Permit •
� CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00137
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/9/2007 PARCEL: 2S102CB -02300
SITE ADDRESS: 13240 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT: 008 JURISDICTION: TIG
PROJECT: WEST SIDE SURGERY
Project Description: Relocate (1) sink & (1) water closet, demo (1) clothes washer & (1) 3" drain.
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CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 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: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PACIFIC PROPERTIES
BY MARTIN JOHNSON Description Date Amount
13200 SW PACIFIC HWY [PLUMB] Permit Fee 4/9/2007 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchart 4/9/2007 $5.80
Phone : Total $78.30
Contractor:
NORTHWEST WATER WORKS
40110 SE MEADOWSONG RD
SANDY, OR 97055 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 668 -0375
FAX 503- 668 -0375
Reg #: LIC 113197
PLM 3 -333PB •
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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. T • - les are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions
to OU ' by calling •3.246.6699 or 1.800.332.2344. •
Is ed By: 0 /et 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.
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SPX (3)1aath I 194.00 I
O Accessory tuald4 0 Multi-Cm*
'gad% tanked bandielon 45.00
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11==33111=11 PT O - 11:13 ri i ,' W. , FOoling drain (no. lixonx 9 -; --....) 1 Page 2
Mamba:nod berm utilities I 110.00
Cross raseerlditandoto tojob siteg I All
- 143211101CS 1 16.60
Rata dran's tOancgtor 16,60
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- Sanitary 5OW er (no. linear ft: ____) i Pato
Storm sgwer (no. Sneer ft.; ___.j i i Fop 2
. Water serrice (no. linage ft.: ...,__,) 1 ! Pg 2
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Tax tnaioloucel no.; p10.- . ; -2,. 3,00 I bisrption I 1640 -
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. Nara . Excitation oak 1640 i
Addrosin Fixtinctsewer cap
, I 16.60
CityiStarefZIP: naw_...._:_Li i i i______ . ji oor siniatob i ■ 16.60
Illionce ( ) Fax:( ) Garbage disposal 115-60 .
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Roof dream (monomial) 1 16.60
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(=MTN .. I. II. II__ venter hearer - '16.60
Add / I _ .1 %. , 1 _ / 40 4 - • -SeMillMil Other
__________ L kiip , j y : 12 . totial
City/Sato/ZIP: lw • , q •
MInIrriurn pond fee: 572.50
Roridential bacidla
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1 Cal Lic.: /4 await* Lic. no.: 3- - ff, ." 4. -,..
Stite ourdIttrge (VA of permit fit) AiS
Authorized Aymara: '_,_./ , - 71/24( )? . TOTAL PER ta MIT PEE IS.
Prints:tam i j • ' „ , Di= jf., TIM wait sopa onion =flirts If is prude Ls not obtained wieuir
-. . ISO eLsys oilier lt hos berm accepted as ompleer.
'Fee me12134010eY seg by Til.Countilkifidtrig Indy:try Service Board.
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TO0e1 SMHOM HUIVA ISHAILLHON 21.00999COS XXI CT:9T LOOZ/90/T70
Accumulative Sewer Tally Parcel # 2S1002CB -02300
Tenant m
Nae:' West Side Surgery This SWR# N/A
Site Address: 13240 SW Pacific Hwy This PLM# 2007 -00137 1
Fixture Value Previous Previous Credits Capped Fixture Fixture New New
# value capped off value added added total total
count off # s count # value # s values
Baptisery/Font 4 0 0 0 0 0
Bath - Tub /Shower 4 0 0 0 0 0
- Jacu77i /Whirlpool 4 0 0 0 0 0
Car Wash - Each Stall 6 0 0 0 0 0
- Drive through 16 0 0 0 0 0
Cuspidor/ Water Aspirator 1 0 0 0 0 0
Dishwasher - Commercial 4 0 0 0 0 0
- Domestic 2 0 0 0 0 0
Drinking Fountain 1 0 0 0 0 0
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink - 2 inch 2 0 0 0 0 0
- 3 inch 5 0 1 5 0 -1 -5
- 4 inch 6 0 0 0 0 0
- Car Wash Dm 6 0 0 0 0 0
Garbage Disposal
- Domestic (to 3/4 HP) 16 0 0 0 0 0
- Commercial (to 5 HP) 32 0 0 0 0 0
- Industrial (over 5 HP) 42 0 0 0 0 0
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Ice Machine /Refrigerator Drain 1 0 0 0 0 0
Oil Sep (Gas Station) 6 0 0 0 0 0
Rec. Vehicle Dump station 16 0 0 0 0 0
Shower - Gang (per head) 1 0 0 0 0 0
- Stall 2 0 0 0 0 0
Sink - Bar /Lavatory 2 0 0 0 0 0
- Bradley 5 0 0 0 0 0
- Commercial • 3 0 0 0 0 0
- Service 3 0 0 0 0 0
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 1 6 0 -1 -6 .
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 0 0 0
Urinal 6 0 - 0 0 0 0
Previous EDU Count 0 0
Capped EDU Credit 0
TOTALS 0 0 2 11 0 0 -2 -11
Current Fixture Value -11 divided by 16 = -0.7 Current EDU 1 EDU = $ 2,700
Previous Fixture Value 0 divided by 16 = 0.0 Previous EDU
Change -11 divided by 16 = -0.7 over (under) $ (1,890.00)
Enter EDU Change Hem! -0.7
Notes: ** *CREDITS } **
Authorized Name /Signature:;Debbie Adamski� Date:! 4/9/2007
Buil g Division
's Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
bmitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I:\ Building \Forms \SewerTallySheet.xls 02/02/07
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CITY OF TIGARD A
BUILDING DIVISION PERMIT #: PLM2007- 00137
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/9/2007
Phone: (503) 639 -4171 ill
Inspection Requests (24 Hrs.): (503) 639 -4175 `_
INSPECTION WORKSHEET FOR DATE: 6/21/2007 TIME: 7:03AM PAGE: 8
SITE ADDRESS: 13240 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: PACIFIC MEDICAL
DESCRIPTION: Relocate (1) sink & (1) water closet, demo (1) clothes washer & (1) 3" drain.
OWNER: PACIFIC PROPERTIES, PHONE #:
CONTRACTOR: NORTHWEST WATER WORKS PHONE #: 503-668-0375
Inspection Request Scheduled For: Date: 6/21/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 050683-01 503-314 -1471 N
Corrections /Comments /Instructions:
/
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ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Pfb Date: i ) / Phone #: (503) 718-
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CITY,OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007-00137
13125 SW Hall Blvd., Tigard, OR 97223 � .. DATE ISSUED: 4/9/2007
Phone: (503) 639 -4171 �i i ; 1
Inspection Requests (24 Hrs.): (503) 639 -4175 - i
INSPECTION WORKSHEET FOR DATE: 4/27/2007 TIME: 7:00AM PAGE: 67
SITE ADDRESS: 13240 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FREWINGS ORCHARD TRACTS LOT #: 008 TYPE OF USE:
PROJECT NAME: PACIFIC MEDICAL
DESCRIPTION: Ro to (1) sink & (1) water closet, demo (1) clothes washer & (1) 3" drain.
OWNER: PACIFIC PROPERTIES, PHONE #:
CONTRACTOR: NORTHWEST WATER WORKS PHONE #: 503- 668 -0375
Inspection Request Scheduled For: Date: 4/27/2007 Pour Tim-•
iA litt/L--
Code # Inspection Description Confirm # Contact # M- -s.•ge
320 Plumbing rough -in 047247 -01 503 -314 -1471
Corrections /Comme is /Instructions:
14 eh :� s
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vre. "0„. 4,.t.....r, ( w lam— '4.- L 4r% .
No t . s __,,,(. ..r.-Wriset_ (iedv.e, -k-aJc-,..:, 0s A- S -- L.0.i
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1/UA: L puc_A-4, c Le ... y . %a...4
0 ____ X I Utl-c--.1/4>L41-1 .
d - mss-------- ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: `4 Date: 4/2', 4 2 Phone #: (503) 718- 1.-(J