Permit CITY OF TIGARD
PLUMBING PERMIT
'' ` COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00433
'TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/21/2007
PARCEL: 25111 CC -00700
•
SITE ADDRESS: 10095 SW CENTURY OAK DR ZONING: R -7
SUBDIVISION: SUMMERFIELD LOT: 004 JURISDICTION: TIG
PROJECT: KOLINA
Project Description: Replace existing fixtures.
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: 1 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: 2 SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
RON KOLINA
10095 SW CENTURY OAK DR Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 9/21/2007 $116.20
[TAX] 8% State Surcha 9/21/2007 $9.30
Phone : 503- 880 -5145 Total $125.50
Contractor:
WESTERN PLUMBING
9460 SW TIGARD STREET
TIGARD, OR 97223 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 639 -5296
FAX 503- 684 -9015
Reg #: LIC 2439
PLM 34 -29PB
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.
Issue' By: /- 1/ / Permittee Signature: at. ( t
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.
WESTERN PLUMB i7 E -, 4 ' 0 3 t 8v o st° 08/18/96 08: 30pm P. 001
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Plumbin Permit A Iieatio k , 1 j j A A ! FO OFFICE USE ONLY
City of Tigard TN � 1 v e t ` B ci Z 0- tSG /U
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II y : Permit No PL l*�2OD � -0 0 ‘. /34 .
13125 SR [tali Blvd., Tigard, Q� 7
Phone: 503.639.4171 Fax: 5''‘'. 0 Plan Review
Date /By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175
Date Ready/By: Page Z
Internet: www.tigard or.gov y' 0 n for
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Notified/Method: el Supplemental
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❑ New construction ❑ Demolition For special information use checklist
Description
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Qty. I Ea. 1 Total
Addition /alteration/replacement 1=1 Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) tlji ii:. 4, 'ti� v,Y,y a; ?fit �: - rztt'i s i ' :iri � )
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't;lrri'. �. �.. �kx :�'- .�t�.:..._�:l`; ?sst,s�:F� S4s ��_ ?.: c' r"_ w.. � � , a!'t - ki�3!.SAt:;..,s:; >?fit:vt: tai: s>�. =��S3: ti�hi�uy () 24920
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath T 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
17:] Master builder Each additional bath /kitchen 45.00
❑ O ther:
=; ip:;it,irti::, :tt.• :. t,:: �:,u ;1s >:: a ... F ires sprinkler s ft.
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IsaatS:r.�i[ �::..,,._.r:�'::aJ....;;�.:;: J. ... _ Site utilities
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lob site address:, O� ,
�d��� Catch basin or area drain 16.60
City/State/ZIP: I 1 fi 0 '^ti Drywell, leach line, or trench drain 16.60
Suite /bldg. /apt. no.: � ( � " � P name: o \S \- _ . Footing drain (no. linear ft.: _) Page 2
Cross street/directions to job site:
Manufactured home utilities 1 10.00
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
• Tax map /parcel no.:
Fixture or item
,• +, _ - Absorption valve
,'ri • ; ;::1 •i•s':! <;r::- r, _, , , 16.60
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p tax 4 n • e,X Q S \ , Backwater valve 16.60
1,-]__1.• • r \Or rA� t i, Clothes washer 16.60
Dishwasher 16.60
till _';f:g:ii 2.ki.g1t' : gli , ..tC1• b;r:l,;I .,.t,,. :i?si: •:re:
:.k1v • ,j • .,r:„ y , i.+,.- =:,,- .t1it::.tt• ':!i°t:: : :p; Drinking fountain ,
a• • t, aL b � 1.t� = .hr�i ',ri 1.i �;�;,' =i'''` tlilkl ; 4ii:w = g 16.60
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Name: `•) 16 QC na 16.60
/� E xpansion tank 16,60
Address: O(Q5 e � - \ Oa\C.. "' \) Fixture /sewer cap 16.60
City /State /ZIP: 1 ii ) CA" °�'� Floor drain /floor sink/Itub 16.60
Phone: (` bT1.. 61`�'� Garbage disposal
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Fax: ( ) age dis o 16 60
T 4 tigi; i , Hose bib
:ii t�+.ya
16.60
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lee 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: ( ) Fax: : ( ) Sink /basin /lavatory 3 16.60 1.. i AO
Tub /shower /shower pan 16.60
E -mail: ` )� {�Q
;ij:, -, ..0 iyili:i alri• ,�:,:, :oast,:. I,I, ,.. :,, -rte : Urinal 16.60
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Business name: n 1 1A mot Water heater V 16.60 t
Address: 64 1,10 0 �,t i iC irr1 'f�.t0 ., Sl, 'kie.1 t Other:
Subtotal 1
City/State /ZW:' g d
� Minimum permit fee: $72.50
Phone: ( )• 1 .. - n(3, - Fax: ( ) 1.9 "`� � 01`J Residential backflow minimum permit fee: $36.25
CCB Lie.: '%. Plumbing Lic. no.:,!4 "1 ph Plan review (25% of permit fee) ---
arge g t � . ;', --- State surch AL PE permit F f [ '
Authorized signature: ��G F , '
TOTAL RMIT GC I
Print name: !mil ' c yc:•jciVCX' Date: 09/_6- This permit application expires if a permit is not obtained within
(80 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building industry Service Board.
I.\ BttildingWormin \ PUN-Penn itnyr.doc 06/26/06 140- 46161'(10 /02 /COM/WntI)
1
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00433
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/2'1/2007
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 Jolt.
INSPECTION WORKSHEET FOR DATE: 4/16/2008 TIME: 7 :00AM PAGE: 38
SITE ADDRESS: 10095 SW CENTURY OAK DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD LOT #: 004 TYPE OF USE:
PROJECT NAME: KOLINA
DESCRIPTION: Replace existing fixtures.
OWNER: KOUNA, RON PHONE #: 503-88t)-5145
CONTRACTOR: WESTERN PLUMBING PHONE #: 503 - 636 - €iQ96
Inspection Request Scheduled For: Date: 4/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 068445 -01 503-639-5296 N
Corrections /Comments /Instructions:
fly/ PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: 61 '''+ ZAD .--^--/ Date: vim l d? Phone #: (503) 718-
CITY OF TIGARD ,..
BUILDING DIVISION PERMIT #: PLM2007 -00433
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Rig 112007
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/11/2008 TIME: 7:01AM PAGE: 19
SITE ADDRESS: 10095 SW CENTURY OAK DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD LOT #: 004 TYPE OF USE:
PROJECT NAME: KOLINA
DESCRIPTION: Replace existing fixtures.
OWNER: KOLINA, RON PHONE #: 503.880 -5145
CONTRACTOR: WESTERN PLUMBING PHONE #: 503 - 639.5296
Inspection Request Scheduled For: Date: 4/11/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 058246 -01 503G39 -5298 l+f
R ov
Corrections /Comments /Instructions: FTO sI NC
❑ PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: WO /0 : Phone #: (503) 718-
•
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: P).,M7007 -0033
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 0/21/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/11/2008 TIME: 7 :01AM PAGE: 11
SITE ADDRESS: 10095 SW CENTURY OAK DR CLASS OF WORK:
SUBDIVISION: SUMMER)°IELD LOT #: 004 TYPE OF USE:
PROJECT NAME: KOLINA
DESCRIPTION: Replace existing fixtures.
OWNER: KOLINA, RON PHONE #: 503 -88() -5145
CONTRACTOR: WESTERN PLUMBING PHONE #: 503 - 633 -296
Inspection Request Scheduled For: Date: 2111/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
322 Shower pan 0€4 16.01 503 -209 -6308 l`
Corrections /Comments /Instructions: •
PASS ❑ PARTIAL APPROVAL ❑ CANCEL 7 NO ACCESS
I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: _1A' \Ar_ Phone #: (503) 718-
CITY OF TIGARD t .. •
BUILDING DIVISION PERMIT #: PLM2007-00433
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/2
Phone: (503) 639-4171 a linpi ifi%
Inspection Requests (24 Hrs.): (503) 639-4175 „JAI 11.1.
INSPECTION WORKSHEET FOR DATE: 10/31/2007 TIME: 7:00AM PAGE: 98
SITE ADDRESS: 10095 SW CENTURY OAK DR CLASS OF WORK:
SUBDIVISION: SilivIMERFIELD LOT #: 004 TYPE OF USE:
PROJECT NAME: KOLINA
DESCRIPTION: Re.place existing fixtures.
OWNER: KOLINA, RON PHONE #: 503-880-5145
CONTRACTOR: WESTERN PLUMBING PHONE #: 503-6395296
Inspection Request Scheduled For: Date: 10/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough-in 058685-01 503-209-6908 N
Corrections/Comments/Instructions:
X PASS 0 PARTIAL APPROVAL 0 CANCEL pi NO ACCESS
0 FAIL El CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: CPA/14 ) I i \ ( awl___ Date: /0)31 i D 1 Phone #: (503) 718-
_ .