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Permit F e d A s'4 , CITY OF TIGARD PLUMBING PERMIT tC I& DEVELOPMENT SERVICES PERMIT #: PLM2005 -00094 �� 13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/11/2005 SITE ADDRESS: 14082 SW 121ST AVE PARCEL: 2S110BB -05100 SUBDIVISION: ARLINGTON RIDGE ZONING: R -3.5 BLOCK: LOT: 028 JURISDICTION: TIG 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: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: 2 SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Tub and shower /pan Owner: FEES BLACK, KENNETH A + GRETA A Description Date Amount 14082 SW 121ST AVE TIGARD, OR 97224 [PLUMB] Permit Fee 3/11/2005 $72.50 [TAX] 8% State Surchan 3/11/2005 $5.80 Phone : Total $78.30 Contractor: POWER PLUMBING CO P O BOX 19418 REQUIRED ITEMS AND REPORTS PORTLAND, OR 97280 Phone : 503 244 - 1900 (� Reg #: L1C 52378 �u - ii PLM 34 -150PB 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) 2 -66 9. Issued By: / - — Permittee Signature: D'1_ Call (503) 639 -4175 by 7:00 P.M. for an inspection the next 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. Mar 11 2005 8:58 HP LASERJET 3200 p.1 ,,, RECEIVED ... ...... Plumbing Permit Applicahkui 2�U5 FOR OFFICE USE ONLY City S Tigard _ f � J Received , f / ,% %� tit No.' _ LL 4 „op° 1.3125 SW Hall Blvd„ Tigard, OR 97223 P lan Revi= r Phone: 503.639.4171 FOX: 503.598.19QITY OF TIG.,,,. -.• a ', t ,,, ',, Other Permit No.: i di'„ 1 . 1 Date/By: aze /By: 24 -Hour Inspection Line: 503.634.41 n LDING D •• Internet: www.ci.ti ar d,or.uS Not v i ' p �-+ Date ed/IMetlu , d: ��G S See Page 2 tar upptementai Information E � ified/MethInformation :0 ' i. :4 :l l :S -s+'' egA .... s ,.. - ::;:.:... 'l :A•x,cc:- ....o - .. :b ` . . . . s.- .. -.� -• _..__...,• ..,...:.,.. s : ' t,.ir. - aa ...z �8 ..i* +Ai�� •.._a_r , ' .r:�E°5��'i ... ., ,��: r. ..., ..._�{...l,t- ,..... �..... :: .rs.. .- v �..,.:..:.:,:. 5�' ��-''{ YU_- ��-:: .�- �s..l���.')r - 1 �4- •�- rs ":':q''�1,:... ; _ �^�'.f . ❑ New construction ❑ Demolition For special information use checklist Description I Qty. I Ea. I Total Addition/alteration/replacement 0 Other: New - y dwellings (includes 100 ft. for utility connection) _ N 1 Z^famil d a in each tility c a ^i x ini: xt•• U Ill, b SFR (1) bath , :. i p z _ _ __ "�3r ='i'� ..,. �i';7.. �'.�;:: 'ta!,.� 'tEie 2L. _ ti "iii:�;e ;.` 104 ~ = nil ,s l� l• gifili r th 249.20 -. , r .a`.;r .- .. =,.. ,. ,` o, „ $�wm;t +l,l: i;a:- t....,._- r..�;E. �;"..h:,,z_�:. -..faG �'.e 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 ❑ Accessory building ❑ Multi- family SFR (3) bath 399.00 Each additional bath/kitchen 45.00 ❑ Master builder r.. ui. 1f :iiRn' . :,i;y!!gm ::. ,:, L+ •:...,.:. Ire sprinkler ( sq. ft) Page F' spi ltil t s ft. Pa 2 e . ..)i: s =- �;{_�n <�'. sxsp��- ,�r�, ' t i a:: ";; .'_::: :; is , . , :.):i.�$� 141' # 0_ ,1'f.' 4!i ''._"'',11: iiz:::ijk ak..i '',4XEi.'. .. -.., ............... . .1 ?�•:,_. .- ��,,,:�;.,,, __ . -,:. ; {,,:,� Site utilities ' Job site address: V 140i P.- I al s -r 4ft_ Catch basin or area drain 16.60 • City /State/ZIP: W 4. j tyv ' 1,224 Drywell, leach line, or trench drain 16.60 Suite/bldg. /apt. no.: FT'oject name: %ta, Footingdrain (no. linear ft.: ) Page 2 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. Fixture or item Tax map /parcel no.: :> :,': nr 7:_ : +,,: +�,.• - r .: ; _ r'IS.r :".rs :,:: t, Absorption valve 16.60 {� :'K.v' fil -1:Rac� i�.i ":t•vi::^ - ". .,.,,;. ,.., a to . .: ... ::..:. ..';.:..�..;; '..,.... - ..._,......___. :. _„ i.:..-: •:�,�::,;::__,,.. :L,.�..�•... - ...¢�:r..., „= � =;;;i Backflow ackflopr ven r \Q4 SP) W Q ft j� �3 i Bacicwater valve 16.60 1 � I Clothes washer 16.60 Dishwasher 16.60 } ,'. ;1; --; - .,: -s�: „_ -:, _-'t, »!, D rinking fountain 16.60 ,._,. ,. �� °.�..�,s..�'.<;��1i41!f� t:,:. ..; .� "` .!..� ,,.... L�. � / � � <. -- - ' . . .::a�• jecors /sump 16.60 • Name: IG. I�i/ i> (/�(�� Expansion tank 16.60 . Address: c mil-- n a-bo yil__, Fixture /sewer cap 16.60 City / State/ZIP: Floor drain /floor sink/hub 16.60 Phone: ( ) Fax: (' ) Garbage disposal 16.60 : ::s' =a? rES'a.; ir1 .,,: : � i �t, r� "ic. Hose bib 16.60 • :1, 1'+,Y• ^�I�, 1Dt� _._._;ii �--,c4 ! L<, �:.: sa'; F�. � L, .. .......:........ =.:. .:......... Ice maker 16.60 x r $�: s`��: ";_ � :; . _ . .._ • - •• Business name: r i ul-ilAi" J.M b,(„j''t9 Interceptor /grease trap 16.60 Contact name: j Medical gas (value: $ ) Page 2 Address: P b J f Primer 16.60 City / State/ZIP: ( Y q `�a,Si ) Roof drain (commercial) 16.60 � 1 M Sink/basin/lavatory 16.60 Phone: ( ) o44_� c (y) I Fax: : ( )2 Li& -Y *7'.Z 5 Tu hoe` show p 2.. 16.60 E - mai l : Urinal 16.60 .tit + - - f_:: :(.:: _ - ' :i5 :1 -,. _ _ - _ ? l �. ' y. 3 - a _.- 6.60 7a::,,Iara�:�� ;�i `.�}.._ d, . :: �::. . : ,i "' € ^: - Water closet Business name: V /5 / t po J Water heater , 16.60 Address: (_/ - I � . •) / y y ' / Other: City/ State/ZIP: if � vY 1c ')3 Minimum it fee: $72.50 �( Subtotal 5U Phone: ( ) ) 4 _.r 90 Fax: ( ) 4'4 - -rs-25 Q Residential backtlow minimum permit fee: $36.25 ' i CCB Lic.: 5 3 Plumbing Lic. no.: 34 - ) 5OPB . Plan review (25% of permit fee) State surcharge (8% of permit fee) fr� Authorized signature: r� TOTAL PERMIT FEE '7 b ,C) Print name: ! /S7'/ f..., � 'ls . Date: 3 /it /b5 This permit application expires if a permit is not obta w / 180 days after it has been accepted as complete. Fee methodology set by Tri -County Building Industry Service Board. is SuildinglPermitslPLM•Peii mApp.doc 12/03 440 4616T( I0 /02 /COM/WEa) CITY OF TIGARD ) • ) BUILDING DIVISION PERMIT #: 214 158 - 1 A t _ 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: t.. Si Phone: (503) 639 -4171 4211 , Inspection Requests (24 Hrs.): (503) 639 -4175 �±i ''I_..�° INSPECTION WORKSHEET FOR DATE: 11/3/2005 TIME: 7:06Alvi PAGE: 51 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Family room /den addition & remodel. 11/2105: Added low voltage for Audio/Stereo. OWNER: BLACK, KENNETH A + GRETA A, PHONE #: CONTRACTOR: OREGON HOME SERVICES LLC PHONE #: 503-772 -4663 Inspection Request Scheduled For: Date: 11/3/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 399 Plumbin • final 020225-02 503-772 -4663 N Cor - tions /Comments /Instructions: �; CT) `1 l►% �.. , ' y_ � e_��fi = 4** / _ �� _► o-,-- F - to 3 S C. \sS 11 , ; ; ' - ■ 4„._,,e) \..4.&,-.0 0 ,(t v ,.. - 0 ,__ c _5( --- z-e___ - 4\2_ CA'NA-The :),- c.-te c k, cr w....._, ---(st A- -75,k-fs--0 <--- k- \./. 1> er•-...A-- 4A,, ( 0.7-\_ • J,/, — ,7_f ax.,„ / nL )-( Yoe j 9-1 L/oti arc i/ 0 G d- -.i • , S i ibDS -- -loth / 5" 8" 64_, AnArjr, ( 9 r - , „„, r% f � / PASS ❑ PARTIAL APPROVAL CANCEL El NO ACCESS "yam FAIL n CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED y� Inspector: � Date: 1 /3/6 Phone #: (503) 718- CITY OF TIGARD .. ,, BUILDING DIVISION PERMIT #: PLM2005 00094 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/11/2005 Phone: (503) 639 -4171 uduloi Inspection Requests (24 Hrs.): (503) 639 -4175 ., `__1. INSPECTION WORKSHEET FOR DATE: 3/14/2005 TIME: 7 :11AM PAGE: 47 SITE ADDRESS: 14082 SW 121ST AVE CLASS OF WORK: SUBDIVISION: ARLINGTON RIDGE LOT #: 028 TYPE OF USE: PROJECT NAME: BLACK DESCRIPTION: Tub and shower /pan OWNER: PHONE #: CONTRACTOR: POWER PLUMBING CO PHONE #: 503 - 2441900 Inspection Request Scheduled For: Date: 3/14/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 320 Plumbing rough -in 001570.01 503 - 522 -6684 Y Corrections /Comments/ Instructions: l • PASS ❑ PARTIAL APPROVAL ❑ CANCEL { I NO ACCESS FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: ‚' i '%,� Date: ---> Phone #: (503) 718 - f Inspections Required for: PLM2005 -00094 ✓ Code Inspection Description PASS Date By ✓ Code Inspection Description PASS Date By 1 BUP - Building Permit ELC - Electrical Permit 405 Excavation 105 Underground /slab cover 410 Fill 110 Temporary electrical service 415 Grading 115 Electrical service /reconnect 205 Footing 120 Electrical rough -in 805 MFG- Structure grading /footing 125 Wall cover 210 Foundation walls 130 Ceiling cover 215 Footing drain 135 Low voltage 220 Slab 140 Sign installation 310 Crawl drain 145 A/C or heating unit circuit 225 Post/beam structural 150 Hot tub /spa /pool 230 Underfloor insulation 195 Misc. inspection: 235 Shear walls /anchors 199 Electrical final 240 Exterior sheathing 245 Firewall 250 Roof nailing ELR - Restricted Energy Permit 255 Wtr proofing basement walls 135 Low voltage 260 Tilt -up panel 195 Misc. inspection: 265 Masonry 199 Electrical final 270 Reinforcing steel (rebar) 275 Framing 810 MFG- Structure set-up MEC - Mechanical Permit 280 Insulation 605 Post/beam mechanical 285 Drywall nailing 610 Gas line 287 Suspended ceiling 615 Mechanical rough -in 295 Misc. inspection: 620 Hydronic piping 899 MFG - Structure final 625 Duct work 498 Grading final 630 Fire damper 299 Final inspection 635 Smoke detector shutdown 640 Exhaust hood 695 Misc. inspection: 699 Mechanical final BUP - Fire Protection System Permit 905 Sprinkler underfloor /slab PLM - Plumbing Permit 910 Sprinkler rough -in 305 Plumbing underslab 915 Fire alarm rough -in 310 Crawl drain 920 Suppression trip test 315 Post/beam plumbing 995 Misc. inspection: X 320 Plumbing rough -in 998 Alarm final 325 RP/backflow preventer 999 Sprinkler final 330 Water service 335 _ Rain drain 340 Storm drain _ SIT - Site Work Permit 505 Sanitary sewer 405 Excavation 345 Culvert/catch basin 410 Fill 350 Septic tank 415 Grading 395 Misc. inspection: 205 Footing X 399 Plumbing final 210 Foundation walls 215 Footing drain 420 Sprinkler supply lines SWR - Sewer Permit 495 Misc. inspection: 505 Sanitary sewer 498 Grading final 595 Misc. inspection: 499 Final inspection 599 Final inspection I: \Building \IVR \InspCard- AOP.doc 02/02/2005 CITY TIGARD.' PLUMBING PERMIT I DEVELOPMENT SERVICES PERMIT #: PLM2005 -00094 1,� .-41 'i DATE ISSUED: 3/11/2005 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 14082 SW 121ST AVE PARCEL: 2S110BB 05100 SUBDIVISION: ARLINGTON RIDGE ZONING: R -3.5 BLOCK: LOT: 028 JURISDICTION: TIG 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: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: • TUB /SHOWERS: 2 SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Remarks: Tub and shower /pan Owner: FEES BLACK, KENNETH A + GRETA A Description Date Amount 14082 SW 121ST AVE TIGARD, OR 97224 [PLUMB] Permit Fee 3/11/2005 $72.50 [TAX] 8% State Surchar1 3/11/2005 $5.80 Phone : Total $78.30 Contractor: POWER PLUMBING CO P O BOX 19418 REQUIRED ITEMS AND REPORTS PORTLAND, OR 97280 Phone : 503- 244 -1900 Reg #: LIC 52378 0 PLM 34 -150PB 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) - Issued By: / 6 Permittee Signature: D'1__ Call (503) 639 -4175 by 7:00 P.M. for an inspection the next 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.