Permit 4 CITY OF TIGARD PLUMBING PERMIT
wi DEVELOPMENT SERVICES PERMIT #: PLM2001 -00598
--- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 D ATE ISSUED: 11/16/01
SITE ADDRESS: 08060 SW PFAFFLE ST PARCEL: 1S136CD -00600
SUBDIVISION: SPRINT PCS WIRELESS MONOPOLE ZONING: C -P
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW 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: 300 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Water service
FEES
Owner:
Type By Date Amount Receipt
EEI SOLUTIONS PRMT CTR 11/16/01 $194.20 27200100000
5665 SW MEADOWS RD, SUITE 300 PLCK CTR 11/16/01 $48.55 27200100000
LAKE OSWEGO, OR 97035 5PCT CTR 11/16/01 $15.54 27200100000
Phone 1: 503 - 294 -2150 Total $258.29
Contractor:
MSI MECHANICAL SYSTEMS INC
21195 NW EVERGREEN PKWY STE 20
HILLSBORO, OR 97124 REQUIRED INSPECTIONS
Phone 1: 503 - 642 -1234 Water Service Insp
Reg #: LIC 00070032 Water Service Insp
RP /Backflow Preventer
P 34-183
RP /Backflow Preventer
Final Inspection
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature: .
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
1iC r 4, / & 1 i, /k p=oi e q,,
Plumbing Permit Application
Datereceived: # g 0/ Permit no. :9 -a 553
i , , G�ty of Tigard Sewer permit no.: Building permit no.:\
Address: 13125 SW Hall Blvd, Tigard, OR 97223
• C' o�gard Pro/ ject 1. no.: Expire date: '6".,-- '0' Phone: (503) 639 -4171 j aPp P �
Fax: (503) 598 -1960 Date issued: By: I Receipt no.: •
Land use approval: Case file no.: [ aymenttype:
O 1 & 2 family dwelling or accessory ercial/mdustrial O Multi- family O Tenant improvement °.
,4New construction O Addition/alteration /replacement O Food service O Other.
JOB SITE INFORMATION FEE St 11EDUULE (for special information use checklist)
Job address: 80(90 sv. () R-C ST-a Description Qty. Fee(ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
Tax map/tax lot/account no.: it 3(4 CJP (900 SFR (1 )lo0s.foreachatflity connedion)
SFR (1) bath
Lot: (Block: Subdivision: SFR (2) bath _ ��
Project name: C IN'tfrttn,a Q c tck &OCn SFR (3) bath
City /county: ( I ZFP: e ra? , 3 Each additional bath/kitchen ('
Description and location of work on premises: Site utilities:
140yrreit— LINE' Catch basin/area drain
Est. date of completion/' inspection: Drywells/leach line/trench drain
Footing drain (no. lin. ft.)
Manufactured home utilities k.
Business name: ris' M £ Cnai 1 J r C R 6 / r . /5 Manholes
Address: A / f 96-/4.4..) eve.4 EerA � )/ 5 e- 4 2c'/ Rain drain connector
City: 4 ?, L 6020 I State: 027I ZIP: 9 77A Sanitary sewer (no. lin. ft.)
Phone (p yZ - /2 3 `// JFax: 4/44- 2a // mail: Storm sewer (no. lin. ft.)
CCB no.: I Plumb. bus. reg. no: Water service (no. lin. ft.) 73Uo . /11 1 `
City /metro lic. no.: Fixture or item:
Contractor's representative signature: G Absorption valve
Z Back flow preventer X. �Z
Print name: Sue. ME 641ST J Date: l $ O t Backwater valve
Basins/lavatory
Name: Eittc, 1�teEUvLSE�1 Clothes washer
jectog fountain(s) IA Fl
(400 SF'irt � 8t0 - Drshwnfo
AS . City: Po I � n 1 . „ I State: e & I ZIP: CiIzo' Euntains)
etxors/sump
Fax: 2 4-S4 5 E -mail: Expansion tank
)6 4 1 Fixture/sewer cap
Name (print): ('A1ry1ER,0 .1 Qp,O 962 `( D WEUO PMO J1 Floor drains /floor sinks/hub
Garbage disposal
Mailing address: ScoGA SW t\EAVAWS - So lT 300 Hose bibb
City: (v f O$ vdElxo l state:oi- I DR 9.103S" Ice maker
Phone: jfin - LOtoo I Fax: 241 -1(( E -mail: Interceptor/grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Owner's signature: Date:' Sump
Tubs/shower/shower pan
Name: UJEi ;iJ E146,WCE-4ni4 - Co CAkst.CCEIZEINI Water closet .
Address: QjOOO Sb3 Qpac.c.. " S'r Water heater
City: Pluslct 0 I State: tom. I ZIP :. 111:2-3 Other.
. Phone: fig. ($ I Fax:>SZ$' (&,11 E -mail: Total
mt am accept seat =dB, ukase call jurisdiction for me iarameam Minimum fee $ / 70
Not all j
Notice: application Plan review (at � %) $ ?A � S`f'
O Visa O MasterCard expires if a permit is not obtained $ 4S • Credit card number: / / within 180 days after it has been State surcharge (8%) .
Name of cardholder as shown on credit card
Expires accepted as complete. TOTAL $ Z S�• Z 9
$
_madder signature Amount " W a l4E C.10 s \ G'r — 440-4616 (603I0OM)
Q: So3 - G 42 - 1284 MSt N1 Kttf p4 CAt S4S're'v1S 14E, vi _. cF ?._ i
c- c - 4(er„ .7� .I t 21i°IS 14t►•t EVelt4REEK) era u� Jp m S _ , .
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
MSI MECHANICAL SYSTEMS INC
21195 NW EVERGREEN PKWY STE 20
HILLSBORO, OR 97124
Plumbing Signature Form
Permit #: PLM2001 -00598
Date Issued: 11/16/01
Parcel: 1 S136CD -00600
Site Address: 08060 SW PFAFFLE ST
Subdivision: SPRINT PCS WIRELESS MONOPOLE
Block: Lot:
Jurisdiction: TIG
Zoning: C -P
Remarks: Water service
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for the
plumbing permit to be valid, please have the appropriate individual from your company sign below and return
this Plumbing Signature Form prior to the start of the work .
No plumbing inspections will be authorized until this completed form is received
•
OWNER: PLUMBING CONTRACTOR:
EEI SOLUTIONS • MSI MECHANICAL SYSTEMS INC
5665 SW MEADOWS RD, SUITE : 21195 NW EVERGREEN PKWY STE 20
LAKE OSWEGO, OR 97035 HILLSBORO, OR 97124
Phone #: 503 - 294 -2150 Phone #: 503 - 642 -1234
Reg #: LIC 00070032
PLM 34 -183
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X i!-
Sign re of Auth. • L Plumber
If you have any questions, please call (503) 639 -4171, ext. # 310
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 -
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received D te,Re ed ��� AM PM BUP
Location ��4/ ia.-4 to Suite MEC
Contact Person Ph ( ) Sick 1/,YPLM ,P 0 / -79105 7
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam `/. g
Shear Anchors
Ext Sheath/Shear gh1%ZL ALM A po—OpS*D
int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
1 S PART FA -
4 0
Pos :earn
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
ASS PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final ri Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA -0 /
Approach/Sidewalk Date Z Inspector ! r / 7-1 Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL