Permit C ITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2009 - 00008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/12/2009
PARCEL: 2S102BC -00110
SITE ADDRESS: 12505 SW BROOKSIDE AVE ZONING: R -4.5
SUBDIVISION: WALNUT ACRES LOT: 009 JURISDICTION: TIG
PROJECT: PROWSE
Project Description: Remodel bathroom.
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: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JIN PROWSE
12505 SW BROOKSIDE AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/12/2009 $72.50
[TAX] 12% State Surch 1/12/2009 $8.70
Phone : 503- 998 -1586 Total $81.20
Contractor:
ALDER PLUMBING INC
2773 N CLARK CT
CORNELIUS, OR 97113 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 -515 -5920
Reg #: LIC 153699
PLM 34 -411PB
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: ou,n Q 11,QA,3 Permittee Signature: Q PP
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.
Plumbing Permit Application RECEIVED
Fixtures
City of Tigard Received JAN 1 2 Date/By: 1. 1 . O q t J Permit No. Q, 00431 ® 13125 SW Hall Blvd., Tigard, OR 97223 2009
11
Plan Review c
C • Phone: 503.639.4171 Fax: 503.598.1960_ Date/By: Other Permit No.c i C oq .0 OO ( S
Inspection Line: 503.639.4175 ITY OF TIGARD Date Read uns H See Page 2 for
1 1 �''\ }Z 0 Internet: www.tigard- or.gov BUILDING DIVIS Notified/Method: I I Supplem Information
Y6 4. - LASS
:::::::'''''74., s,, .. •TYP O WORK ; i .1v „: ' -
w; , (ar t . •• - 1: ... FEE *r'SCHEDULE4 ;aa..0
. :;'{ • it
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
IX Addition/alteration /replacement ❑ Other: New 1 - 2- family dwellings (includes 100 ft. for each utility connection)
"? - . i °
CATEGORY OF CONS FRUCTION •, $ lr , SFR (1) bath 24920
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family
SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
*' J OB ,SIT INFORMATION "AND' LOCATION , ` °' _ ,1
- . .. � ." � � � ,�,„ ,�: �. �� -. � ... .. • '� ° _-t" ' _,.., ':� °� Site utilities
Job site address: I Z rj 0 5 51x) Q rook Sq - - Ave, Catch basin or area drain 16.60
City/State/ZIP: - 5 ,,r b R q77-7-3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name:
Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
I II •• J Manholes 16.60
lit t N t2 t B f b 0 K S► (te >C- S-1 f e.4 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: , ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: (Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
r , ,i 'S,AVo. s n ' , • ro'' `; �`` ° .aDESCRil ION.OF.
' •WO.RK'' s "I, "'' "".re >,'A 4 "L ;!° i ce. ..
� . �.. > ,i1,,' Backflow preventer Page 2
fit coNtC15y,(4 ha'11 - Gad. ' e gC. t Wry .z.s.o( 5L e I Backwater valve 16.60
p e -h, PE (KfPIx) ABS (Attu) j..1 �c�l0a� Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
Ejectors /sump
'.',..!.:''.• '1:7-•
'o � L�:`'�PItOPERTY OWNER - . e c UQ , „; "i,❑' ° ' "� °, .� �:, ", 16.60
u „s
Name: ,3 , V f O WS Expansion tank 16.60
Address: ]M gt Si) 1 6 aka * e( r Fixture/sewercap 16.60
City /State/ZIP: - 1- p 0 L 9 7 2_7 y Floor drain/floor sink/hub 16.60
Phone: ( co3) ?' g' I . '6 Fax: ( ) Garbage disposal 16.60
t . ti � G Hose bib 16.60
a� • ^ ❑'APPLICANT=' .4,•'"' '❑ CONTACT ,PERSON''
e: `
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( )
Sink/basin/lavatory ) 16.60 /6. 6 0
Tub /shower /shower pan 1 16.60 it, • ( b
E -mail:
Urinal 16.60
• , f • ' ` ....,' .� , CONTRACTOR • „ • •. Water closet /-7 4- ( 16.60 1 L. k 0
Business name: A- ` D f )Z I 14/ 6- 1 N( Water heater 16.60
Address: 3130 m r kt l-e) cock 3 Other:
City/State /ZIP: i-s a \ .. \ociiro 0 9., C( 7 12(L ,- Subtotal
I Minimum permit fee:' $72.50 -72 , B
Phone: ( 5G? ) S 1.1-- 5-q2..6. Fax: ( 503) C 53 _3 6 ?.f Residential backflow minimum permit fee: $36.25
CCB Lie.: ) 53� c3 t. 23 . ( Plumbing Lic. no.: ` t4 I'pa Plan review (25% of permit fee) 18. L
-
/ 7 . 1 • 1 i State surcharge (12% of permit fee) g' .70
Authorized signature: TOTAL PERMIT FEE _
Print name: kA w N - I {q u t 1 l Q r• I Date: This permit application expires if a permit is not obtained w
180 days after it has been accepted as complete. 81
*Fee methodology set by Tri-County Building Industry Service Board.
I:1 Building \PermitsWLMF- PermitApp.doc 12/27 /06 440.46i6T(10 /02/COM/WEB)
CITY OF TIGARD `
BUILDING DIVISION PERMIT #: PLW1 � room
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Hz-
Phone: (503) 639 -4171 "Pl
Inspection Requests (24 Hrs.): (503) 639 -4175 ^'i �..
INSPECTION WORKSHEET FOR DATE: Ail 161 L TIME: PAGE:
SITE ADDRESS: 25O6' 5 w B(40014,6 R pi - CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:1)L , m
OWNER: PHONE #:
CONTRACTOR: A Lima, PLV I PHONE #:
Inspection Request Scheduled For: Date:41)0k Pour Time:
Code # Inspection Description Confirm # Contact # Message
i 1 P‘-v'MRs (4 L...
Corrections /Comments / Instructions:
i) S Ro Mr�t, q gov t i 20° E: .
E PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
3 g FAIL 0 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • Uv L Date: 4/1 i qo 9 Phone #: (503) 718- 2•44(:).
CITY._,QF TIGARD ,
BUILI5ING DIVISION
PERMIT #: KM2009-00008
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/1212009
Phone: (503) 639-4171 Az'Ati
Inspection Requests (24 Hrs.): (503) 639-4175 AI Jr! !`
INSPECTION WORKSHEET FOR •DATE: •0/2009 TIME: 7 PAGE: 14
SITE ADDRESS: 12505 t:31N BROOKSIDE AVE CLASS OF WORK:
SUBDIVISION: WALNUT ACRES LOT #: q TYPE OF USE:
PROJECT NAME: PROWSE
DESCRIPTION: R b a th room.
OWNER: pRowsE • PHONE #: 503.998_1 stwi
CONTRACTOR: ALDER PLUMBING INC PHONE #: 503-515-5920
Inspection Request Scheduled For: Date: •/26/2009 Pour Time: •
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough-in 080005-01 50°3.998-1586
Corrections/Comments/Instructions:
. ,
411V , MOM "Ni •
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PASS El PARTIAL APPROVAL .CANCEL pi NO ACCESS
El FAIL El CALL FOR INSPECTION j ADDIT :NAL ; EES ASSESSED
Inspector: Date: ■ Phone #: (503) 718-