Permit !�n ✓,ew CITY OF TIGARD PLUMBING PERMIT
"� COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00325
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 7/24/2007
PARCEL: 1 S 134BC -00401
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 ZONING: C -N
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: PROVIDENCE
Project Description: TI - demo (1) backflow preventer and (1) lab sink.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PROVIDENCE HEALTH SYSTEM
4607 NE GLISAN Description Date Amount
PORTLAND, OR 97213 [PLUMB] Permit Fee 7/24/2007 $72.50
[TAX] 8% State Surcha 7/24/2007 $5.80
Phone : 503- 215 -6282 Total $78.30
Contractor:
HEINZ MECHANICAL INC
2615 NW ST HELENS RD
PORTLAND, OR 97210 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 220 -0855
FAX 503- 220 -0260
Reg #: LIC 43866
PLM 34 -165PB
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 B • /, i i % Permittee Signat me 4/ / e ✓�
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.
✓ d ~ RECEIVED
Building Fixtures
Plumbing Permit Application JUL 2 •2 I:oa oI: r SCI: List: OM.). City of Tigard j , I'1 • "" . • 7 A Q PermirNo. • P11to0 2!J 3 �
�
SW 1 .
a 13125 SW Hall Blvd, Tigard, U�I /9 )1 � 1� -U t F lan Review
Phone: 503.639.4171 F4j IL
J I ZJ IIN U DIVT 1 L)T o ; 'r Other Permit No.:
r t c a x D Inspection Line 503.639. 1� 1 . ' Ready/By 1 ® See page 2 for
Internet www-tigard- or.gov Notified/Method • / ' t 3 Supplemental Information
.,.. a .04 ... _- . 4.. ..,. " .,,,. . - 4Mr: 1 . .
❑ New construction ❑ Demolition For spedal Information use cheenst.
Description I Qty_ I Ea. I Total
l 1teration/replacement 0 Other- Newt- 2-family dwellings (includes 100 ft. for each utility connection)
"�.1'= ':sky.
a
`, ''Cl(r'Q Y* [J 1+1A SFR 0) bait 24920
❑ 1- and 2- family dwelling ❑lrommercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi-family SFR (3) bath 399.00
❑ Master builder additional bath/kitchen 45.00
�. ❑ Other. Fire sprinkler ( sq. ft.) Page 2
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:t`ypr ;r.r �* v %L_• lit` k L'i 1„:` ` `'!�' IQ
Site utilities
Job site address: V1,4_47., 5 W ' G 0. ot_L S peAv 1,m, -d Catch basin or area drain I I 16.60
City/State/ZIP: • 1-i A. rt„Q _ O Q. 4 1/ )- 3 Drywall, leach line, or trench drain 16.60
Suite/bldg./apt. no.: /D/ I Project name: Pn-o -X'�T % 1 Footing "'Gt" - drain (no, linear ft.: _J Page 2
try Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60 _
Rain drain connector 16.60
Sanitary sewer (no. linear 1t.: 1 Page 2
a Storm sewer (no_ linear ft.: ) Page 2
Subdivision: i S` / 3(16E---* C)9 I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map/parcel no,:
Fixture 1 m
:...;:. :.: •: ..._:,:.. _.., ' .
or to
_ _ Absorption valve ib 60
I N``O ORtC
Q
_ `ASCR IPT -
fl Page Badc w re enter o
0
P
g
pail"- 5 4..-Lbt. MA- G}oF2 eat ' s Z Backwater valve 16.60
� S z -s TL�C� A A-a-f 4 o-Cs cam-. Clothes washer 16.60
Dishwasher 16.60
::, ., ;.r:° r akin fountain 16.60
P
- TEN'
TY'.O.WNE .
PER ,
4.
,..::; " -; �� ..... _ .....:..:...,. �;:,' ',;•;..;;' z�'! . ,. � •:: . `i Ejectors/sump 16.60
Name: f21.6 (i f) -- e . • b+ Q 4vt-- vi- 5 Yi 5 t CV711 Expansion tank 16.60
Address: /'Z4 5 w S G 14 G. L.Z.. PP L -(y'2 Rv Fixture/sewer cap 16.60
City/State/ZIP: 1 1 C . Am-() Q /L, C. ` L2, 3 Floor drain/floor sink/hub I 16.60
Phone: ( )
Fax:
Garbage disposal 16.60
Hose bib 1660
. ' Ice maker 16.60
Business name: EC Z ni•- CG ('4 Pt Iv, L G A' L- Interceptor /grease trap 16.60
Contact name: ( A m iv L D CZ- t, b Cv (= Medical gas (value: $ ) Page 2
Address: 2 '(® y5 1` 4 (4 $ T H a t . a 12.r9/44) Primer 16.60
City/State�IP: { r- } nilf) 62_, �� 2,1--a
Roof drain (commercial) 16.60
/ in/lavatory De-- j 16,60 i .
Phone: (50 3) 2.2.0 - Co - I Fax:: ( 603) 22O. d,Z,(90 ub /shower /shower pan 16.60
E- mail: CS Cce n O e, 424, *4 .L. - rte CG , Cow Urinal -_,
16.60
........
�QN'l7N.
. ?:5_: '� ... W closet - 16.60
eater c neat
Business name: Ha` Z M ei-;4 N, < A L Water heater 16.60
Address: Other:
�� b � � W � ?' . � a � � � � D Subtotal
City/S(ate/ZIP: P ae , r irA, t.,t, D 0-R, G `- 2.4-0
Minimum permit fee: $72.50 14, $�
Phone: (6o3) - Z2..0 a e 6- Fax: ( 563) 2,2•4 - 62-4 a Residential backflow minimum permit fee: $3625 /01
Plan review (25% of permit fee)
CCB Lic.: 3 8 6s- L Plumbing Lic. 46 p Q State surcharge .5 % of permit fee) �- VD
Authorized signature: r TOTAL PERMIT FEE 7 8. 3e)
Print name: Cg A. a L p 12- i✓Er G rr I Date: 7-2-0-07 The 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
t:1Bu ldvtglpeemitslPLMF -Pe mitApp.doe 04/06/06 440- 4616T(10i02/COM (WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00:325
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/24/2007
Phone: (503) 639 -4171 �� 1 g
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/17/2007 TIME: 7:00AM PAGE: 47
SITE ADDRESS: 12442 SW SCHOLLS FERRY RD 101 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PROVIDENCE
DESCRIPTION: TI - demo (1) backflow preventer and (1) lab sink.
OWNER: PROVIDENCE HEALTH SYSTEM, PHONE #: 503.216.6282
CONTRACTOR: HEINZ MECHANICAL INC PHONE #: 503- 220 -0055
Inspection Request Scheduled For: Date: 9/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 055758.01 503 - 519 -3965 N
r + 11 -
j No. l
Corrections /Comments /Instructions:
B A l:a� �� Hw. -� DR_ 1/4)..e. 1 op; LA v
a..re., " 1 - ---71 9A-.)
•
X PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \A A Date: 1 11 1' Phone #: (503) 718-