Permit C ITY OF TIGARD PLUMBING PERMIT
A, DEVELOPMENT SERVICES PERMIT #: P -00299
A 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 7/20/20020/200 5
PARCEL: 1S135DD-03301
SITE ADDRESS: 11945 SW PACIFIC HWY 250 ZONING: C -G
SUBDIVISION: HOFFARBER TRACTS NO.1 LOT: 002 JURISDICTION: TIG
Project Description: Building fixtures. 10 Sewer caps, Drinking fountain, primer and expansion tank.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; 2 TRAPS:
STORIES: 1 WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: 1 GREASE TRAPS:
LAVATORIES: 4 OTHER FIXTURES: 3
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 3 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TIGARD PROPERTIES INC Description Date Amount
8320 NE HWY 99
VANCOUVER, WA 98668 [PLUMB] Permit Fee 7/20/2005 $431.60
[PLMPLN] Plan Review 7/20/2005 $107.90
Phone : 360 - 574 - 6255 [TAX] 8% State Surchari 7/20/2005 $34.53
Total $574.03
Contractor:
PMSI LLC
21195 NW EVERGREEN PKWY STE 20 REQUIRED ITEMS AND REPORTS
HILLSBORO, OR 97124
Phone : 503- 466 -2222
Reg #: LIC 158286
PLM 34 -434PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 503 -246 9 or 1-800 -332 -2 4.
Issued By: wo Permittee Signature:
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Jul 19 05 10:35a msi *meth 5034662211 p.2
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Plumbing Permit Application FOR OFFICE USE ONLY
City of Tigard I }at ✓ Receiv F _ _. 0 S —
SW r V: !'cttnit No.: N r Z z...? 1 31:5 ��1 I tall 1)Ivd„ Tigard, OR 9732;1 t� .. ��
Phone: 503.639,4171 Fax: 503.59$. 1960 ft, Plan Review Other
24- flour Inspection Line: 503.639.4175 tT
'�4 ! r imetity; 11-12,-01"
/L -01" �� Aher l u Nu ;$W .2L0 a S- °cu.()
�� _, Date Rod /8 ': !urn: ^ J
Itltcrii ( www.ct.ugnrd.or.us
Noti y ) ti Pent I Inf for
fted/Methad: TI G 5i lententa
Ppl ir. nation ��
•
TYPE OF WORK FEE' SCHEDULE : .
0 New cunslnlcli0n ❑ Demolition For special information use the :klist. (�
llrxcri IBM ,. En. I Tow `eJS`
— ❑ Addition/alteration/replacement ❑ Other: ., New 1 dwellings (includes 100 It Ibr each utility connection)
CATEGORY OF CONSTRUCTION SI:R (I) bath 249.20
❑ I- and 2- tanlily dwelling ❑ Cant rltcreinl/ industrial SFIt (2) bath 350.00 --
❑ Accessory building ❑ Multi - family ShR (3) bath _ 399.00
bath additional hathlkilchgt 45.00
❑ Master builder ❑ Oilier; —
Fitt' spunkier ( , sq. ft.) Page 2
- f
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / f T 'fs 5 (i✓ P!}G F/C /l y Catch or area Y - —
drain 16.60
City/State/ZIP: — p E.
L Q. �(,Ij pl _Oki-. V rywcl I, leach line, or trench chain 16,60
Suite/bldg./apt. nu.: P Project uanie: s Footing drain (n0. linear IL: i _) Page 2
1.4 ' , Manufactured home utilities 1 1(1.00
(cross slrccl/dircctiona to tp•(' I� 1 Wt{ Q t ` —
J Manholes 16.60
• Rain drain connector 16.60
Sanitar newer (no. linen* ti. _ ) Page 2
Storm sewer (no. lin Ii.: Page 2
Subdivision: I Water (no. linu`tr IL __) Page 2
Lot no.:
Tax Inup /parvcl no.:
Fixture or Item
Absorption valve 16.60
DESCRIPTION 01 WORK ,
n � 7 Back flow prevcnter Page 2
f iWV�I (1/K-((� U" pU"C 1/�`� ( Backwater va lve _ L
� I (i.6U
Clothes washer I6.6(1
Dishwasher 16.60
• ❑ PROPERTY OWNER I ❑ 1'a NAAT Drinking fountain I 16.60 6 &
lijcctors/sunip 16,60
Name: "^
- F N1vw inll tank 16,60 r�,p '4' 0
Address' Fixture/seweu cup '� IQ 16,60 ((,7( 0 0
Ci ty / Stale /ZIP: Floor diaiuthwrsink/huh 1 2 16.60 5'5
Phone: ( ) Fax: ( ) (iarb:+ disposal _ (6.60
. ❑ APPLICANT' ❑ CONTACT PERSON Hose bib 16.60
Business name:
lee maker 16.60
Interceptor/grease trap 16.60
Contact name: Medical gas (value: $ _ ) Page 2
6'
Address; Primer -7 1 16.60 / 1 rd
City /State /ZII': Rmml'drain (commercial) 16.60
Phone: ( ) I Fax :: ( ) Sink/basin /lavatory J 5 16.6(1 V;• u.
E-mail:
Tub /shower /shower pan 16.60
Urinal f I 16.60 )t°, /pi,
/ CONTRACTOR Water cluset b 4 3 16.60 �, v
Business name: Pitt - r L-• L. (, Water heater
�l J 10.00 (( ( J
Address: a i ( t ,u � 6, -[..V itet(A . 'I' .Ai ,?.. Other: Atop biwyC .I ( (1 Water
0
City /Stale / , - v 0 Q 1(s 1 J Sub 2,5
�
minimum permit ICY: $72,5
Phone: (�p3) i 9-?-. Fax; (.?o) �lK �`' »-'( Re Residential back flow minis riU3)1 permit Ice: f 36,25 / / • b O J
C'CB Lie.: J Plumbing 1 - ic. no.: Plan review (35' /c of ft'r
� d c , 3�- �13�( - . /0770 1
Authorized signature ' 3 Q�/ P „, )„.. ,,, L.21......1 S tole butdutgc (Wt(. ufpwrtilit fu:) 3 '1' •e.3
_ �� - + TOrAI.PERM � • 0
Print name: �.((, �,(+ (' �blv�s Ci” 17 :Ite:1 /f q (U5 This permit application expires it' a permit is not ubtnint wit n hin
1RIl tiny, stripe. it Loa been xeeepled ms eemplt•te.
*Fee methodology set by'I•ri-('t only Building Industry Service lio lyd.
;: \Rvdn, .ertsitsUeLMd`ermitnpp.d tuwo.+ ' O.anu QM/wCIi)
Accumulative Sewer Tally Parcel # 1S135DD- 003301
Tenant Name: J o-Ann Fabric This SWRI 2005 -00220
Site Address: 11945 SW Pacific Hwy. This PLM# 2005 -00299
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 1 1 1 1 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain /Sink - 2 inch 2 0 10 20 2 4 -8 -16
- 3 inch 5 0 4 20 2 10 -2 -10
- 4 inch 6 0 0 0 0 0
- Car Wash Dr 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 1 32 0 -1 -32
- Industrial (over 5 HP) 42 0 0 0 0 0
Ice Machine /Refrigerator Drain 1 0 4 4 0 -4 -4
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 4 8 5 10 1 2
- Bradley 5 0 0 0 0 0
• _
- Commercial 3 0 6 18 0 -6 -18
- Service 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 5 30 3 18 -2 -12
Urinal 6 0 1 6 1 6 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 36 139 15 52 -21 -87
Current Fixture Value -87 divided by 16 = -5.4 Current EDU 1 EDU = $ 2,600
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -87 divided by 16 = -5.4 over (under) $ (14,040.00)
Enter EDU Ch . I , e Here -5.4
Notes:
Authorized Name /Signature• " Date: it - as
,,,
11Alt ote: The property • ' er sh, Building Division tain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher
ich must be submitted to th ity of Tigard Building Division to redeem credits towards future system development charges.
i:\Building%Sewer TallOSewerTallySheet.xds 7/1/05
I CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00299
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 7/20/2005
Phone: (503) 639 -4171 ` / °'f �'IlI+I
Inspection Requests (24 Hrs.): (503) 639 -4175
I
INSPECTION WORKSHEET FOR DATE: 9!9/2005 TIME: 7:07AM PAGE: 46
SITE ADDRESS: 11945 SW PACIFIC HWY (250 1 CLASS OF WORK:
SUBDIVISION: HOFFARBER TRACTS NO -.1 LOT #: 002 TYPE OF USE:
PROJECT NAME: 0 ANN "FABRICS
DESCRIPTION: Building fixtures. 10 Sewer caps, Drinking fountain, primer and expansion tank.
OWNER: TIGARD PROPERTIES INC, PHONE #: 360.5746255
CONTRACTOR: PMSI LLC PHONE #: 503.466.2222
Inspection Request Scheduled For: Date: 9/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 015293.01 503.849 -5526 N
Corrections /Comments /Instructions:
r e r i..2.„../
'gp_9ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /
Date: Phone #: (503) 718-