Permit CITY OF TIGARD
PLUMBING PERMIT
I ; DEVELOPMENT SERVICES PERMIT #: PLM2005 -00034
'� I � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/7/2005
SITE ADDRESS: 13500 SW PACIFIC HWY 50 - PARCEL: 2S102CC -00500
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SUBDIVISION: PHOTO ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 0 BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Bldg. fixtures: 2 sinks. Clothes washer removed per tenant 2/7/05.
FEES
Owner:
Description Date Amount
13500 PACIFIC CORP
BY CAP ADVISORS [PLUMB] Permit Fee 2/1/2005 $72.50
38345 W TEN MILE RD, STE 170 [TAX] 8% State Surcharl 2/1/2005 $5.80
FARMINGTON HILLS, MI 48335 Total $78.30
Phone :
Contractor:
MIKE PATTERSON PLUMBING
15028 S MITCHELL LANE
OREGON CITY, OR 97045 REQUIRED INSPECTIONS
P Plumbing rough -in
Phone : 632 7374
Plumbing final
Reg #: LIC 81746
PLM 3 -359PB
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 - 6699.
Issued By �� / / Permittee Signature: e
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
on P'luml��ing 503 - 632 -5647 p.2
Jan 28 05 01:39p Mike Patters
• I' - - - - -- v • •i1• RECE r ear' TI GAM)
!0 001
Plumbing Permit Applicati8AN 28 20
CTRYofTlgat'd x roli w�r•lce t_s>: c»tti�
13125 SW Hall Blr& Tigard. OR 97223 D D m i � � � ( -0 5- r to.
Phone: 503.639.4171 Fax: 503598.1960 CITY O � Y1 : , . elan Review
LnI X05 -0e.,7 34
Flow Inspection Line: 503.639.4175 BUILDING 8 '•' ' x/R a Other No..
Internet: www.ci.tigartl.onus � 't i�` Da Dare Read �it/��D '{fIDt7J
24-
y' / la Sec Page Z rye
i.\ -c . Nmiied m„,,... r'
` I: l:`7•.. ! � =( "?•<_N yv r r:,;' �o _ r:wru r a ( 6° PPlenLeetatlwforuLatlor
al r. . ,. ' " 1 I: +? '-, -.: sit 0.0)07 4-v - ■' y.,.
0 Nemv cosshucfion . : � : .: - _ .` �•:S:'::i!. _ :l:.:dl•;. - ..:�,+�.a:�• .::: ..'. . .. ..
❑ Dano)ition For 'pedal infonearten use ea ea list
e _� Addition/alteration/replacement 0 °thee Description 1 Qty. 1 E. J Total
-': +� eF �fn °J i, 4 T8( 11�]► . a t , " ' „" : • ? e;�. +•• - ; 1 SFR 1- 2 -6amitr dwellings (includes 100 ft. foe each utility connection
. F - ' •. ' . _4 - ..,. . �(.-.; :•... 21 ; - R (I) b ath 1
" " - 249.20
❑ 1- and 2- family dwelling Ilk CortUgoK(slflndustrial SFR (2) bath
❑ Accessory buildlng 350.00
Q Multi - family SFR (3) bath 399.00
❑ Master builder ❑ Other - Each additional bat /Intchen 45.00
•: r -= r =: , ;.fir"
Page 2
r! ; . "'� Sate ut(Otles �- s9 R)
Job site addles,: 1 r
rr
sap Gry/StatdZlP• �� V� C• r Catch basin or area drain 16.60
1 Drywe11. leach line. or trench drain 16.60
Suite/bldgiapt no.: Project name: I Footing drain (no. linear R: 1 Page 2
Cross street/din:ai s to job site: PIA S 1 Man holes red home utilities 110.00
Yl "! Manholes 16.60
Rain drain connector 16.60
Sanitary ee ue (no. linear 4i: ) Page 2
Storm sewer (no. linear R: ) Page 2
Subdivision I Lot no.. Water service (no. linear Rt: ) Page 2
map/parcel no.: FixFixture or item
Tax
k1`: �:t -. ,, oa:l J,:. ..i; P .. ` .° . ! ? �1 7 X3.;:1:; i .C•' '. �:. Absorption valve I 16.60
t >ti :•.i.. •- J iff:% �;•i i Bsckflow prevcnter I PA 2
-J-Y1'+- -( I in /i_.�.-• ._, r_ .r e-1 I Backwater valve 16.60
f ` c.' a.t 1:::.U1C t Clothes washer 16.60
Dishwasher 16.60
:, ;e »; ` r
; .: : � eta..r 3; 0 ,.. E ,Er :;:.. !k i F t : J -_ .- Drinking fountain 16.60
Name .° • = "'- 1• .; - Y
Name - P_" , _ I l-a .--1 • Ejeetors/sump 1660
Address: _ ,�� J. Expansion tank 16.60
1 r' •. 4-r ] Filcture/aewvcap
City/State/ZIP. -.t Cpl 1 'P c2 j -] Floor drain/floor sink/hub 16.60
Phone: , 16.60
UV J 3 ) Q s Fax: ( ) Garbage disposal
:5�1 7t� r ° TT 16.60 I
one:: L U IF34o .. ' d , r : 44.t� " ' ' : . !Ago l'c� ; . Hose bib 16.60 J
Business name t ice maker 16.60
Contact name Interceptor /grease nap 16.60
Addtsss:
Medical gas (value: $ ) Page 2
Prima 16.00
Ciry/Statr/ZiP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( ) Sink/basin/lavatory 16.60
E -mail:
Tub/shower/shower pan 16.60
_li�: µq` =.del\ l • JL J.'9.. . F_ ,.
Urinal
!
••: �•; r �•;t: ii:�S. Y•f *itilv�: s 11_,,,.,,� �':t'� 'I.- .... ,... ...•, 16.60
"'.°44 i ' i`Ft:.l a?,' �1" :": ter ` .. : =Y' Water 16.
� •.r �'� •' •�' closet 60
B
easiness sam X11 V�J ��-lr -�'�>� ( _..,.L 1- ; Water beater 16.60
Address: ,+ , u - r
Cicy/StattJJLIP:rJ a. 411111 I Other:
` / I 1111 Subtotal
Phone' ( ) (.1'30-• " ) r] ' 1 Minimum permit fee: 572.50
-1 Residential boekilpw minimum permit fee: 536.23
CCC/3 Lic.: Ail I a -OG D Pl an review
D ,�� (259G of permit fee)
State surcharge of permit fee)
Authorized � n_
( -O •& TOTAL L PERM1IT FEE - 1425.,3=,
Pontn 1 Writ
1 7PS C] i P application aspires if a `ante..` is cwt obtained within
180 days ar h nay bee aorrpred» complete.
*Fee methodology set by Tri- County Building tndusay Service Hoard.
analain surw litortM- raaJur®.eor CM) 44O4616T11002/COM/w861
i
CITY OF TIGARD
BUILDING DIVISION PERMIT #: reCROD05 0� -
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED:
Phone: (503) 639 - 4171 44P/4 0'
Inspection Requests (24 Hrs.): (503) 639 -4175 dg.A. '''I
INSPECTION WORKSHEET FOR DATE: 317 TIME: PAGE:
w
SITE ADDRESS. 1 361)0 n �
pD 1'Q � C (y � • � , CLASS OF WORK. ,
SUBDIVISION: V LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: Ski f eryt PHONE #: Co - 7 a74
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # 39q Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions: 1-60)(7-- 0 I V
SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 17 7, Date / / Phone #: (503) 718 -
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