Permit CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00157
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/25/2007
PARCEL: 25101 DA -00102
SITE ADDRESS: 13221 SW 68TH PKWY 401 ZONING: MUE
SUBDIVISION: TRIANGLE CORPORATE PARK LOT: 002 JURISDICTION: TIG
PROJECT: HEALTH NET
Project Description: Plumbing fixtures: New sink and WH.
CLASS OF WORK: ALT GARBAGE DISPOSALS: 0 MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 0 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
TIGARD TRIANGLE I LLC Description Date Amount
4650 SW MACADAM AVE STE 220
PORTLAND, OR 97201 [PLUMB] Permit Fee 4/24/2007 $72.50
[TAX] 8% State Surcha 4/24/2007 $5.80
Phone : Total $78.30
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -4139
FAX 503 -691 -2328
Reg #: LIC 87852
PLM 34 -166PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
i
Issued By A __I , � � Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection thaff usiness /ay.
This permit card shall be kept in a conspicuous place on the job site until co . letion e project.
Approved plans are required on the job site at the time of each inspectio
Avra20. 2007 3:42PM Rayborns Plumbing No. 3142 P. 1
4 -t o l 02-
•
Plumbin2 Permit ADDli i.( ;t: O H I( t. i r, oNI,N
~ ~ _- City of Tigard CEIVED Received . /0 ii/ P�itx
. 7
Ili 13125 SW Hall Blvd., Tigard, OR . ji. * Date/By: °�7 �O ` �l ��
I Pho 503.639.4171 Fax 503.. 0 2007 may: Other Pmt N iR afy - �, •
T i (� A 1; 1
Inspection Line: 503.639A175 CITY OF TIGARD �0 Ready/By: >; a See Page 2 for
1nUeanet Www.tigacd -vr.gw Not fi d /Method: Information 4
. 1NG.DIVISION - p; sca aoF.DuL� �, 1/ t 1,11144.4
❑ New construction ❑ Demolition or 3�'eda►rf(on$on use e6e�e U
® Addition/alteration/repl ❑ Other. New 1- 1 Qty, Ea. Total
_ New 1- 2- !Amity dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION . . SFR (1) bath 24920
❑ 1- and 2- family dwelling ® CommcrciaUmdushial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder El Other: Bust additional bath/kitcben 45.00
Fire sprinkler (_ sq. R) Page 2
• • BOB SITE INFORMATION• AND LOCATION, Site utilities
Job site address: 13221 SW 68' a PARKWAY Catch basin or area drain 16.60
City/State/ZIP: TIGARD, OREGON . Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. nos >00.40 1 !Project name; HEALTH NET Footing drain (no. linear R: _j Page 2
Cross st eet/directioas to job site: Manufactured home utilities 1 10.00
Manholes _ 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear R: `J . Page 2
Stored sewer (no. linear R: _) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.; ,_) Page 2
Tax map /parcel no.: Fixture or item
Absorption valve 16.60 ' •
DESCRD''ffON.:OF 'WORK' Bndkflowpreventer Page 2
TENANT IMPROVEMENT OF EXISTING SUITE. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60 • ❑ PROPERTY OWNER • , E. • ,. 0 'ENS' Drinking fountain 16.60
Name: Eject ors/sump 16.60
Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City/State/ZW: Floor drain/floor sink/hub 16.60
•
Phone: ( ) Fax: ( ) Garbage disposal G yP 0 16.60 16.60 •
• ®. APPLICANT • 'P •CONTACT. PERSON Hose bib 16.60 •
Ice maker 16.60
Business name: Rayborn'a Plumbing
Interceptor/grease tray 16.60
Contact name: RANDY DEADMOND Medical gas (value: $ ) Page 2
Address: 19990 SW CIPOLE RD. Primer 16.60
City/State/ZIP: TUALATIN, OR 97062 ' ", drain (commercial) 16.60
Phone: (503) 692 -4139 I Fax: : (503) 691-23211 in/lavatory 1 16.60 16.60
Tub/shower/shower pan 16.60
E -mail: randy®rayborns.com Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Rayborn's Plumbing Water heeler 1 16.60 16.60
Address: 19990 SW CIPOLE RD. Other:
City/State/DT: TUALATIN, OREGON 97062 Subtotal 49.80
Minimum permit fee: S72.50
Phone: (503) 692 -4139 Fax: (503) 691 -2328 Residential backtlow minimum permit fee: $36.25 72.50
CCB Lic.: 87852 Plumbing Liu no.: 34 -166PB Plan review (25% of permit fee)
Authorized signature: Stale surcharge (8% of permit fee) 5.80
TOTAL PERMIT FEE 78.30
Print name: RANDY DEADMOND 1 Date: 4/20/07 This permit application expires if a permit is not obtained within
180 days after it bar been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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CITY OF TIGARD A BUILDING DIV ION- PERMIT #: PLM2007- 00107
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/25/2007
Phone: (503) 639 -4171 il
Inspection Requests (24 Hrs.): (503) 639 -4175 �•
__..
INSPECTION WORKSHEET FOR DATE: 6/8/2007 TIME: 7:01AM PAGE: 27
SITE ADDRESS: 13221 SW 68TH PKWY 401 CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 002 TYPE OF USE:
PROJECT NAME: HEALTH NET
DESCRIPTION: Plumbing fixtures: New sink and WH.
OWNER: TIGARD TRIANGLE I LLC, PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 -692 -4139
Inspection Request Scheduled For: Date: 6/8/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 049869 -01 503 - 692 -4139 Y
Corrections /Comments /Instructions:
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f A ' ' -S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: f 14- 'I/ Date: Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00157
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/25/2007
Phone: (503) 639 -4171 - , 0 1
Inspection Requests (24 Hrs.): (503) 639 -4175 . _.111- L
INSPECTION WORKSHEET FOR DATE: 5/23/2007 TIME: 7:OOAM PAGE: 42
SITE ADDRESS: 13221 SW 68TH PKWY 401 CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 002 TYPE OF USE:
PROJECT NAME: HEALTH NET
DESCRIPTION: Plumbing fixtures: New sink and WH.
OWNER: TIGARD TRIANGLE I LLC, PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503
Inspection Request Scheduled For: Date: 5/23/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 048897 -01 503 - 692 -4139 N
Corrections /Comments/ Instructions:
•
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7/
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•
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!/f PA .S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
/ IL ,kC LL FOR INSPECTION .,Q{ ADDITIONAL FEES ASSESSED
11 1
Inspector: A' / Date: ✓ f/ Phone #: (503) 718 -
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00157
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/2512007
Phone: (503) 639 -4171 0 %si
Inspection Requests (24 Hrs.): (503) 639 -4175 4 s "') I..
INSPECTION WORKSHEET FOR DATE: 5/18/2007 TIME: 7:02AM PAGE: 53
SITE ADDRESS: 13221 SW 68TH PKWY 401 CLASS OF WORK:
SUBDIVISION: TRIANGLE CORPORATE PARK LOT #: 002 TYPE OF USE:
PROJECT NAME: HEALTH NET
DESCRIPTION: Plumbing fixtures: New sink and WH.
OWNER: TIGARD TRIANGLE I LLC. PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 -692 -4139
Inspection Request Scheduled For: Date: 5/18/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 048595 -01 503 - 692 -4139 N
Corrections /Comments/ Instructions:
Y/ , ',./
❑ PASS [PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL 9 FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: l Date Phone #: (503) 718-