Permit �•'� CITY OF TIGAR•
D PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00109
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/17/2008
PARCEL: 1S133DD-02500
SITE ADDRESS: 12903 SW VILLAGE PARK LN ZONING: R -4 5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 LOT: 064 JURISDICTION: TIG
PROJECT: BETZ
Project Description: installing (2) lavatories, (1) tub, (1) shower, and (1) 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: URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: 2 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
LARRY & DE BETZ Description Date Amount
12903 SW VILLAGE PARK LN
TIGARD, OR 97223 [PLUMB] Permit Fee 3/17/2008 $83.00
[TAX] 12% State Surch 3/17/2008 $9.96
Phone : 503 -799 -1247 Total $92.96
Contractor:
3 MOUNTAINS PLUMBING
20345 SW PACIFIC HWY STE 103
SHERWOOD, OR 97140 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -925 -1342
FAX 503- 925 -9104
Reg #: LIC 169499
PLM PB99
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 � � � Permittee Signature: 5.2e w// GI/\./
.41/1
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.
t ` / I ' 03 -17 - 2008 08:57 3 MTNS PLUMBING 5039259104 PRGE3
Pl Permit Application ° •
`tiff
Building Fixtures ECEN E---- � I l( r� n l Ic t. I ,t l,:l.
City of Tigard ± - ••ermit Nu.. ,! ��
13125 SW Ilan Blvd., Tigard. OR `9 R 1 7 Ll)U6 plan Review ■ ....r_ .
i • Phone, 503.639,4171 1- ex; 503,598.1960 ® Irate lil y, Other Permit No
1' I i; A1;1 :1 Inspection Line: 503,639 G % I Y OF T1� A � Date Reedy/By' Page
Internet: www.ti •aid -ut guy A` lone. See r'M 2 for
6 6 - 11 ��n1� OW No Date I Sapplemrntwl InrnrmaMnn •
TYPE OF ' RK FEE* SCHEDULE
i lew construction ❑ Demolition 'or speelai luforaeasion use cherklise.
Descriptio t 1 ( ?h'• 1 F _L Total
O Addition /alteration /replacement ❑ Other New I.2 family dwellings (includes 100 ft. fur each utility connection)
CA'T'EGORY OF CONSTRIr(ITION SFK (I) bath 249 20
1 -and 2- family dwelling ❑ Commercialfindustrial SFR (2) bath V „ - 35(1.00
Q Accessory building ❑ Multi- family SFR (3) bath 3519.00 _...._
^ .,, .
.. ..... .. _ _. ., .._ —_._ . � __ _.... Each additional bath/kitchen 45 00
❑ Master builder ❑ Other:
Fire sprinkler ( sq ft) Page 2
'--
JOB SITE INFORMATION AND LOCATION Site utilities _
Job site address: i C • i i i 1 • Catch basin or area drain 16.60
City/State/LIP: 11 kOX• 0 R 9 „ r� Drywell. leach line, or trench drain 16.60
V } ( Footing drain (no. linear ft : ) Page 2
Suitc/bldg. /apt. no.: Project name:
--- Manufactured home utilities 110.00
Cross street /directions to job site ”
__..., ...» _ Manholes 16.6U
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Stmm sewer (no. linear R: ) Page 2
Jar
Subdivision: Tot nu.: Water service (no. linear ft.` } ) Page 2
°^""— Fixture or item
Tax map/parcel no.:
Absorption valve 16 60
1
DESCRIPTION OF WORK liackflow preventer Page 2
In Ti _ 1 lL - TD (,eA- '‘ wer 13ackwaler 16.60
1 a O( ex A b Clothes washer 16.60
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT
fountain 16 60 «
/ Ejectors /sump 16 60
Name L xr
(bb i Re ,t `Z. Expansion tank _... 16.60
addr , I . c,i0V C � t )i 11 f, ed Qkr k L.tn . , Fixture/sewer cap 16.60
City/State /ZIP: 1 a rA f o R _ C /I ,4a� Floor drain /floor sink/huh 16.60
Phone; (ij � . 1 4 —.13 r4 ITCH ) — Garbage disposal 16.60
❑ APPLICANT 0 CONTACT PERSON Hose- bib 16 60 W
Ice maker 1660
Business name:
Interceptor/grease trap 16.60
—
Contact - Medical gas (value. S ) Page 2
ontac name- Address: ^^ Primer 16.60
__
City /State/LIP: .._,._.,.._. Roof drain (commercial) 16.60
Phone ( ) fax:: ( ) ° '" "' Sink/basin/lavatory 16.60 33. 2_0 -- �- Tub/shower /shower pan Z 16.60 33 _
E -mail- — ...
�. — _� _ _ __ _ __ __ _ __ Urinal 16.60
`ere 0Ie, P yh I u , d10 TRACTOR d b water closet 1 16.60 1(
Busine n ame: M QII h l A Y1 _( ( 7 Water heater 16.60 , __
W.'84.4.9.- n l � ,1 �' - -- ..
Address: ..__.
(� �Ct4` I 1 C� N-t _ W IL--1 L� ()tiler: Subtotal
City /State/ZIP: ' ,,erwood 1 C '1 I -- -
Minimum permit tee: $72.50
Phone: ( ) Fax: ( ' 'a ) Redential si �j3 ~ ,
yap — 134; gash �o -.,. , .,___ _...�.__ backflow minimum permit fcc: $36.25
CCB Lie.: l Li 9 9 Plumbing Lic. no.: pis Plan review (25% of permit fee)
` a ` 1 State surcharge (12% of permit fee) q G
Authorized signature; 47 TOTAL PERMIT FEE
9
Print name: Vi t( h tkr 1 e Date- 0 .3 -- 0_08 This permit application expires if a permit is nut obtained within
1 )AD days after It has been accepted as complete.
*Fri methn1nlnuv cm Iry Iri- l' guild inn Indo5rrv'ervier Amid
CITY OF TIGARD ,.
BUILDING DIVISION ., • y PERMIT #: PLM2008 -00109
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/17/2008
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 „„ I �!
INSPECTION WORKSHEET FOR DATE: 4/4/2008 TIME: 7:02AM PAGE: 4
SITE ADDRESS: 12903 SW VILLAGE PARK LN CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 LOT #: 064 TYPE OF USE:
PROJECT NAME: BETZ
DESCRIPTION: installing (2) lavatories, (1) tub, (1) shower, and (1) water closet.
OWNER: BETZ, LARRY & DEI3I3IE PHONE #: 503 - 799•'1247
CONTRACTOR: 3 MOUNTAINS PLUMBING PHONE #: 503 - 926 - 1342
Inspection Request Scheduled For: Date: 4/4/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 067933 -01 503-710-2331 N
Corrections /Comments/ Instructions:
M P I „..,a cl ,,1 U A:4 /4 Te.,.�� 1- , ct e r,4.,.,
Cuf _ cJ1.--r..l4-L,Qt J
,PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: " W `-"‘"-' . Date: 4// d//'b Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2008- 00109 •
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/171200i
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ••• ■
INSPECTION WORKSHEET FOR DATE: 3/24/2008 TIME: 7:00AM PAGE: 42
SITE ADDRESS: 12903 SW VILLAGE PARK LN CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 LOT #: 06'l TYPE OF USE:
PROJECT NAME: )EI`Z
DESCRIPTION: installing (2) lavatories, (1) tub, (1) shower, and (1) water closet.
OWNER: E3ETZ LARRY & DEBBIE PHONE #: Q3799 -1247
CONTRACTOR: 3 MOUNTAINS PLUMBING PHONE #: 503
Inspection Request Scheduled For: Date: 3/24/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 067157 -01 503925 -1342 ' N
500.t w�w��o�. ....ON-0 Ly / t a.._A
Corrections/Comments/Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Q V Date: 3 ) 9:41/cam Phone #: (503) 718-
- - — - - - -
f
CITY OF TIGIRD • J
BUILDING DIVISION • PERMIT #: f t•M2 "aa` _001'ael
1 13125 SW Hall Blvd., Tigard, Oft 97223 - \ 1 DATE ISSUED:
Phone: (503) 639 -4171 Inspection Requests (24 Hrs.): (503) 639 - 4175 Zlit
INSPECTION WORKSHEET FOR DATE:3 1 ITI OM TIME: PAGE:
SITE ADDRESS: 12 9 a3 V) )1 A 9-Q+ Lc- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR let,IVA 01....A ,p ry 1 ‘'L9, PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 R oLky■-., e i 1, 5 06691-9 56'3 l2co By -tam
Lco3 - 7/0 233 $,; )
Corrections /Comments /Instructions:
•
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
_ FAIL 111 CALL FOR INSPECTION 111 ADDITIONAL FEES ASSESSED
Inspector ' J \ ' Date: ? /T7 YZ) Phone #: (503) 718-