Permit CITY TIGARD PLUMBING PERMIT
iA, DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00377
.� ii DATE ISSUED: 8/10/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 134AC -05500
SITE ADDRESS: 10985 SW 109TH AVE ZONING: R -4.5
SUBDIVISION: HART'S LANDING LOT: 026 JURISDICTION: TIG
Project Description: Remodel fixtures. Other fix. hose bibb.
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: 1
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 0 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
PIN, JOHN W
10985 SW 109TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 8/10/2006 $72.50
[TAX] 8% State Surcha 8/10/2006 $5.80
Phone: 503- 684 -8180 Total $78.30
Contractor:
NORTHWEST CENTRAL PLUMBING
2870 SE 75TH AVE #206
HILLSBORO, OR 97123 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 642 -2067
FAX 503- 624 -5954
Reg #: LIC 72253
PLM 34 -197PB
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:f ` � Permittee Signature: , / ( a C4. /--
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.
08/09/2006 11:52 FAX l 002/003
rTh Plumbin Per it A s i l ion fi — r i OR c»HFti ��.:usr. 01.4,y
Cit y Tigard Tigard Receive•.
- Permit No. a.4' a^i� 0 [ 7
11125 SW Hall Blvd., Tig, rd, OR 97223 0 9 vale/e I • 6 —
Phone: 503.639.4171 Fa , 503,598,1960 AUG 0 9 200 r %"Jr Plan Revi.w
4 1 i, ' � � ' I 1 Date /B • other Pe ,ul Nu
24- Hour Inspection Line: 03.639.4175 2 • once Ready/El Internet www ci•0gsrd Or. S ` • - ° - Y Y Supplemental See Page 2 for
V ft iii-∎ i dN 4C:it 44 i 6 NotifiedlMethod: S lam
�.
1 r t ii '91WirNTIt Prel 1t. t FEE' SCHEDULE
0 New construction ' t Dernolitinn rt}J ' For special ifonnationuse checkliss.
Descri.tion Qt , Ea Total
:., 4ddtuoeialterauonirepl +cement ❑ Other; (dew l- 2- family dwellings (includes 100 ft. for each utility connector
C • TEGORY OF CONSTRUCTION SFR ( I) bath ■ 759 20
NCI- and 2- family dweliin- ❑ Commercial /industrial SFR (2) bath 3.5000
❑ Accessory building ❑ Multi - family • SFR (3) bath 3519 01)
Each additional bath/kitchen 45 00
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
I , i ' Site utilities
Job site address: QGj. I O'er . . _ Catch basin or area drain 16 60
o.. e\1 a a Drywcll, leach line, or trench drain 16 60
•
Suite/bldg./apt. no : ■ Project name: • v_. • S i ;
Footing drain (no linear ft,. ) Page 2
Manufactured home utilities 1 10.00
Cross street/directions to j b 'site:
Manholes 16 60
Rain drain connector 16 6(1
Sanitary sewer (no linear ft ) Page 2
Storm sewer (no. linear ft - ) Page 2
Water service (no. linear ft ) Pa 2
Subdivision; Lol no,;
Fixture Or item
Tax map /parcel no Absorption valve 16 60
1l7ESCI B11i2N OF WORK Backflow preventer PAgc 2
6 4 Gil d,►• . •A- IrQ.4w1 •o, ' ° Backwater valve M 16.60
Clothes washer 16.60
Dishwasher 16,60
❑ pR01Y '031111, .1 11$IZ' , ' I -CANT Drinking fountain It 611
Ejectors /sump IS 60
Name: Expansion tank 16 tit
Address; Pixture/sewer cap 16 60
City /State/ZIP: Floor drain/floor sink/hub 16 60
Phone' ( 1 Fax: ( ) Garbage disposal 16 60
Hose bib 16 60 li( (44
❑ APPLIC Q„ Cf)]VTAC 1' ]t?$iRSON Ice maker 16 0 0
Business name'
Interceptor /grease trap 16,6u
Contact name Medical gas (value' $ 1 Page 2
Address: Primer 16 6(1
City /State /ZIP: Roof drain (commercial) 1660
Phone, ( ) Fag::( )
Sink/basin /lavatory 16.60 (o , (r°
Tub /shower /shower pan ' I6 60 1 Co -(eO
E -mail
. Urinal I 16,60
CQNTIMCTO,It Winer closer 16 60
Business name: Northwest Central Plumbing Co., Inc. Water heater 16 60
Address: 2870 SE 75 Ave ue, Unit #206► Other A Subtotal
City/State./ZIP: Hillsboro/ �IR/97123 1 ( . $ t
Minim permit fcc. $73.50
Phone: (503) 642 - 2067 Fax: (503) 642 -5954 Residential backflow min,murn3ermn fee, 536. 12 •
CCB Lic : 72253 Pian review (25% of acne' tl fez)
/ State surcharge (8% of peruul feel S, TO
Authorized signatUl'e; i' TOTAL PERMIT FEE - 7 S
i
Print name: John CO 'man Date'n„ s O+ �p& Thin permit application expires if a permit is not obtained within
V^ �J n 180 days after it has been accepted as complete.
"Fee methodology set by Tr1-County Building Industry Service Board
, \ B,dJine \Penn,lt\PLN- Peru,,,Apr1115' (16/1)5 daU -46I STtililB2 /C'OvvwEB)
CITY OF TIGARD
- BUILDING DWVISrON PERMIT #: PLM2006 -00377
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2006
Phone: (503) 639 -4171 90411
Inspection Requests (24 Hrs.): (503) 639 -4175 frlafk IL
INSPECTION WORKSHEET FOR DATE: 11/32006 TIME: 5:07PM PAGE: 17
SITE ADDRESS: 10985 SW 109TH AVE CLASS OF WORK:
SUBDIVISION: HART'S LANDING LOT #: 026 TYPE OF USE:
PROJECT NAME: PIN
DESCRIPTION: Remodel fixtures. Other fix. hose Bibb.
OWNER: PIN, JOHN W, PHONE #: 5503 -684 -8180
CONTRACTOR: NORTHWEST CENTRAL PLUMBING PHONE #: 503 - 642 -2067
Inspection Request Scheduled For: Date: 11/6/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 039319 -01 60a-642-2067 Y
Corrections /Comments /Instructions:
F l ;17 / ,
/ / 16/I" i
,I
PASS 0 PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: fr ) °/ Date: I? 3 6 Phone #: (503) 718-
•
CITY OF TIGARD BUILDING DIVISION PERMIT #: PLM2006-00377
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 8/10/2006
Phone: (503) 639 -4171 Mi , 'II
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/31/2006 TIME: 7 :00AM PAGE: 58
SITE ADDRESS: 10985 SW 109TH AVE CLASS OF WORK:
SUBDIVISION: HART'S LANDING LOT #: 076 TYPE OF USE:
PROJECT NAME: PIN
DESCRIPTION: Remodel fixtures. Other fix. hose bibb. ,
OWNER: PIN, JOHN W, PHONE #: 503
CONTRACTOR: NORTHWEST CENTRAL PLUMBING PHONE #: 503 -642 -2067
Inspection Request Scheduled For: Date: 8/31/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
322 Shower pan 035857 -01 503- 572 -3274 Y
Corrections /Comments /Instructions:
X PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
U FAIL ❑ CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: V u‘ ,-6- Date: T\s 1D(- Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM200E 00377
13125 SW Hall Blvd., Tigard, OR 97223 r =',, . * : DATE ISSUED: 8/10/2006
Phone: (503) 639- 4171 u9u�� °I II ' I
Inspection Requests (24 Hrs.): (503) 639 -4175 .��_... I_.
INSPECTION WORKSHEET FOR DATE: 0/11/2006 TIME: 7 :06AM PAGE: 68
SITE ADDRESS: 10905 SW 109TH AVE CLASS OF WORK:
SUBDIVISION: HARTS LANDING LOT #: 026 TYPE OF USE:
PROJECT NAME: RN
DESCRIPTION: Remodel fixtures. Other fix. hose bibb.
OWNER: PIN, JOHN W, PHONE #: 503 - 6134 -8110
CONTRACTOR: NORTHWEST CENTRAL PLUMBING PHONE #: 543 -642 -2067
Inspection Request Scheduled For: Date: 8/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 034809 -01 503.672 -2067 Y
Corrections /Comments /Instructions: .
\>. t
f
PASS I I PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
n FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Q I-13/ I s D 718- Inspector: /14' 7 Date: / Phone #: (503) 71