Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00169
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 4/27/2007
PARCEL: 2 S 103 D D -012 01
SITE ADDRESS: 13920 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: GOODWILL INDUSTRIES CENTER LOT: JURISDICTION: TIG
PROJECT: GOODWILL INDUSTRIES
Project Description: Interior fixtures. Other fixtures: 1 drinking fountain, 4 hose bibbs.
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; 2 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: 1 GREASE TRAPS:
LAVATORIES: 6 OTHER FIXTURES: 5
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 5 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: 1 ft
Owner: FEES
GOODWILL INDUSTRIES
1943 SE 6TH AVE Description Date Amount
PORTLAND, OR 97221 [PLUMB] Permit Fee 4/27/2007 $348.60
[TAX] 8% State Surcha 4/27/2007 $27.89
Phone : 503- 238 -6190 Total $376.49
Contractor:
WILLAMETTE PLUMBING & MECHANICAL
PO BOX 5805
SALEM, OR 97304 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 585 -4682
FAX 503 -585 -0013
Reg #: LIC 159315
PLM 27 -70PB
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 By: 40 �J/ Permiftee Signature: « 977 _ �y
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.
Apr 25 07 03:39p Jul.:0.40-v p.2
aS70
A .
. . •
Plum Permit Application - k-t "' ' - , r FOR OFF IC - E. ILSE ONLY
i■ -
City of
1 13125 SW Hall Blvd Tigard ' -d- 9922 = olil o7 ae5A Permit Na: .3. 2007...0
., Tigard, 3 1- ......--/
111 1 Pim Etmi
11 Phone: 503.639.4171 Fax 503.598.1960 100 DatrAty. Other Permit No.: z
Inspection Line: 503.639.4175 APR 25
TIGARD pate Ready/By: All Ii3 See Page 2 for .
Internet www.tigard-or.gov t 1 1 .. . otiBedAiethod: ,.. , .,. ... .... .. ... . . . , suricinen
Wtvifif/7*; 5 - :"VY*IZA?!.. tr .„
New construction
ia ..*::' ''''• ••,:li,A
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For special Information sue checklist.
X Deralifik1A •" .
i'',V....' ' ' ' • Description I Qty. I Ea. I Total
0 Addition/alteration/replacement L-Mli "Other:
New I- 2-family dwellings (includes 100 ft. for each utility connectic
- 47* 4 0:4J i; Aj.ki*iii*:*;'q;;;.. P, 4;::::', ;.1±.' SFR (1) bath 24920
IZI I- and 2•farndy dwelling Mgorrmiercial/industrial SFR (2) bath 350.00
0 Accessory building 0 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen • 45.00
0 Master builder 0 Other:
, , .. „ , .. Fire sprinkler ( sq. II.) Page 2
; .-i.,-:''''.17,_ Site utilities
Job site address: ‘ Z SC 5w ?c, C. 1,4 y Catch basin or area drain 16.61)
City/State/ZIP: - T ICcitc4 i 0 g-- CI, 7j5, ' Drywell, leach line, or trench drain 16.60 . .
Suite/bldg./apt. no.: I Project name: &00 t . Footing drain (no. linear ft: ) Page 2
Z.,414/3
Manufactured home utilities 110.00
Cross streetldirections to job site:
Manholes 16.60
64/ /AL. 9::%.% Id Si _ Rain drain connector 16.60
Sanitary sewer (no linear ft.: ) Page 2
Storm sewer (no. linear fl.: ___) Page 2
Subdivision: I Lot no.: kW I Water service (no. linear IL: ) Page 2 _ -
Fixture or Item
Tax map/parcel no.: ?..c
.. . . Absorption valve 16.60
Page 2
fc; 7ri le: "7 Backwater valve 16.60
Clothes washer 16.60
•
Dishwasher 16_60
.:°:::.'s".;7 ' :$1 1 1 6 410104 . i l i t i.4 : 4 *** 4-i. .Mg t *Pi* 4 ''Vt1:1.:*42/0,# ; gr l *i
Drinking fountain I 16 . 6 ° 14. 60
16.60
Nam (cOncttd; i I 74 , .44Siri e S Expansion tank 16.60
Address: it? 43 SC c, K i-11 Ave. Fixture/sewer cap 'i 16.60
City/State/LIP: Pe 0 I:: 627Zig-t Floor drain/floor sink/hub a I 16.60 33.20
Phone: ( z 38 - 6/q0 Fax: ( s ) z--31 - 1 os-
Garbage disposal / 16.60
1:; `:::.f7f.. Hose b q y` 16.60
- Ice - 16.60
Business name: IA :1 rr•etc - Pa L's r•v k.■It 4 . illtn.tat l LI-C- Interceptor/grease trap 16.60
Contact name: K tr. $....„,
Medical gas (value: $ ) ' Page 2
Address: p A . 6,.L. s s r as. Primer 16.60
Roof drain (co cial) t / /' 16.60 I t 5 0
City/State/ZIP: 5,,,j a R 4-7 -? , IN
- sithabasi vatory W 16.60 61(1.6
Phone: (5 4)) ) 3-gs, tils2 Fax: : " 6 6)3
Tub/shower er pan 16_60
E-mail: •
Urinal i i t/ / - 16.60
CONTRACTOR W ater closet .5.V 6.60 <33 0
es
Busins name: talk fya eykl f Water beater I 16.60 1
Address: p R s-- Other.
0 Subtotal 3 Lig .6e.),
City/State/ZIP: 5.1/ro (,) p, 7 3 c
Minimum pennit fce: $72.50
Phone: (5 ) ( 5 _ cfea z Fax: (5::. ) 5 O. ij Residential backilow minimum permit fee: $36.23
CCB Lic.: i cq 3 f5 Plumbing Lie. no.: rA77 or Plan review (25% of permit fee)
State surcharge (8% of permit fee) `. 7. el
Authorized signatur / TOTAL PERMIT FEE 3 75
I Print name: /Z etr i..... „540... 5 ....p.r . r . I , I Date: Jr.. _.... This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building . .1 stry Service Board.
IABuiWing`Pconit1WU4-PerrnitApp doer Cd26006 4404616710102/COM/WEB) .4....t....k., •
-j
■___ .■../
+. ' . • Accumulative Sewer Tally Parcel # 2S103DD -01201
Tenant Name: Goodwill Industries This SWR# (1.6) CREDITS DUE
Site Address: 13920 SW Pacific This PLM# 2006 -00169
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
- Jacu77 ✓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 1 1 1 1
Eye Wash 1 0 0 0 0 0
Floor Drain/Sink - 2 inch 2 0 0 2 4 2 4
- 3 inch 5 0 0 0 0 0
- 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
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 5 10 5 10
- Bradley 5 0 0 0 0 0
- Commercial 3 0 0 0 0 0
- Service 3 0 0 1 3 1 3
Swimming Pool Filter 1 0 0 0 0 0
Washer - Clothes 6 0 0 0 0 0
Water Extractor 6 0 0 0 0 0
Water Closet - Toilet 6 0 0 5 30 5 30
Urinal 6 0 0 1 6 1 6
Previous EDU Count 5 80 80
Capped EDU Credit 5 80
TOTALS 0 80 0 0 15 54 15 54
Current Fixture Value 54 divided by 16 = 3.4 Current EDU 1 EDU = $ 2,700
Previous Fixture Value 80 divided by 16 = 5.0 Previous EDU
Cha nge -26 divided by 16 = -1.6 over (under) $ (4,320.00)
Enter EDU Change Here -1.6
Notes:
Authorized Name /Signature: Barbara Butler Date: 4/26/2007
Building Division
'Note: The property owner shall retain the ORIGINAL sewer tally record. If credits exist, this document will serve as a voucher which must be
submitted to the City of Tigard Building Division to redeem credits towards future system development charges.
I: \Building \Forms \SewerTallySheet.xls 02/02/07
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00169
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/2007
Phone: (503) 639 -4171 � D�d�°�oj�l�
Inspection Requests (24 Hrs.): (503) 639 -4175 s__.„ -
INSPECTION WORKSHEET FOR DATE: 6/7/2007 TIME: 7:00AM PAGE: 53
SITE ADDRESS: 13920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: GOODWILL INDUSTRIES CENTER LOT #: TYPE OF USE:
PROJECT NAME: GOODWILL INDUSTRIES
DESCRIPTION: Interior fixtures. Other fixtures: 1 drinking fountain, 4 hose bibbs.
OWNER: GOODWLL INDUSTRIES, PHONE #: 503.238 -6190
CONTRACTOR: WILLAMETTE PLUMBING & MECHANICAL PHONE #: 503585 - 4682
Inspection Request Scheduled For: Date: 6/7 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 049764 -02 503 - 209-3586 N
Corrections /Comments /Instructions:
6 2'.66
6 1 / / /t .d---7/ ..
ii, /��
4
i
6 0, 6 ,„, i
c _PASS ❑ PARTIAL APPROVAL 11 CANCEL ❑ NO ACCESS
❑ _ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
e
Ins ctor: 1.0 VA/ # 1 ,p Date: Jd � � r ) Phone (503) 718- 8
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00169
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/27/2007
Phone: (503) 639 -4171 4 I I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/30/2007 TIME: 7:00AM PAGE: 21
SITE ADDRESS: 13920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: GOODWILL INDUSTRIES CENTER LOT #: TYPE OF USE:
PROJECT NAME: GOODWILL INDUSTRIES
DESCRIPTION: Interior fixtures. Other fixtures: 1 drinking fountain, 4 hose bibbs.
OWNER: GOODWILL INDUSTRIES, PHONE #: 503 - 238-6190
CONTRACTOR: WILLAMETTE PLUMBING & MECHANICAL PHONE #: 503 -505 -4682
Inspection Request Scheduled For: Date: 4/30/2007 Pour. Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough - in 047332 - 01 503 339.4094 N
Corrections /Comments/ Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: c ;)Imo►— Date: L 1/30) 0 7 Phone #: (503) 718=
1 Iffir .
OF TIGARD
. II
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/20/2007
Phone: (503) 639 -4171 / '11 ji 4' <
Inspection Requests (24 Hrs.): (503) 639 -4175 F. "
INSPECTION WORKSHEET FOR DATE: 4/27/2007 TIME: 7:00AM PAGE: 22
SITE ADDRESS: 13920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: GOODWILL INDUSTRIES CENTER LOT #: TYPE OF USE:
PROJECT NAME: GOODWILL INDUSTRIES
DESCRIPTION: Site utility work for new retail /donation center. Other fixtures: 1 ejector pump, 3 manholes and 7 rain
drain connectors.
OWNER: GOODWILL INDUSTRIES, PHONE #: 503. 238.6190
CONTRACTOR: WILLAMETTE PLUMBING & MECHANICAL PHONE #: 503-565-4682
Inspection Request Scheduled For: Date: 4/27/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
305 Plumbing underslab 047260 -01 503-932 -4094 N
Corrections /Comments /Instructions: PLH. q/0•01 n".
0,(c-a4,_e_t."- A f> 5 s t1/4....A toka,t._( 4-civeL.A." .
• kt a, i I pta)tt_ep___ Arp Pr k b C/" `
4 V\AA A 24 ,,,...-- Lz. 53 . / N e-r u.....c Nfte_6.j0, g,
- 3 " ` al 4 4 r.- c. C l am-
. v
N a Q , , Z O A .
D e , 0
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
0 47 -�� 2 Inspector: Date: +ill � b , Phone #: (503) 718 I
OF TIGARD
BUILDING DIVISION PERMIT #: PL t
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/20/2007
Phone: (503) 639 -4171 /One�o '
Inspection Requests (24 Hrs.): (503) 639 -4175 L.
INSPECTION WORKSHEET FOR DATE: 4/26/2007 TIME: 7:00AM PAGE: 55
SITE ADDRESS: 13920 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: GOODWILL INDUSTRIES CENTER LOT #: TYPE OF USE:
PROJECT NAME: GOODWILL INDUSTRIES
DESCRIPTION: Site utility work for new retail /donation center. Other fixtures: 1 ejector pump, 3 manholes and 7 rain
drain connectors.
OWNER: GOODWILL INDUSTRIES, PHONE #: 503 - 238-6190
CONTRACTOR: WILLAMETTE PLUMBING & MECHANICAL PHONE #: 503 - 585 -4682
Inspection Request Scheduled For: Date: 4/26/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 047179 -01 503.339.4094 N
Corrections /Comments /Instructions:
"rot 1 ) win\ (v c_cr" P t v",s nay 14 \✓ P..e
C T+'; , p ' - fi r - 6 l (j5,5 q ✓) A is y 1, P w t t/ d� f'� ` �' �'0 �� S C� /�( 1� a �n ' ` I L-' l fmnre-,4
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ti11�`'i 1 1""'- Date: 4 4 12a 1 DYE Phone #: (503) 718-