Permit 1 ► t
ir 9 PLUMBING PERMIT
CITY OF TIGARD
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00193
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/16/2007'
PARCEL: 2S110BB -05500
SITE ADDRESS: 14210 SW 121ST AVE ZONING: R -3.5
SUBDIVISION: ARLINGTON RIDGE LOT: 032 JURISDICTION: TIG
PROJECT: HOSMAN
Project Description: Plumbing for new pool house, (1) lavatory with shower, toilet, water heater, floor drain, backflow
preventer, hose bib and primer (see other).
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 2
TUB /SHOWERS: 1 SEWER LINE: ft •
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ROBERT & D HOSMAN •
14210 SW 121ST AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 5/.16/2007 $152.45
[TAX] 8% State Surcha 5/16/2007 $12.20
Phone : Total $164.65
•
Contractor:
BEAVERTON PLUMBING INC
13980 SW TUALATIN VALLEY HWY
BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 - 643 -7619 •
FAX 503- 643=7620
Reg #: LIC 12889
PLM 34 -4PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
a Issued t By: _ /� / r Permittee Signature: � � [Q. On
• Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be. kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
Ma. : 15 G7 02:15p Beaverton Plumbing Inc 5036437620 p. 2
I
- ar
Plumbing Permit Application a O'n. gt° � 1 .- 4 FOR OFFICE USE ONLY •
»
E. „ ,.,tc Y ' . `'' t l * "
City of Ti rard " L r- s
� " Received z
�' Datc /Ity: 5 ! is IN- S 1 I'crmil No.: PI H2► J� .. M 1
q 1312$ SW Hall Bl Ti p, ;trd, OR 97223
Plan I(cv,cw
■ • . Phone: 503.639.4171 1 503.598.JL$A' 1 r 2001 ( )tlxr t'cru,it No.: -0019 -
1 I):adlf ill
Inspection Line: 503.639.4175 t)atr. it n 411.1-;<- ® ticc 1'0 •� 2 lur
TIGARD y` y; k'
Internet: www,lipardk)r.guv � v w-p'•, ,. !• Nnli6wl /Mclluxl: Supptrmanlel leformndo.t
TYPE OF WOR :.,%. .& • , ,
-- - --,, _ T ' . Tr: r FEE* ScnFDUI r
® New construction '--.; ' ❑ Demolition j I'nr• dr►IlujnrmaAnn me rAcckli�r.
Description I Otv. I I n- I Total
LI Addition /altcraiion/rcpl ; tccmcnl - , Q (.)laser; New I.2•- family dwellings (includes I00 A. fur each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) hntll 249.20
❑
I. and 2- Family dwelling Cl Commercial /industrial SI'R (2) bath 350.00
---- .... - SIR (3) bath 399.00
E3 Accessory building El Multi-family _ __.. . -
-- "- - -- - -- Hach additional hash /kitchen 45.00
❑ Master builder ['Other:
- -- Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site titililies
•loh site address: 14210 SW 121`' AVE Catch basin or area drain ,
I 16.60 - -
City /St :ate /' /.II': BEAVERTON, OREGON Drywell. leach line, or trench drain 16.60
Suite/bldg./apt. n0.: Project name: IIOSS hooting drain (no. linear II..: ) Page 2 -
" - ' Manutheturcd home utilities 1 10.00
Cross streel/dirco;lions to,joh site:
- - - Manholes 16.60
Rain drain connector - - -- 16.60
Sanitary sewer (no. linear ll.: _) Page 2
T Storm sewer (no. linear 11.: _ ) Page 2
- - -
Ioluu.t
Subdivision: Water service (no. linear ft.: _ ) PagC 7. - -
- "- Fixture or Item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OI' WORK Backtlow prcvcntcr 1 Page 2 36.25
PLUMBING FOR A NEW PUOI, I IO(ISE Ituekwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER I ❑ 'TENANT Drinking fountain 16.60
I ijecutrs/surnp 1 6.60
Name: I IOSSIIIAN
lixpansinn tank 16.60
Address: 14210 SW 121 AVE Fixture/sewer cap_ _ _ 16.60
City/State/ZIP: BEAVERI ON, OREGON Floor (train /floor sink /hub - - I 16.60 16.60
Phone: ( ) Fax: ( ) Garbage disposal _____ 16.60
Hose bib 1 16.611 16.(10
❑ APPLICANT ❑ CONTACT PERSON
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ 1 Page 2
Address: Primer - - - -- 1 16,60 16.60
City /State/ZIP: Roxal'drain (commercial) 16.60
•""••"'"„'• Sink/hnsin /lav:unry 1 16.61) 16.60
Phone: Phone: ( ) I Fax:: ( )
Tub /shower /shower pun 1 16.60 16.60
I: -mail:
~
Urinal 16.60
CON TRACTOR Water closet 1 16.60 16.6(1
Business name: Beaverton Plumbing. Inc Water healer I 16.60 16.60
Address: 1398() SW TIUAI.ATIN VALLEY II WY Other:
City/State/ZIP: REA VER'1'UN, OREGON 97005 Subtotal 152.45
-
Minimum permit Ice: $72,50
l'Itonc: (503) 643.7619 Fax: (503) 643.7620 Residential backflow minimum permit fee; $36.25
- - -- -
CC'I3 Lie.: 012889 Plumbing Lie. nu.; 34 Plan review (25% of permit tcc)
-" ' ` '--" Slate surcharge (8% of permit fee) 1210
Authorized signature: C' ^ TOTAI, PFRMIT hl:r 164.65
Print nrameSIISAN I)EAN Date: 5/15/07 This permit application expires il'a permit is not obtained within
IA() days after if has hccn accepted nc complete.
*I:cc methodology set by Tri- County Building Industry Service Board.
0. ouudluftrcruursun .xt- rtxnwnpp.dQc ot'zwa; 440.4510111U/a/t.:OWW'cul
CITY OF TIGARD PL-'( 26 d7, 04 f 3
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 p , DATE ISSUED:
Phone: (503) 639 -4171 1,,
Inspection Requests (24 Hrs.): (503) 639 -4175 b1; til5
INSPECTION WORKSHEET FOR DATE: b /Vip c- TIME: PAGE:
SITE ADDRESS: 14 Z v■ s AN< CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections/ Comments/ I
761
v'
Lrl1/4A1 o
5./1/4i k 3
\
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: /a p Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00193
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/16/2007
Phone: (503) 639 -4171 t_011111?"
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/17/2007 TIME: 7:OOAM PAGE: 36
SITE ADDRESS: 14210 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: ARLINGTON RIDGE LOT #: 032 TYPE OF USE:
PROJECT NAME: HOSMAN
DESCRIPTION: Plurbing for new pool house, (1) lavatory with shower, toilet, water heate5, floor drain, b; cldlow
preventer, hose bib and primer (see other).
OWNER: HOSMAN, ROBERT & DARCI PHONE #: NA
CONTRACTOR: B3EAVERTON PLUMBING INC PHONE #: 503-643 -7619
Inspection Request Scheduled For: Date: 5/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 048509 -01 503.643 -7619 N
Corrections /Comments/ Instructions:
`. PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION _ ADDITIONAL FEES ASSESSED
Inspector: 1 Date i 7/Phone #: 503 718 - p ( )
• CITY OFTIGARD
BUILDING DIVISION A PERMIT #: PLM2007.00193
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5//612007
Phone: (503) 639 - 4171 °'`����'
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/'15/2007 TIME: 7:02AM PAGE: 37
SITE ADDRESS: 14210 SW 121ST AVE CLASS OF WORK:
SUBDIVISION: ARLINGTON RIDGE LOT #: 032 TYPE OF USE:
PROJECT NAME: HOSMAN
DESCRIPTION: Plumbing for new pool house, (1) lavatory with shower, toilet, vuater heats, floor drain, backflow
preventer, hose bib and primer (see other).
OWNER: HOSMAN, ROBERT & DARCI PHONE #: NA
CONTRACTOR: BEAVERTON PLUMBING INC PHONE #: 503 -643 -7619
Inspection Request Scheduled For: Date: 6/15/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
32.2 Shower pan 050310.01 503-643-7619 N
Corrections /Comments/ Instructions:
"
•
PASS n PARTIAL APPROVAL n CANCEL 1 1 NO ACCESS
1 1 FAIL n CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspectgl`!V 2 Date: ,q/.5/6 Phone #: (503) 718 -