Permit - CITY O F TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00279
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/25/2008
PARCEL: 25111 BC -04200
SITE ADDRESS: 14563 SW 100TH AVE ZONING: R -3.5
SUBDIVISION: PP1992 - 077 LOT: 002 JURISDICTION: TIG
PROJECT: YOKE
Project Description: Replacing existing sinks, tub and water closet.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
NICK & KAT YOKE
14563 SW 100TH AVE Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 6/25/2008 $72.50
[TAX] 12% State Surch 6/25/2008 $8.70
Phone : 503 603 - 0993 Total $81.20
Contractor:
OWNER
REQUIRED ITEMS AND REPORTS
Contact # : PRI
Reg #:
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialt Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is t started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to fol rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0 O. o may obtain apies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued B / � Permittee Signatur= '
Air
Call 503.639.4175 by 7:00 a.m. for an inspection • :t 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.
Plumbing Permit Application
Building Fixtures FOR OFFICE USE ONLY
• City of Tigard V `� Date /By� / ; ifz� Permit No.. /�7
1 11
13125 SW Hall Blvd., Tigard, OR 9 C � ;tat �
0 Plan Review
1 Phone: 503.639.4171 Fax: 503.59 e �QO� Other Permit No.:
Inspection Line: 503.639.4175 w\
J Date/By:
\� �� ;iii( eady /B Juris El See Page 2 for
T I G A R U
InInternet: www tigard- or.gov J d/ Method y. .4 Supplemental Information
PE " )NE E'° SEtt
For special information use checklist
❑ New construction ❑ Demo 10\t‘
a Description Qty. Ea. Total
X Addition/alteration /replacement ❑ OtheY New 1 - 2 - family dwellings (includes 100 ft. for each utility connection)
+t".ATEG *V OF" CON RUit;.'"'1('1ON SFR (1) bath 249.20
XI- and 2- family dwelling El Commercial /industrial SFR (2) bath 350.00
1:1 Accessory building El multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other: Fire sprinkler ( sq. ft.) Page 2
�; � • I'ORI 'ION " l Ara) � "ON Site utilities
Job site address: 1 5 ( , 2 5 1 00 4 4., Catch basin or area drain 16.60
City /State /ZIP: 7 5e ,,,A U/_ 7 2L4 Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: I Project name: U 1,(e_ Footing drain (no. linear ft.: _) Page 2
G Manufactured home utilities 110.00
Cross street/directions to job site: (((
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2
Tax map /parcel no.:
Fixture or item
-, f Absorption valve 16.60
� �. '� dt , . - .s € , . .' ,„, . ',, Backflow preventer Page 2
,�1.tA4 -(.t- - f - 444- L (/(LLIJL . Am-el/tit. " d/1Q../L 4 5, Backwater valve 16.60
G(/Lain, 1i-6 ji-A 0' h{-,Qil `i0A-12tfd1 �u ), 14451 ie ftjlie / Clothes washer 16.60
1/A5 4 yl tilts k ni „ 'r / ,r tor 5w -C- Dishwasher 16.60
.
a r / r [ t ] i „ z- Drinking fountain 16.60
,',,"` 9 ° `-" Ejectors /sump 16.60
Name: /dz., ,, ij r?Y_e,
Expansion tank 16.60
A )
Address: 14 5 (o 5k) 10 ,4v{. Fixture /sewer cap 16.60
City /State /ZIP: 1 7 5 ,a-A 0 2 O172,L., Floor drain/floor sink/hub 16.60
Phone: (5 ) 1,0 p CI Fax: ( 57)3 ) ( ...16 - q351), Garbage disposal 16.60
66/1. Hose maker 16 60
/91 . Ice m er
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: 1 1 C ( ?) 5 IA ) i O t-f'h /ivt Primer 16.60
City /State /ZIP: -r( Cc (A v / el 7 Z 2- , 1 Roof drain (commercial) 16.60
Phone: (95) , c� ,� ( �Z 4. 2, 1.3 5 � Sink /basin lavatory 16.60 ��'1�
D 2 / D 9 I Fax:: ') l
E-mail: tip k �� 4, t N Tub /shower /shower pan + 16.60 ,
Urinal 16.60
.:�1 Rr
" � i- t(:,,,,,,,,,:# „,,, r; Water closet ( 16.60 /C . ( 6
Business name: ( �r' Water heater 16.60
Address: ( Other:
City /State /ZIP: Subtotal rLI
Minimum permit fee: $72.50 qN
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25 70\
CCB Lie.: Plumbing Lic. no.: Plan review (25% of permit fee)
Authorized signatur / / ' State surcharge (12% of permit fee) ' 7e2
TOTAL PERMIT FEE / C`
Print name �� 11de e n f �d _ Date: 1. /L$ /o T his 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 Industry Service Board.
I:\ Building \Permits\PLMF- PermitApp.doc 12/27/06 440- 4616T(I0 /02/COM/WEB)
Informat Notice to Property Owners About
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C o nst ru ction Responsibilities Statemen
Oregon Law req ui r es re construction permit applicants st who tement are not licensed
with the Construction Con tra ctor s Board to sign the following a befo a
building permit can b e issued. [ ORS 7 01.0 55 (4)]
This statement is required for residential building electrical, mechanical and p l u mbing perm
Licensed arc hitect and engineer applicants, exempt from licensing under ORS 701.010(7 need
not submit this statement. This statement will be , filed with the permit.
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This form is s to bu ilding ,,� P ermit ddrss: # : �� 7C/ 6,5-7‘
perm offices by the Oregon �, A e -_NCO -3.
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as r equire d by OR S 701.055 (6 4 � ✓ f ` ' 4re/f ���`*.
Issued by:
/ • Date
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This copy to issuing permit office
CITY OF TIGARD • . , , .
BUILDING DIVISION
PERMIT #: PIN2000-00279
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/251200
A
0
Phone: (503) 639-4171 Jititi II?'
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1//2009 TIME: 7 PAGE: 13
6
SITE ADDRESS: 14563 SW 100TH AVE CLASS OF WORK:
SUBDIVISION: pp1992.077 LOT #: 002 TYPE OF USE:
PROJECT NAME: yoKE
DESCRIPTION: Replacing existing sinks, tub and water closet.
OWNER: YOKE, NICK & KATHY PHONE #: 503,6030993
CONTRACTOR: OWNER PHONE #:
Inspec . Requetheduled For: Date: 116/2009 Pour Time:
Code spection Description Confirm # Contact # Message
399 PI (I rnbing final 079412-01 603-603-0993 N
Corrections/Comments/Instructions:
, •
, v
..,
i/k_maeic_ 7:2-7- 1/9-6
kil PASS Ft PARTIAL APPROVAL 11 CANCEL 0 NO ACCESS
I FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
( (
Inspector: Date: Phone #: (503) 718-
CITY OF TIGARD ,, 4
BUILDING DIVISION PERMIT #: PLM2000- 002.79
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Gl2l2F10t3
Phone: (503) 639 -4171 / ir1"li11 di i r
Inspection Requests (24 Hrs.): (503) 639 -4175 = ' ei
INSPECTION WORKSHEET FOR DATE: 1211/2008 TIME: 7:00AM PAGE: 24
SITE ADDRESS: 14563 SW 100TH AVE CLASS OF WORK:
SUBDIVISION: PP1992-077 LOT #: 002 TYPE OF USE:
PROJECT NAME: YOKE
DESCRIPTION: Replacing existing sinks, tub and water closet.
OWNER: YOKE, NICK & KATHY PHONE #: 603 - 603.0993
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 121//2008 Pour Time: - d
AA d
Co # Inspection Description Confirm # Contact # Mes• :'ge I V 6
399 Plumbing final 070609.02 503 - 603.0993 Y
Corrections /Comments /Instructions:
--\ tA, \9 VQ / fLA—,C V2
6A..("AJ—e—c ' +e-/t4.—e - 7 ®p
W i -- (AR-- T ‘' (4:
❑ PAS . 1� El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL 1 � I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �/ � Date: � / V Phone #: (503) 718
CITY OF TIGARD
BUILDING DIVISION . , -A PERMIT #: PLM2008-00279
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: 61250008
Phone: (503) 639-4171 iergo A
Inspection Requests (24 Hrs.): (503) 639-4175 Ail- AL
INSPECTION WORKSHEET FOR DATE: 9/10/2008 TIME: 7:00AM PAGE: 20
SITE ADDRESS: 14563 SW 100TH AVE CLASS OF WORK:
SUBDIVISION: PP1992 LOT #: 002 TYPE OF USE:
PROJECT NAME: YOKE
DESCRIPTION: Replacing existing sinks, tub and water closet_
OWNER: YOKE, NICK & KATHY PHONE #: 503-603-0993
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 9/10/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
322 Shower pan 075304-01 503-603-0993 Y
Corrections/Comments/Instructions:
PASS El PARTIAL APPROVAL El CANCEL lEl NO ACCESS
7 FAIL 7 CALL FOR INSPECTION Ell ADDITIONAL FEES ASSESSED
Inspector: (P Th ij i,... \ 12, Date: cli \\c \'0 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PL M2008-00279
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2512008
Phone: (503) 639 -4171 u tm�ii�l li
Inspection Requests (24 Hrs.): (503) 639 -4175 !!+�
INSPECTION WORKSHEET FOR DATE: 8/1412008 TIME: 7:00AM PAGE: 1
SITE ADDRESS: 14;63'1M 100TH AVE CLASS OF WORK:
SUBDIVISION: PR1902 - 077 LOT #: 002 TYPE OF USE:
PROJECT NAME: YOKE
DESCRIPTION: Replacing existing sinks, tub and water closet.
OWNER: YOKE, NICK. & KATHY PHONE # : 503-603-0993
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: - Date: 811412008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 ivlisc. inspection 074201 -01 503- 603 -0993 Y
Corrections /Comments /T nstructions:
P /2) ./ ■ A C- no C vo."- ..c,AA. J -0 tJ )46 4 1 ) t a l 01 a 1.-./1-....••* Tu L .
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: CV \V,A.JiA \ }ti--- Date:7( (`-k 0') Phone #: (503) 718-
CITY OF TIGARD
• BUILDING DIVISION PERMIT #: Pt_M2008 00219
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 612512008
Phone: (503) 639 -4171 440p; ' (I
Inspection Requests (24 Hrs.): (503) 639 - 4175±+` '•! �..
INSPECTION WORKSHEET FOR DATE: 7/3/2008 TIME: 7:00AM PAGE: 22
SITE ADDRESS: 14563 SW 100TH AVE CLASS OF WORK:
SUBDIVISION: PP1892 077 LOT #: 002 TYPE OF USE:
PROJECT NAME: YOKE
DESCRIPTION: Replacing existing sinks, tub -and water- closet -.
OWNER: YOKE, NICK & KATHY PHONE #: 503- 603.0993
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7 /3/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 072178 503-696-5097 N
Corrections /Comments /Instructions: I''
new r✓,- C� A A- i t pp 1 N-2 i _r�:r Li . �G /L Dv sjJr
❑ PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 07k4 A_- Date: 7/< ?J 0 7' Phone #: (503) 718-
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: PLM2008-00279
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/2512008
Phone: (503) 639 -4171 Mitt
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/27/2008 TIME: 7:01AM PAGE: 23
SITE ADDRESS: 14563 SW 100TH AVE CLASS OF WORK:
SUBDIVISION: PP1992 - 077 LOT #: 002 TYPE OF USE:
PROJECT NAME: YOKE
DESCRIPTION: Replacing existing sinks, tub and water closet.
OWNER: YOKE, NICK & KATHY PHONE #: 503- 603M993
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/27/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 071930-01 503- - 603.0993 N
Corrections /Comments/ Instructions:
R c So 1e_ : 3 7J- I w 'o S 3 - 2) ? 2 2 td,
LI PASS wl PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C5 , vr.. , ch \tYa- Date: 6 '7, Phone #: (503) 718-