Permit A , 1M
CITY T I GA R® PLUMBING PERMIT
irk DEVELOPMENT SERVICES PES UMBI P 16/2%0 -00525
'� II 13125 SW Hall Blvd., T igard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/6/2005
PARCEL: 1S126BC-01506
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 480 ZONING: C -G
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: TI
CLASS OF WORK: ADD GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 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: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
WYSE INVESTMENTS Description Date Amount
111 SW 5TH AVE SUITE 1100
PORTLAND, OR 97204 [PLUMB] Permit Fee 10/6/2005 $72.50
[TAX] 8% State Surcharl 10/6/2005 $5.80
Phone : 503 294 - 0400 Total $78.30
Contractor:
PMSI LLC
21195 NW EVERGREEN PKWY #204 REQUIRED ITEMS AND REPORTS
HILLSBORO, OR 97124
Phone : 503- 466 -2222
Reg #: LIC 158286
PLM 34 -434PB
Th is 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 -01 1 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calling 5', -246-64'9 1- 00- 332 -2344.
Issued . : k • , .O_t / 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.
OCT -06 - 2005 08 19 MSI 5034662211 P.01/01
RECEIVE
• Plumbing Permit Applicatiotur 0 6 20i5 FOR OFFICE USE ONLY
City of Tigard Received 0
g T I I, AR �' Date. By: Permit No • G iii r/r , 1
13125 SW Hall Blvd., Tigard, OR 97223 WY OF Plan Review # �,,2 /
" - Phone: 503,639.4171 Fax: 503.598.1960 f � +i.± �' Other Permitt ��rOG[J.7 "�- C�JL/♦
BUILD �; Date/By:
24- Hour Inspection Line: 503.639.4175 Date Ready /By: Jam ® See Page 2 for
Internet www ci tigard or.us Notified/Method: Supplemental Information
:.:;'y. `, ....-.Z.,-..--_,
-::- ., �. ;< ._ri ' „; OF WORK , ' . ' FEE* SCHEDULE , ,
❑ New construction ❑ Demolition For special information use checklist
Description I Q y I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
': - c' �= _ � = i`_' CATEGORY GP CONSTRUCTION, , _ _ , - SFR (I) bath 24920
❑ I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family
SFR (3) bath 399.00
Each additional bath /kitchen 45 00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
;•i;„ a ;=: ; :ig ;-IJOB•SITE NFORMATIONA . - Site utilities
Job site address: %) O W 4 /et> , Catch basin or area drain ■ 16 60 . ,'
City/ State/ZIP: j ` nA j 4 - _ Suite/bldg./apt. no.:4. ] Project name: Page 2
Manufactured home utilities 110 00
Cross street /directions to job site: 16.60
Rain drain connector 16 •t
Sanitary sewer (no. linear ft.: _ ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linearil.• ) Page 2
Subdivision: / Lot no.:
Fixture or item
Tax map /parcel no.: /5 / a6 6e...,- o/6 s'
Absorption valve 16.60
.:,;_.;a,': r -,„,,... DESCRIP ION.OP WORK ,
_s :: z,.. °`c' Bockflow preventer Page 2
10 I 3 — S -"-k. ?ilL..« k0 ? A,.. Backwater valve 16 • t
• Clothes washer 16.60
Dishwasher 16.60
•. ti; h Jl Drinking fountain • t
;; N "PROPERTY OWNER - . I • ❑ TENANT
Effectors/sump 16.60
Name: Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub A 1 16.60 (tP I
Phone: ( ) Fax: ( ) Garbage disposal 16.60
Nose bib • t
..'fJ? "iii”' APPLIC�{NT "! " - ❑ CONTACT PERSON
;.i.... i - . .. -- - - - Ice maker . t
Business name: interceptor /grease trap ■
Contact name: �
� � p� — s� 1 Medical gas (value: $ ) Page 2
Address : / Primer ' : ( ) Tub/shower/shower pan CNTRACTOR . Business name: 16.60
Address: \ V0\5 Z Q `), A P4-i4 Other. I Errpr / -
City/ State/ZIP: ` ) Subtotal rum
! � �� �� M inimum permit fee: $72.50
_khonerra„ 4(01,0 D-a-j-a- Fax: ( ) &41.S0 a-3-1 ( Residential backflow minimum permit fee: $36.25 • W
..�g 3k-14.1.341z3 Plan review (25% of permit fee) lafffil
�B Lic.: �� Plumbing Lic. no.:
.L.' State surcharge (8% of permit fee)
Authorized signature: TOTAL PERMIT FEE WWI
Print name: Date: This permit application expires if a permit is not obtained within
180 days after it has been accepted as cumplete. ,
41--` Neap >u of 5 , TOTAL P.01
CITY OF TIGARD
•
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
PMSI LLC
21195 NW EVERGREEN PKWY #204
HILLSBORO, OR 97124
•
Plumbing Signature Form
Permit #: PLM2005 -00525
Date issued: 10/6/2005
Parcel: 1 S126BC -01506
Site Address: 09020 SW WASHINGTON SQUARE RD 480
Subdivision:
Block: Lot:
Jurisdiction: C -G
Zoning: TIG
Remarks: TI
Your company has been indicated as the plumbing contractor for the permit indicated above. In order for
' the plumbing permit to be valid, please have the appropriate individual from your company sign below and
return this Plumbing Signature Form prior to the start of the work to the address above, ATTN: Building
Division.
No plumbing inspections will be authorized until this completed form is received
OWNER: PLUMBING CONTRACTOR:
WYSE INVESTMENTS PMSI LLC
111 SW 5TH AVE SUITE 1100 21195 NW EVERGREEN PKWY #204
PORTLAND, OR 97204 HILLSBORO, OR 97124
Phone #:503-294-0400 Phone #: 503- 466 -2222
Reg #: LIC 158286
PLM 34 -434PB
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X e' •
• - Signature of Authorized Plum
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005-00525
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/642005
Phone: (503) 639 -4171 ,,"11d'
Inspection Requests (24 Hrs.): (503) 639 -4175 _.‘1;
''I I..
INSPECTION WORKSHEET FOR DATE: 11/9/2005 TIME: 7:09AM PAGE: 70
SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 480 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: UNITED HEALTH
DESCRIPTION: TI •
•
OWNER: WYSE INVESTMENTS, PHONE #: 503.294 -0400
CONTRACTOR: PMSI LLC PHONE #: 503 - 466-2222
Inspection Request Scheduled For: Date: 11/9/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 020662 -01 503 - 209 -9348 N
Corrections /Comments /Instructions:
(%; PASS ❑ PARTIAL APPROVAL ❑ CANCEL . ❑ NO ACCESS •
❑ F. L ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / L Date: / Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00525
13125 SW Hall Blvd., Tigard, OR 97223 t _-" DATE ISSUED: 10/6/2005
Phone: (503) 639 -4171 �■■ ,, il l
Inspection Requests (24 Hrs.): (503) 639 -4175 ...'..'!� " -_..
INSPECTION WORKSHEET FOR DATE: 10/13/2005 TIME: 7:04AM PAGE: 105
' • SITE ADDRESS: 09020 SW WASHINGTON SQUARE RD 480 CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: UNITED HEALTH
DESCRIPTION: TI
OWNER: WYSE INVESTMENTS, PHONE #: 503 - 294 -0400
CONTRACTOR: PMSI LLC ' PHONE #: 503-466.2222
Inspection Request Scheduled For: Date: 10/13/2005 Pour Time:
' Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 018202 -01 503 -519 -0606 N
•
Corrections /Comments /Instructions:
1 6 1' l /6 , r „, c ,_,/,-„,,, .
•
❑ PASS t ' , ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED .
Inspector D ate: 0 IP � 0 Phone #: (503) 718-