Permit 9 i6 g
CITY O F TIGARD CARD .. 1, PLUMBING PERMIT
t �I� DEVELOPMENT SERVICES PERMIT #: PLM2006 -00419
---' 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 9/12/2006
PARCEL: 25111 BD - 02100
SITE ADDRESS: 09755 SW PEMBROOK ST ZONING: R - 3.5
SUBDIVISION: CLOUD CAP LOT: 003 JURISDICTION: TIG
Project Description: Add sink to shop and water heater.
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: 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
SARINEN, ANNETTE C +
EASTON, WILLIAM J Description Date Amount
9755 SW PEMBROOK ST [PLUMB] Permit Fee 9/12/2006 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcha 9/12/2006 $5.80
Phone : Total $78.30
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69 1 f
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS C
0
Contact # : PRI 503- 692 -4139
FAX 503- 691 -2328 17K? o[� O
Reg #: LIC 87852 0
PLM 34 -166PB y/ 1 L. / O .r
11
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: 4444 Permittee Signature: e fri ,9
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.
•
- INSPECTORS SIGNATURES ARE NOT
Inspections Required for: PLM2006- 00419. • REQUIRED ON GREEN INSPECTION CARD.
✓ Code I Inspection Description I PASS Date By ✓ Code I Inspection Description I PASS Date I By I
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground/slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
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 MEC - Mechanical Permit
810 MFG - Structure set -up
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 322 Shower pan
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\Inspection Cards \Forms\AOP - InspCard- Blank.doc 12/09/2005
A CITY OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00419
.Ak • �
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 9/12/2006
PARCEL: 25111 BD -02100
SITE ADDRESS: 09755 SW PEMBROOK ST ZONING: R - 3.5
SUBDIVISION: CLOUD CAP LOT: 003 JURISDICTION: TIG
Project Description: Add sink to shop and water heater.
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: 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
SARINEN, ANNETTE C +
EASTON, WILLIAM J Description Date Amount
9755 SW PEMBROOK ST [PLUMB] Permit Fee 9/12/2006 $72.50
TIGARD, OR 97224 [TAX] 8% State Surcha 9/12/2006 $5.80
. Phone : Total $78.30
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -4139
FAX 503- 691 -2328
Reg #: LIC 87852
PLM 34 -166PB
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: /atka4 6-‘44 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.
Sep. 12. 2006 10:38AM Rayborns Plumbing No. 6232 P. 1
- 1. la T :
PlumbinQ Permit AupliCitic n q ,/ 1L - 1 • Foit OFFICE Usl: ONLY
City of Tigard Received "• / ofi 415 Permit No. kni. 006,_ ov //9
13125 SW Hall Blvd., Tigard, OR 97223 _ Daffy:
I - .,,, •,, PlanRevr
Phone: 503.639.4171 Fax: 503.598.1960 '
24 Hour Inspection [inc : 503.639.4175 L i • 2 0 , J I I Date/By: Otter Permit No.:
-
24 Hour
wwev,el. tlgeld.Or.us 1' _- Date Ready/By: hill: El See Page 1 for
._..,. �..� . r. 6 e t
w Notified/Method: I
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Total
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11.' Addition/alteration/replacement ❑
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Fr rl i_1., ?; r;:l '; 1 : `
�.= 1 e 5 :r ; 7 r ,:1 -- :.- _ _ New 1- 2- family dwellings (includes 100 R for each utility connection)
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- �;- •�l'.,l i_ , . _:. , :.! j -..,. 1 _ - SFR ( I) bath 24920
g.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 ❑ Other:
n, - I r ^- :- -- r c , ( , r 1 �- -, Fire sprinkler (� sq. R) I I Page 2
F yn` { », Vii% iLr ■r J.I„ il,+tF1 ] : I� I` •a,.?! uj * .j
L 1.., , li,L r. .6__ac ,.>. , . � . , . , ... , �,... ...� ._: [I 1 L r .'.: . r � : Site utilities
Job site address: 975 S - A s / 1.e, Catch basin or area drain 16.60
City /State/ZIP: 77yaff / OA 9749•9 *' Drywell, (each line, or trench drain 16.60
Suite/bIdgJapt. no.: Project name: Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60 _
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) I Page 2
Subdivision: Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: - -
:]'L + +,,...,., �,�!?.r:;"sr,!,: -. -- :,1?�r „ ;T' .- , �, r :r. - - Absorption valve
a= . 1 :1 ' {'a f�' ��' T 1 ; 7 ( �r ���'. � l7? °f1l i,
_
- � _- .,._ _ •, - -- ' 1 B ackflow preventer pa 2
� i g
i / /A Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
,,,
r;, Ei r 17 f 1 } i t'S 1 1 i 1 11 { l ' r : 1 EI , 1 1 I '-'.+717, ' r Drinking fountain 16. ir emu. r . I .ial. _ ��,:i �� 1 � 911 '\; ( 1 't17 r. ) ' ' 60
5 _._.1 w :...,._. !., : "..l :! -.... , 1 Ejectors/sump 16.60
r
ir if
i /I a.` Expansion tank - 16.60
Address: 97S c_cid / r../Y .AJ) Fixture/sewer cap 16.60
City/State/ZIP: % ,na �
i �� Floor drainlfloorsink /hub 16.60
Phone: , - Fax; ( ) Garbage disposal 16 -
.60
..
F > :ii c;_4;;Y,:,i.?ca^^ -a'n•� '`;; ''`.in '''diT':' 7, ;;.tr?,•; :::; };,iP;=; .;:r1 - :;p Hose bib • : a� 1 �L� k . .) t 4 , l� a . 1 ? t 'r rt l ? 1 �1 ,1 r 1.. f 1> ir,l n$ e b 1 16,60 • n
/ / lee maker 16.60
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Business name: 4it�ie i P /LGI7f bl /Il / �]l^�
� J , 0- .- �, Medical gas (value: $ ) Page 2
✓ lritettxptor /rease trap I6.60
,
Contact name: ,�]
Address: � .` .1. 49 Primer 16.60
%7 ,J D 9� ' 0 h Y Roof drain (commercial) 16.60 ids
City/State/ZIP: / )
Phone: Fax; 49,--3-3?, _ Sink/basin/lavatory / 16.60 • , -
� D3) 69�- 9/3 `sue Tub /shower/shower pan 16.60 �-
E -mail: iS : ° L_ , -, I2S
., , ��_ i, r-,� ; 1 �) s Urinal 16.60
t,i , Il , . :i -- k -i ' 1 3 i' P '' . 1 f` ; t'' r I:: ! i , i ' l I .. �.
...._._y�� :il r� .., . ,,., � _ : ,..,v .t._ .1 .-: .',.'---L. . ; w_
ter
name: tor closat 16.60
ine: W ater heater / 16.60 / f'
'/is Pk r`i ins f
Address: 1) ig ell 0 Other:
City/State/ZIP: 4zt� li e)/ N6 Subtotal 3
Minimum permit fee: $72.50 C 1
Phone: 67, 9.• - y /3y Fax; 5 ) 6 7/ x.3)8 Residential backflow minimum permit fee: $36.25 7 •
CCB Lic.: O / g ., Plumbing Lic. no.:y -/ 6 G p Plan review (25% of permit fee)
State surcharge (8% of permit fee) .5, IC6
Authorized signature: • TOTAL PERMIT FEE 7g: 30
Print name: � , _ t. - 1 Date: 9 / e z, This 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.
is\ BuildinglPemiltr\PLM -P rmiiApp.doo 06/05 4404616T(I0/OVCOM/WrB)
CITY OF TIGARD • a •
BUILDING DIVISION PERMIT #: PLM2006.00419
13125 SW Hall Blvd., Tigard, OR 97223 .,_. - DATE ISSUED: 9/12/2006
Phone: (503) 639 -4171 il
. Inspection Requests (24 Hrs.): (503) 639 -4175 s_ "_ _..
INSPECTION WORKSHEET FOR DATE: 9/28/2006 TIME: 7:02AM PAGE: 23
SITE ADDRESS: 09755 SW PEMBROOK ST CLASS OF WORK:
SUBDIVISION: CLOUD CAP LOT #: 003 TYPE OF USE:
. PROJECT NAME: SARINEN
DESCRIPTION: Add sink to shop and water heater.
OWNER: PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 -692 -4139
Inspection Request Scheduled For: Date: 9/20/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 037310-01 . 503-692-4139 N
Corrections /Comments /Instructions:
/ll «. /.. ` / / ./ L
- /
k1 " SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I /; °
Inspector: Date: 4 4 Phone #: (503) 718- 21-q__Y___
CITY OFTIGARD
i BUILDING DIVISION PERMIT #: PLM2006-00419
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/17/2006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 s' �- ' I � ..
INSPECTION WORKSHEET FOR DATE: 9/27/2006 TIME: 7 :07AM PAGE: 47
SITE ADDRESS: 09755 SW PEMBROOK ST CLASS OF WORK:
SUBDIVISION: CLOUD CAP LOT #: 003 TYPE OF USE:
PROJECT NAME: SARINF_N
DESCRIPTION: Add sink to shop and water heater.
OWNER: PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503-692 -4139
Inspection Request Scheduled For: Date: 9/27/2006 Pour Time: •
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 037205-01 603 -692 -4139 N
Corrections /Comments /Instructions: /
Iv /
' S N; "I. - TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
V FAIL r CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: PI i 12' Date: q ), i 6 Phone #: (503) 718 -