closets. Add: (1) sink & (1) washer.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 503 - 785 -1840
Inspection Request Scheduled For: Date: 5/29/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 049115-02 503. 740 -8116 N
Corrections /Comments/ Instructions:
O ASS ❑ PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 4C v Date: / Phone #: (503) 718-
CITY OF TIGARD _
BUILDING DIVISION , PERMIT #: PLM2007 -00196
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/16/2007
Phone: (503) 639-4171 fllf
Inspection Requests (24 Hrs.): (503) 639 -4175 . A:_
INSPECTION WORKSHEET FOR DATE: 5/29/2007 TIME: 7 :02AM PAGE: 65
SITE ADDRESS: 16570 SW 72ND AVE B9 CLASS OF WORK:
SUBDIVISION: OREGON BUSINESS PARK I LOT #: 00C TYPE OF USE:
PROJECT NAME: SERVICE MASTERS
DESCRIPTION: TI - Cap: (3) Iays, (2) sinks, (1) washer, (3) water closets. Add (1) sink & (1) washer.
OWNER: PACIFIC REALTY ASSOCIATES, PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 503 - 785-1840
Inspection Request Scheduled For: Date: 5/29/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 049115 -01 503 - 740 -8116 N
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED 'di&
Inspector: Date: / / ti Phone #: (503) 718-
CITY OF TIGARD • . ,
BUILDING DIVISION • • PERMIT #: PLM2007-00196
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/16/2007
Phone: (503) 639 -4171 ay �' ,
Inspection Requests (24 Hrs.): (503) 639 -4175 �'' I I -
INSPECTION WORKSHEET FOR DATE: 5/17/2007 TIME: 7:OOAM PAGE: 15
SITE ADDRESS: 16570 SW 72ND AVE BLDG l CLASS OF WORK:
SUBDIVISION: PACTRUST BUSINESS CE TER LOT #: TYPE OF USE:
PROJECT NAME: SERVICE MASTERS
DESCRIPTION: TI - Cap: (3) lays, (2) sinks, (1) washer, (3) water closets. Add: (1) sink & (1) washer.
OWNER: PACIFIC REALTY ASSOCIATES. PHONE #:
CONTRACTOR: ADDISON PLUMBING PHONE #: 503.7135.1840
Inspection Request Scheduled For: Date: 5/17 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # -ssage '
305 Plumbing underslab 048526-02 503-320-8601 Y
Corrections /Com ents /Instructions:
W .._____
Nll �C'. vv._____t___It..._
„.‘,„,,.. 0 „,„,_
Tze. ,
•
r// P. S 64 APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: `✓ (�-' Date: c 1- 7 I? Phone #: (503) 718