Permit Reprin+rcl -to Corrtc± fader - s. StN 5/i7 ,/o.7-
' a CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00190
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/15/2007
PARCEL: 2S 103DD- 01201
SITE ADDRESS: 13920 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: GOODWILL INDUSTRIES CENTER LOT: JURISDICTION: TIG
PROJECT: GOODWILL INDUSTRIES
Project Description: Installing commercial backflow preventer.
•
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OFUSE: COM WASHING MACH: 'BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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
GOODWILL INDUSTRIES
1943 SE 6TH Description Date Amount
PORTLAND, OR 97214 [PLUMB] Permit Fee 5/15/2007 $72.50
[TAX] 8% State Surcha 5/15/2007 $5.80
Phone : Total $78.30
Contractor:
GREEN ART LANDSCAPING
8335 NW CORNELIUS PASS RD
HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 617 -9990
FAX 503 -617 -0878
Reg #: LIC 5968
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 or 1.800.332.2344.
Issued By: 1/ if _ _ : / I Permittee Signature: � , e (4)11/sal
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.
05/15/2007 16:07 5036170878 GREEN ART LANDSCAPIN PAGE 02/07
_, .«
• Plumbing Permit Application I.OI{ (11:1 . I (,\ I.1
City of Tigard Received
te/FY: o� c 1LdV Permit NO.: �(,_(,83 .-0:::490 A 13125 SW Hall Blvd., Tigard, OR 97223 5 IS
III rlm
>s Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 l>aly. Other Permit No.; • .
inspection Linc: 503,639.4175 . p ��• • "�.
T I G A It 17 P Date Bendy /By: .h.e.• IA See Page 2 for
Internet: www,tigard- or.gov Notified/Method: S lementalInformation
• . •1 WR
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
% Addition/alteration/replacement ❑Other: New 1- 2- family dwellings (includes 100 It. for each utility connection)
' CATEGORY OF CONSTRUCTION SFR (I) bath 249.20 '
❑ 1- and 2- family dwelling $Commctcial /industrial SFR (2) bath 350.00
❑ Accessory building ___ ❑ Multifamily SFR (3) bath 399.00
Each additional bath/kitchen
❑ Master builder 45.00 1
. 0
13 x12D R Fire sprinkler ( sq. ft.) L p 2
1 - \ JQ� S)I� FORMA ON AND LOCA770N
Site utilities
Job site a d d r e s s . -S t-'`� Catch basin or ama drain 16.60 t
City /State/Z1P: d t . r ( +1 . J Drywcll, Icach line, or trench drain 16.60
Suite/bldg. /apt. no.: 6 'roicct f c: r - Footing drain (no. linear ft.: _) Page 2
Cross street/dircctions to job site: St LA l - Manufactured home utilities 110,00
6, �� &' 1• �" Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ,_) Page 2
• Storm sewer (no. linear R: ) Page 2
Subdivision: l Lot no.: Water service (no. linear R.: _ ) Page 2
Tax map /parcel no,: Fixture or item
Absorption valve 16.60
h: DESCRIPTION OF WORK Backflow pm -venter I Page 2 IQ ifiCt
1 4 ,4 r, a - flirt s F,r ® fl it - Backwater valve 16.60 .
Mt 4 , I , . - Clothes washer 16.60
{ Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Name �'� ��` l Expansion tank 16.60
k .>,�� s i� .. t. r�L ( tank 16.60
Address: /
!A ■ . a' a . / g1 , ' _ Fixturclscwcr cap _ 16.60
City /State/ZIP: 0 . 1 4, g _ R t it 6 Floor drain/floor sink/hub 16.60
Phone: ( ) Fait: ( ) Garbage disposal 16.60
IX APPLICANT ❑ CONTACT PERSON - Hose bib 16.60
Business name: �',?., , I fcc maker 16,60
v _ .� A . /k 4. 4. , interceptor /grease trap 16.60
Contact name; g
ate.. Medical gas (value: $ ) Page 2
Address: 1 - he MIALI1 � Primer 16.60
City /Statc/ZlP: 1 AI k p ..1? � I �' Roof drain (commercial) 16.60 •
Phone: 1 • , L p :: , (_ .. • m
Sink/basin/lavatory 16.60 -AP
I '' 11 � 1 p �6 �� Tub/shower/shower pan 16.60
E-mail: �
.►
�� �� Urine 16.60
- CONTRACTOR Water closet 16.60
Business name: Water heater 16.60 FO
Address: Other. I An
City/State./7.113: M 0 1 O - Subtotal f 1
Minimum permit foe: $72.50 `C7V "
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36,25
CC'B Lic.: f Lj 1tJl'I1t�IIii bi.i.aiL• Plan review (25% of permit feel
Authorized signature: 0 - _ State surcharge TOTAL P fee) $�
_.. _. TOTAL PERMIT FEE tam
Print name: lit. ` �.; c This permit application expires if a permit it not obtained within 11
130 days after it has been accepted as complete. j p
*Fee methodology set by Tri- County Building Industry Service Board.
I ;\fib iding \Permit \PLM PermtApp.doc 00126/06 440- 4616T(10t02/COM/wEg1 1- to �] (r 0
P '2coc - 09(3 '9- W` T() lJ
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00190
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1&200/
Phone: (503) 639-4171 g p!Il
Inspection Requests (24 Hrs.): (503) 639 -4175 M
INSPECTION WORKSHEET FOR DATE: 6/8/2007 TIME: 7:01AM PAGE: 34
SITE ADDRESS: 13920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: GOODWILL INDUSTRIES CENTER LOT #: TYPE OF USE:
PROJECT NAME: GOODWMLL INDUSTRIES
DESCRIPTION: Installing commercial backflow preventer.
OWNER: GOODWILL INDUSTRIES, PHONE #:
CONTRACTOR: GREEN ART LANDSCAPING PHONE #: 503 - 6179990
Inspection Request Scheduled For: Date: 618/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 049866 -01 503 -617 -9990 N
Corrections/Comments/Instructions:
- a Fj,51/PM OW, . 1 9. I*lr
A
/'J O r r . zi--y_Ai
` ' • S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FO INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: r r Phone #: 503
p G Date: 1 v p ( ) 718 -