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Permit CITY TIGARD PLUMBING PERMIT ° COMMUNITY DEVELOPMENT PERMIT #: PLM2006 -00119 TtGARD: 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/18/2007 PARCEL: 1 S135DD -05600 SITE ADDRESS: 11830 SW GREENBURG RD ZONING: R -12 SUBDIVISION: WELSH PARTITION LOT: JURISDICTION: TIG PROJECT: WELSH PARTITION Project Description: Storm and sanitary CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: 1 FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: 137 ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: 155 ft Owner: FEES VICTOR WELSH 20055 SW PACIFIC HWY Description Date Amount SHERWOOD, OR 97140 [PLUMB] Permit Fee 5/5/2006 $219.40 [PLMPLN] Plan Review 5/5/2006 $54.85 Phone : [TAX] 8% State Surcha 5/5/2006 $17.55 Total $291.80 Contractor: FIVE STAR PLUMBING LLC 6138 SE 136TH AVE PORTLAND, OR 97236 REQUIRED ITEMS AND REPORTS Contact # : PRI 503- 987 -5000 Reg #: LIC 176756 PLM PB370 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 ru or i . uesti. • _ to OUNC by calling 503.246.6699 or 1.800.332.2344. Issu d By: j � tol Permittee SignatureSk. 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. J S30 $0 G-g ee7J 1 3 01Z -G-' 6 b( . 1 1 l: - Plumbing er leati+ } FOR OFFICE USE ONLY City of Tigard . • Received / j / � p No.: /, ' 1 3125 SW Hall Blvd., Tigard, OR 97223 1-j PlateBy �+ �, j ,� /� Phone: 503.639.4171 Fax: 503.598.1960 I Date/By: Plan Review ... ,,I7 (5 / , �, .� Other Permit No ": 24 Hour Inspection Line: 503.(39141 -; tGP;;L. ■ IV Date Ready/By: Tr S /61 ® See Page 2 for Internet: www.oi.tigard.or.us p Notified/Meth �� Su lementallnformation ) ' L fll\IC h1�/1.e PP TYPE OF WORK FEE* SCHEDULE - '11) XNew construction ❑ Demolition For special information use checklist Description 1 Qty. 1 Ea. 1 Total ❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 249.20 `g( 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 // SFR (3) bath 399.00 r ❑ Accessory building ❑ Multi- family l Each additional bath/kitchen 45.00 ❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities Job site address: //530 f (,,' 6,,,, ,r. � k. � d Ca tch basin or area drain � 16.60 6 �� City /State /ZIP: 7%5 ,.1 , 04' Drywell, leach line, or trench drain 16.60 ,■ Suite/bldg. /apt. no.: / Project name:t2e %1 r )!/. ., : fil o0S - 0o00.3 Footing drain (no. linear ft.: _) Page 2 ` _ S / Manufactured home utilities 110.00 Cross street/directions to job site: 9'9 ( )�' tee, ler /e/. Manholes 16.60 Rain drain connector 16.60 4e Sanitary sewer (no. linear ft.: / 37 ) Page 2 /0/ --- Jy Storm sewer (no. linear ft: IS$ ) Page 2 /pi ' f Subdivision: Lot no.: 41 o o Water service (no. linear fl.: ) Page 2 O Fixture or item Tax map /parcel no.: se a 5 Ike JE4 ✓e0t4, 15 1o..*,i1, /, .,t4 4 n / 4,e�/ Absorption valve 16.60 DESCRIPTION OF WORK L Backflow preventer Page 2 f fo ....,. 7` - fe .,,•fa ,Te' y ,, j Backwater valve 16.60 / Clothes washer 16.60 Dishwasher 16.60 Drinking fountain 16.60 PROPERTY OWNER I 0 TENANT Ejectors /sump 16.60 Name: 06 fo r 4 'e 64 //47/i/ �// 4 A . -Ac. Expansion tank 16.60 Address: D o 5S 1w / o.rci ire /r: w • Jt.: ie /o$ Fixture /sewer cap 16.60 City /State /ZIP: f/1 e.',* ,,� oo d ✓ d/4 9 7/40 r Floor drain/floor sink/hub 16.60 Phone: ( co) ) Co LC- 9 /S/ Fax: (Soy) G ZS' 9/SJ Garbage disposal 16.60 ❑ APPLICANT 'CONTACT PERSON Hose bib 16.60 Ice maker 16.60 Business name: C , /7/,;„ yre -/O e , r e-/ lit G . Interceptor /grease trap 16.60 Contact name: 4 4-,, J r <' , Medical gas (value: $ ) Page 2 Address: g z X 0 //j` M /(2, Primer 16.60 City/State /ZIP: A t fe 0 R 9 7 / /fc Roof drain (commercial) 16.60 Sink/basin/lavatory 16.60 Phone: ( .ce , j) -- 605/ I Fax: : (SOI) 537- 197 7 Tub /shower /shower pan 16.60 E -mail: p a n d c? cop, co ✓/ Mr/ Urinal 16.60 / CONTRACTOR �1 ,I Water closet 16.60 di-- Business name: j e5 i f a f/J/ Jc , jj Water heater 16.60 Address: (p 1? iS dt. 3 ( / U t. Other: City /State /ZIP: fr ► 0 _, o2 c t "7 9-�j Subtotal Z f 9 1 ?- - Minimum permit fee: $72.50 Phone: (5p3) 9 S'i - ".61)60 Fax: ( ) Residential backflow minimum permit fee: $36.25 �_ _ Q Pl review (25% of permit fee) •�},� CCB Lic.: / 7 (P �' Plumbing Lie. n, : PB 37 U /17,, State surcharge (8% of permit fee) ... 53 Authorized signature: _ D TOTAL PERMIT FEE Z .q1 .. Print name: t . G 7 / ( cit /e-Ls�4 Date: / This permit application expires if a permit is not obtaine within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Ruildinp Industry Service Roard CITY OF TIGARD r ic ,A BUILDING DIVISION PERMIT #: PLM2006.00119 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/18/2007 Phone: (503) 639 -4171 I(Il. Inspection Requests (24 Hrs.): (503) 639 -4175 "__.. INSPECTION WORKSHEET FOR DATE: /0/912007 TIME: 7:00Am PAGE: E4 SITE ADDRESS: 11830 SW t REENBLIRC RIB CLASS OF WORK: SUBDIVISION: WELSH PARTITION LOT #: TYPE OF USE: PROJECT NAME: WELSH PARTITION DESCRIPTION: Storm and sanitary OWNER: PHONE #: CONTRACTOR: FIVE STAR PLUJM13U'JG LLC PHONE #: 603.987.6000 Inspection Request Scheduled For: Date: •10/912007 Pour Time: Code # Inspection Description Confirm # Contact # Message 605 Sanitary sewer 057167-04 503-781-9886 N Corrections /Comments/ Instructions: W ) , / k 4 4 f '- vv.-...dt 4,Tu4 A J e6 . l i SS+ i- 4_ S- 4-4..;1, I,AA 10 p.e, v1 TLAb (>1,, p tA, L3 ►-Le. w a v K ,zv, . ...c 1 b M: Vi Li L -4-e. ♦- M ke, Sit ev k c'.-4 ,,,,,,,0„,,,,...J9,...) N PASS PARTIAL APPROVAL n CANCEL U NO ACCESS l FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: di x+4 1 L__ Date: 1 ('T 1 a7 Phone #: (503) 718 - CITY i OF TIGARD BUILDING DIVISION PERMIT #: PI 12005..g0E19 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9i1812007 Phone: (503) 639 -4171 '' Inspection Requests (24 Hrs.): (503) 639 -4175 AL INSPECTION WORKSHEET FOR DATE: 10/3/2007 TIME: 7:OOAM PAGE: 65 SITE ADDRESS: 11830 SW GREENBURG RD CLASS OF WORK: SUBDIVISION: WELSH PARTITION LOT #: TYPE OF USE: PROJECT NAME: lAiELSH PARTITION DESCRIPTION: Storm and E.: anitaiy OWNER: PHONE #: CONTRACTOR: FIVE STAR PLUMBING LLC PHONE #: : Inspection Request Scheduled For: .Date: 10/'2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 340 Storm drain 057167 -03 503- 781 -98th Y Corrections /Comments/ Instructions: W i s ✓ V o ✓r- - , / ( 4— e r ... r ∎ L v ( p . wk. i (c; L be 1 0 ' r 4 , - - evt,pe✓-- L,t 1 4-J rre ik 10 ( Vq. LA„; ar- Mt V. &L � X- PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS n FAIL n CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: Q6 Date: 1 O 1 Phone #: (503) 718- CITY OF TIGARD , ,, BUILDING DIVISION PERMIT #: p;(()' 9 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/18/2001 Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 -4175 s' t�� INSPECTION WORKSHEET FOR DATE: 10/5/2007 TIME: 7:01AM PAGE: 7 SITE ADDRESS: 1183() SW GREENBURG RD CLASS OF WORK: SUBDIVISION: > L H PARTITION LOT #: TYPE OF USE: PROJECT NAME: WELSH PARTITION DESCRIPTION: Sic= and sanitary OWNER: PHONE #: CONTRACTOR: FIVE STAR PLUMBING LLC PHONE #: 5033 -9x37 -5000 Inspection Request Scheduled For: Date: 10f5/7007 Pour Time: Code # Inspection Description Confirm # Contact # Message 340 Storm drain 057061 -01 503 -781 -9888 N Corrections /Comments/ Instructions: n PASS n PARTIAL APPROVAL CANCEL n NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: _ 1 / 1 "'J; 1 I P-- Date: ' Phone #: (503) 718- CITY OF TIGARD BUILDING DIVISION PERMIT #: Pi M2006.00118 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: g/ 18/20(yf Phone: (503) 639 -4171 � ��ii111�, Inspection Requests (24 Hrs.): (503) 639 -4175 ��' '` _... INSPECTION WORKSHEET FOR DATE: 10/5/2007 TIME: 7 :0•1Aiy PAGE: 8 SITE ADDRESS: 11030 SW t3REENDURC RD CLASS OF WORK: SUBDIVISION: wELSH PARTITION LOT #: TYPE OF USE: PROJECT NAME: WELSH PARTITION DESCRIPTION: Strarm and sanitary OWNER: PHONE #: CONTRACTOR: FIVE STAR PLUMBING LLC PHONE #: 503. 987 -5000 Inspection Request Scheduled For: Date: 10/5,9007 Pour Time: Code # Inspection Description Confirm # Contact # Message 605 Sanitary sewer 067061-02 5037131 -8888 N Corrections /Comments/ Instructions: PASS n PARTIAL APPROVAL X CANCEL ❑ NO ACCESS I I FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: c6\it ,i 1 Date: /04C /o') Phone #: (503) 718- �1c r CITY tiFTOG ;' 1 ° COMMUNITY DEVELOPMENT 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 Plumbing Signature Form IMPORTANT PERMIT NOTICE FIVE STAR PLUMBING LLC 6138 SE 136TH AVE PORTLAND, OR 97236 Permit #: PLM2006 -00119 Date Issued: 9/18/2007 Parcel: 1S13500-05600 Site Address: 11830 SW GREENBURG RD Subdivision: WELSH PARTITION Lot: Jurisdiction: R -12 Zoning: TIG Project Name: WELSH PARTITION Description: Storm and sanitary Your company has been indicated as the plumbing contractor for the permit referenced 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. Please mail the form to: City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681. If you have any questions please call 503.718.2433. No plumbing inspections will be authorized until this completed form is received OWNER: PLUMBING CONTRACTOR: VICTOR WELSH FIVE STAR PLUMBING LLC 20055 SW PACIFIC HWY 6138 SE 136TH AVE SHERWOOD, OR 97140 PORTLAND, OR 97236 Phone #: Phone #: 503 -987 -5000 Reg #: LIC 176756 PLM PB370 AN INK SIGNATURE IS REQUIRED ON THIS FORM • X CO 0' € Signature of Authorized Plumber Name (printed) �'