Permit r,. CITY OF TIGARD
PLUMBING PERMIT
a DEVELOPMENT SERVICES - PERMIT #: PLM1999 -00379
AI
rI " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 12350 SW TIEDEMAN AVE PARCEL: 2S103AA -01905
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 008 JURISDICTION: TIG
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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect water service to new meter location for city.
FEES
Owner:
Type By Date Amount Receipt
YORK, DANIEL L/KATHLEEN S
12350 SW TIEDEMAN
TIGARD, OR 97223 Total
Phone 1:
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 503 - 692 -4139 Water Line Insp
Reg #: LIC 000878 Final Inspection
PLM 34 -166PB .
ORIGINAL
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature: `2 G��
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
e lb
CITY OF TIGARD Plumbing Permit Application Plan Check •
13125 SW I TALL BLVD. Commercial and Residential Recd By •
TIGARD, OR 97223 Date Recd t r
•
(503) 639 -4171 Date to P.E.
Print or Type Data to DST
. Incomplete or Illegible applications will not be accepted Pe""" • �� Gb37 9
Related SWR i
Called
• Name of Development/Naiad ' 1 ;MI ' E MOW '.tl;)f W.io -,: ;. ;;Mirrilli
Job Sink 11.50
Address Street Address Suite Lavatory • 11.50
173 SO S W T E,0 AnO Tub or Tub /Shower Comb. 11.50
Bldg 8 City /Slate Zip Shower Only • 11.50
Tt Water Closet _ 11.50
Name
np Dishwasher " .11.50
Owner Mailing dices Suite Garbage Disposal • 11.50
Washing Machine 11.50
City/Slate Zip Phone Floor Drain/Floor Sink 2" 11.50
Marne 3• 11.50
4 11.50
Occupant Mailing Address Suite Water Heater O conversion 0 ilke kind 11.50
Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 11.50
• Urinal 11.50
Name n S Other Fixtures (Specify) 15.00
tc T��h re�
. Contractor Mailing Addr a Suite
Po. 60k 6c1
Prior to permit City /Stale Zip Phone Sewer - 1st 100' 38.00
issuance, a copy 71 9 Lct i r. q 106 6 ?2 - 9 J
of all licenses are Oregon Const. Cont. Board LMI Exp. Date 4 , Y Sewer - each additional 100' 92,00
required If 6f-p5 Z lZ / "-//q q Water Service - let 100' I 38.00 361,
expired in COT Plumbing tic. r Ex . Rate Water Service - each additional 200' 32.00
database 3 ! _ / 6 6 P V' - J � 51 1 a-ss' Storm & Rain Drain - 1st 100' 38.00
Name Sloan & Rain Drain = each additional 100' 32.00 •
Architect Mobile Home Space 32.00
or Mailing Address Suite Commercial back Flow Prevention Device or Anti- 32.00 '
• Pollution Device
Engineer City/State Zip Phone Residential Backflow Prevention Device' 18.00
(Irrigation liming devices require a separate
Describe work to be done: restricted energy permit.)
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Any Trap or Waste Nol Connected to a Fixture 11:50
Residential • Commercial 0 - Catch Basin 11.50 •
Additional description of work: Co,n n a of t u q +a Se9-V 1 •R. Insp. of Existing Plumbing 60.00
#d n e km M $1÷4i-- c qtr o f /1=- e 1 1 y, per/hr
Ave you capping, moving or replacing any fixtures? Specially Requested Inspections 50.00
per/hr
Yes 0 No 0 Rain Drain, single family dwelling 45.00
If yes, see back of form to Indicate work performed by Grease Traps 11.50
'
. . fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY ni; 5,jl,
I hereby acknowledge that I have read this application. that the information QUANTITY TOTAL
Y 0 P Isometric a riser diagram la required if Quantity Total is 2.9 141 r*!;!:t', " ct:
given Is coned, That I am the owner or authorized agent of the owner, and 'SUBTOTAL , g. 1 40. r s t d 1} a
that plans submitted are in compliance with Oregon Stale Laws.
l SURCHARGE ,2 3 _ �
Signature of Owncr /A oat .. - Da :_...7461 le :�i! -• A>t '
t� g e n .PI
/
Na 8 �=iC.:. ��r -._
Contact Person nfd Phone •• 25% =1!l: ' .1 � ;x ,
l . . , a 6 i Requir is . 9 OF SUBTOTAL rL . . „Wk
_ i Q a~ Gq Z / h qty. total is • ' ` .Z
1 ,''= • FS P i 1r( '' f `d4r � . " • TOTAL `,' '' i* �t •
A { �o r
�r i r 1 y 2' ..�, �� � .G�. , 1Lf L� i
, ''9 Ji.n� It itt Iii M:1
;l a f. .. 1 , � iALt =� , i -' _ - I• A x; 'Minimum permit feels $50 + 5% surcharge, except Residential WWI. SY
:, f , �.,.. �,;:.
• • • I r i e i . A _ l i , ;n r t : i � • t ' A ,. ra p .I Prevention Device, which Is $25 + 5% surcharge P.; T , ' . �;• 11 :;:, e t l $ ; .1 ,,1 % ; ::3 "All New Commercial Buildings require plans with Isometric or riser dia ram
and plan review
•
LtdalaVarrnslplumarp.doc 612!99 •
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 49//3//9 AM / PM BLD
Location ia3 - 5-1) ILL l� Suite MEC
Contact Person LL b fY S "1-1-4444- �J �,, , Ph ' S 39 PLM t9q/ -379
Contractor "' ' Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
T
ea y Se Sanitary Sewer
Rajn-Qrains
S PART FAIL
CHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ j Unable to inspect - no access
ADA
Approach /Sidewalk
Other Date / ), 9' Inspector i Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from .the job site.