Permit 4 V CITY OF TIGARD
• PLUMBING PERMIT
• COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00355
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/27/2008
PARCEL: 1S136AD-04000
SITE ADDRESS: 11509 SW PACIFIC HWY ZONING: C -
SUBDIVISION: PACIFIC TERRACE LOT: 007 JURISDICTION: TIG
PROJECT: VILLELA THERAPUTIC CENTER
Project Description: Installing clothes washer.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS:
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: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SMITH, EDITA M
833 NW 170TH DR Description Date Amount
BEAVERTON, OR 97006 [PLUMB] Permit Fee 8/27/2008 $72.50
[TAX] 12% State Surch 8/27/2008 $8.70
Phone : Total $81.20
Contractor:
JTR PLUMBING INC
4272 NE BEAUMEAD ST
HILLSBORO, OR 97124 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 209 -4290
Reg #: LIC 155929
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.
44111111111P
Issued B `� / Permittee Signature
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.
Plumbing Permit Application l S 9 ,4-(
• Building Fixtures .. FOR OFFICE l SE o\El
City of Tigard , V ry � Received ; 0 )-'i Of- 137-7- Permit No.: Pie, o2Cifir -c)0 5S
I 13125 SW Hall Blvd., Tigard, OR 972233
c Phone: 503.639.4171 Fax: 503.598.1 \ Other Permit No.:
Inspection Line: 503 hcis: El See Page t for
TIGnRD �Cj d/M
Internet: www.tigard -0r.gov p. R B Y: M e ho d :
�[p Supplemental Information
TYPE OF WORK ,,�y ell' � 5 � FEE* SCHEDULE
• ' ❑ New construction ❑ Demo1 \ For sperm information use checklist
U� I Qty. I En. I Tel
10 Addition/alteration/replacement ❑ Other: New 1 - 2 -family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 24920
0 1- and 2 -family dwelling .a Commercial/ industrial SFR (2) bath , 350.00
❑ Accessory building 0 Multi-family SFR (3) bath 399.00
Master builder Each additional bath/kitchen 45.00
El Other:
Fire sprinkler ( sq. ft) Page 2
' JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 11509 sw Pacific Hwy Catch basin or area drain 16.60
City/State/ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite/bldgJapt. no.: I Project name: v, fJI ti ,,aQu�'Z ( 4Footing drain (no. linear IL: _) Page 2
r Manufactured home utilities 110.00
Cross street/directions to job site: Pacific Terrace LCC .
Manholes 16.60
• Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
1 Storm sewer (no. linear ft: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft: _) Page 2
Future or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Install Washer & Dryer Hook ups next to an existing sink. ' Backwater valve 16.60
Clothes washer 1 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ® TENANT Drinking fountain 16.60
Ejectors/swim 16.60
Name: Leslie Villela Expansion tank 16.60
Address: 11385 SW 135 Ave #1 Fixture/sewer cap ' 16.60
City/ State/ZIP: Tigard, OR 97223 Floor drain/floor sink/hub - 16.60
Phone: (760)672-0033 Fax: ( ) Garbage disposal 16.60
In APPLICANT I ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: fvM d V interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/ State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( ) Sink/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E -mail: Urinal 16.60
/ C C ONTRACTOR Water closet 16.60
Business name: J -c Z (- p ,, Q J„ ( C Water heater 16.60
Address: 9 2_1 / T K I� (IV 1‘.1-12 S , Other:
(Z.- Subtotal
City/ State/ZIP: � (.(.S go 0.-b 0 c( 7 ti., 0 Minimum permit fee: $72.50
Phone:'( SO,) 209. - It j 9, p Fax: ( ) Residential back low minimum permit fee: $3625 ,5 CI
CCB Lic.: 1 5 - 9 29 Plumbing Lic. no.: 3 y - Lt ZZ _ Plan review (25% of permit fee)
State surcharge (12% of permit fee) ,. 70
Authorized signature:
Tar 9 -rc&,.JE CO..... TOTAL PERMIT FEE 61
Print name: S o C 2 Tq,v a (' � l Date: c.: ? . 0a I 71his p application expires Ha wit is not obtained within
g 180 days after it has been accepted as complete.
'Fee methodology set by Tri -County Building Industry Service Board.
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STAEDTLER' No. 932 8111S0 8 1/2 "x11" ISOMETRIC
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: PI_M 00B 003 ;5
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/27/20013
Phone: (503) 639 -4171 '11
Inspection Requests (24 Hrs.): (503) 639 -4175 ., ' :_.
INSPECTION WORKSHEET FOR DATE: 9/2/2000 TIME: 7:01AM PAGE: 19
SITE ADDRESS: 11509 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: PACIFIC TERRACE LOT #: 007 TYPE OF USE:
PROJECT NAME: VI1.LELA THERAPUTIC CENTER
DESCRIPTION: Installing clothes washer.
OWNER: SMITH, EDITA M, PHONE #:
CONTRACTOR: JTR PLUMBING INC PHONE #: 503-209A290
Inspection Request Scheduled For: Date: 9/212008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 074920-01 760 672 -0033 N
Corrections /Comments /Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ___4\-A-- ;A 11-4 Date: `2 t -d Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION A. PERMIT #: PL.M2008- 003'5
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/27/2000
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 .':� '''I..
INSPECTION WORKSHEET FOR DATE: 9/2/2008 TIME: 7:01AM PAGE: 10
SITE ADDRESS: 11509 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: PACIFIC TERRACE LOT #: 007 TYPE OF USE:
PROJECT NAME: VILLELA THERAPUTIC CENTER
DESCRIPTION: Installing clothes washer.
OWNER: SMITH, ED1TA M, PHONE #: .
CONTRACTOR: J1R PLUMBING INC PHONE #: 503 - 209 - 4290
Inspection Request Scheduled For: Date: 9/2/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
605 Sanitary sewer 074921 -01 760672-0033 N
Corrections /Comments /Instructions:
• 1
g PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: vu iYhA� \ V V'-^a Date: 9 \2 \OO Phone #: (503) 718-