Permit n CITY OF F TIGARD I GA R® PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007- 00120.
DATE ISSUED: 3/27/2007
TtGARD: 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 136DD -04100
SITE ADDRESS: 11850 SW 67TH AVE ZONING: MUE
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT: 007 JURISDICTION: TIG
PROJECT: TIGARD TRIANGLE COMMONS
Project Description: Commercial backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 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
PACIFIC NW PROPERTIES
ATTN: PAUL GRAM Description Date Amount
P.O. BOX 2206 [PLUMB] Permit Fee 3/27/2007 $72.50
BEAVERTON, OR 97075 [TAX] 8% State Surcha 3/27/2007 $5.80
Phone : 503- 626 -3500 Total $78.30
Contractor:
PEAK LANDSCAPING
PO BOX 927
CORNELIUS, OR 97113 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 359 -7801
FAX 503- 359 -9202
Reg #: PLM 8339
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 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.
I • , ' tM a..., 61,/1
Plumbing Permit Application FOR OFFICE USE ONLY
Cit of Ti and M Received ,� •�
y g r � � W J Date/By i / . Permit No.: t i Uaro � e7/»
a 13125 SW Hall Blvd., Tigard, OR 0 - -' Plan Revie
I N
Phone: 503.639.4171 Fax: 503.598.196Q Date/By: Other Permit No.:
T I GA RD Inspection Line: 503.639.4175 11i1 �1 LOP Date Ready /By: 1r H See Page 2 for
Internet: www.tigard or.gov ( Notified /Method: �/ Supplemental Information
TYPE OF W f3" r- ,, FEE* SCHEDULE
lill New 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 (I) bath 249.20
❑ 1- and 2- family dwelling V Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder ❑ Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE I.NFORMATION AND LOCATION Site utilities
Job site address: ,. �� (01.a- Catch basin or area drain 16.60
City /State /ZIP: � � I IG.," O Drywell, leach line, or trench drain 16.60
t
Suite/bldg. /apt. no.: Project nam : t la,ri. �, (- Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: _ ) Page 2
Fixture or item
Tax map /parcel no.: 04 (o 0
Absorption valve 16.60
f DESCRIPTION OF WORK Backflow preventer 1 Page 2 LX44( D
r, •1 t 4 . Ow Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Expansion tank 16.60
Address: Fixture /sewer cap 16.60
City /State /ZIP: Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
N tit APPLICANT ❑ CONTACT PERSON Hose bib 16.60
^ Ice maker 16.60
Business name: ca� l � „�"� Q i ce _
r„„` "` "' - - Interceptor /grease trap 16.60
Contact name: C21/CO-a^."_ Medical gas (value: $ ) Page 2
Address: $C;It''-' q ' Primer 16.60
City /State /ZIP: C___ J j ` 0. , O q71 13 Roof drain (commercial) 16.60
Phone: (i 3 3� 7 g2c9 Fax: :;13 3 - eiDno, Sink basin /lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: V 1,•,,,_ 2 kr,..ro. , Lam„ Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: A -C4J00f.re . py X Water heater 16.60
Address: 1 Other:
City /State /ZIP: Subtotal
A 0, tic 1 Minimum permit fee: $72.50 .A ^
Phone: ( ) i Fax: ( ) Residential backflow minimum permit fee: $36.25 7 p1•, 0
n 2 n3 3 Plan review (25% of permit fee)
��: C11L7 � 9 is �7 Plumbing Lic. no.: �
/ Q r) State surcharge (8% of permit fee) 6".
Authorized signature: 7/`"-�
TOTAL PERMIT FEE41, .g. 1 !D
I r \ �
Print name: � ` Date: '.� f 51o') This permit application expires if a permit is not obtain within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I: \Building \Permits \PLM- PermitApp.doc 06 /26/06 440- 4616T(10/02 /COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00120
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3127/2007
Phone: (503) 639 -4171 ' ^,.. ��1
Inspection Requests (24 Hrs.): (503) 639 -4175 . ! =� FL
INSPECTION WORKSHEET FOR DATE: 8/20/2007 TIME: 7:02AM PAGE: 48
SITE ADDRESS: 11850 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: TIGARD TRIANGLE COMMONS LOT #: 007 TYPE OF USE:
PROJECT NAME: ' TIGARD TRIANGLE COMMONS
DESCRIPTION: Commercial backflow preventer for irrigation.
OWNER: PACIFIC NW PROPERTIES, PHONE #: 503- 626 -3500
CONTRACTOR: PEAK LANDSCAPING PHONE #: 503 -359 -7801
Inspection Request Scheduled For: Date: 8/20 /2007 Pour Time:
Code # Inspection,Description Confirm # Contact # Message
395 Misc. inspection ' 054292 -01 503 - 533-8173 Y
Corrections /Comments /Instructions:
Cf-3/-/ LA )4.)
• . ,
. _
1_ .
IXPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: __ ~"�" Date: 53 Yri Phone #: (503) 718-
,