Permit CITY OF TIGARD PLUMBING PERMIT
�� DEVELOPMENT SERVICES PLUMBING
PLM2005 -00613
..� ! 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/31/2005
PARCEL: 2S 102C B -02300
SITE ADDRESS: 13200 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT: 008 JURISDICTION: TIG
Project Description: (2) backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 2
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC PROPERTIES Description Date Amount
BY MARTIN JOHNSON
13200 SW PACIFIC HWY [PLUMB] Permit Fee 10/31/200: $92.80
TIGARD, OR 97223 [TAX] 8% State Surchari 10/31/200E $7.42
Phone : Total $100.22
Contractor:
PACIFIC LANDSCAPE
PO BOX 1155 REQUIRED ITEMS AND REPORTS
HILLSBORO, OR 97123
Phone : 503 648 - 3900
Reg #: PLM 7318
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 -2344.
Issued By: Permittee Signature: fr
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 am required on the job site at the time of each inspection.
Plumbs ' ermi s I . 'c on ' = • ,--,
City of Tigard Re Dace �ved y I PAs J
� 5a pemitNo.: j�b /3
13125 SW Hall Blvd., Tigard, OR 9 /(/
Phone: 503.639.4171 Fax: 503.50 2 2005 Plan Review
/ �"m���M ° �' Date/By: Other Permit No.:
24- Hour Inspection Line: 503.639.4175 1fa.I Date Ready/By: r B See Page 2 for
Internet: www.ci.ti ardor. y'7 �r
g 11 , 7 0l, 1 Notified/Method: Supplemental Information
BMWM 1l FEE' SG DULE
El New construction I l1QOh For special information use checklist
Description I Qty. I Ea. I Total
Addition/alteration /replacement ❑ Other. New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
❑ 1- and 2- family dwelling JCornmercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/Idtchen 45.00
❑ Other:
Fire sprinlder (- sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / 326 rj 5i.,..1 ,P, Fl L 'kJ,/ Catch basin or area drain 16.60
City/State /ZIP: -7704 / 02.. ?per g7u.3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: F L MrD t q (, o F6 Lz. Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
/ q G L) 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
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK
r �� Backflow preventer Z Page 2 'j2, 'c
gAt Oriez PeeOEN .7...5-7
i../5�i� -t L..47 c c r a Backwater valve 16.60
Clothes washer 16.60
f / Dishwasher I 16.60
❑ PROPERTY OWNER l ❑ TENANT Drinking fountain 16.60
Ejectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
APPLICANT [CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Fi 4 Miw g r4AN (' Interceptor /grew trap 16.60
Contact name: 1'Y G20tSC tt Medical gas (value: $ ) Page 2
Address: 2f 55S I A.tieretd De. Primer 16.60
City/State /ZIP: 4 w Oa 9 /a y Roof drain (commercial) 16.60
P h o n e : ( - ) ( 3 l l I Fax:: (50 ) CO fZ -2164 Sink/basin/lavatory 16.60 -
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: .1"t me_ /e --, Water heater 16.60
Address: a€ i/G /: •`I ;Asti Other.
City/State/ZIP: 3- - / -4 fr / Subtotal �/ z,�
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: d
X p Plumbin g Lic. no.: 14 2,s Z Plan review (25% of permit fee)
State surcharge (8% of permit fee) 4.7 y 2
Authorized signature: TOTAL PERMIT FEE 3 )CO, ZZ,
Print name: p r 1,L,l cita c i+ I Date: /0(2715 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 \Permits\PLM- PamitApp.doc 06/05 4404616T(10/02/COM/WEB)
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: PLM2005.00613
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/31/2005
Phone: (503) 639 -4171 `":11 ICI
Inspection Requests (24 Hrs.): (503) 639 -4175 ^: _..
INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 7:13AM PAGE: 92
SITE ADDRESS: 13200 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FREVVINGS ORCHARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: eAIC MEDICAL
DESCRIPTION: (2) backflow preventer for irrigation.
OWNER: PACIFIC PROPERTIES, PHONE #:
CONTRACTOR: PACIFIC LANDSCAPE PHONE #: 503-648-3900
Inspection Request Scheduled For: Date: 11/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 021940 -01 503-969-1005 N
Corrections /Comments/ Instructions:
/
,( ')4de /
_ /7' / . ,e) -----
•.
Ifil -ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector:! r 0 Date: Phone #: (503) 718 -
CITY OF TIGARD , . -
BUILDING DIVISION PERMIT #: PLM2005 -00613
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/31/2005
Phone: (503) 639 -4171 A „ �,j�l , l
Inspection Requests (24 Hrs.): (503) 639 -4175 ^:_..
INSPECTION WORKSHEET FOR DATE: 11/14/2005 TIME: 7:12AM PAGE: 114
SITE ADDRESS: 132.00 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: PACIFIC MEDICAL
DESCRIPTION: (2) baclflow preventer for irrigation.
OWNER: PACIFIC PROPERTIES, PHONE #:
CONTRACTOR: PACIFIC LANDSCAPE PHONE #: 503- 648.3900
Inspection Request Scheduled For: Date: 11/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP/backflow preventer 021095`01 503 - 648.3900 N
Corrections /Comments/ Instructions: ( 74 ._, I 41
l
/ __ r _��,�_ •
/� • .�f, /, • ��i // /1
'/ / I'J 0/2.4
IP i
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I
Inspector: rfi Date: l(i V 6 Phone #: (503) 718