Permit CITY TIGARD PLUMBING PERMIT
F DEVELOPMENT SERVICES PERMIT #: PLM1999 -00385
� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 10610 SW WALNUT ST PARCEL: 2S102BC -02006
SUBDIVISION: NO. TIGARDVILLE ADDITION ZONING: R -4.5
BLOCK: LOT: 024 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
EDWARDS, ANNE D + HARVEY 0
10610 SW WALNUT ST
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: XP-61A-44(4----) Permittee Signature: -1 1 4 -a --
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
' '4)
CITY'OF TIGARD Plumbing Permit Application Plan check ff
13125 SW I TALL BLVD. Commercial and Residential Reed By
TIGARD, OR 97223 Date Reed
(603) 639 -4171 Date to P.E.
Print or Type Date to DST •
Incomplete or Illegible applications will not be accepted Permuai�rn 09 Oo385
Related SWR ill
Called
Name of Development/Project i IOW Ma. r ,16 r r
Job Sink 11.50
Address Street Address r /, Suite Lavatory 11.50
_.J_
•
Q CI o Sly VI `q Tub or Tub /Shower Comb. 11.50
Bldg I I City /Slate J 1 Zip Shower Only 11.50
• tc� � Water Closet 11.50
Name I
0v01X / AninC& (`7A•/J Dishwasher ' . 11.50
Owner Mailing Address 1 Suite Garbage Disposal 11.50
Washing Machine 11.50
City/Stale Zip Phone Floor Drain/Floor Sink 2" 11.50
Name 3" 11.50
4 ' 11.50
•
Occupant Mailing Address ' Suite Water Heater O conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
City /Stale Zip Phone Laundry Room Tray 11.50 •
• Urinal 11.50
Name t
t q 60 Q h � t P (01 Alb l n Other Fixtures (Specify) 15.00
Contractor M fling Add' s Suite •
•
PO. 6ok 61 _
Prior to permit City /Slate Zip Phone Sewer - 161 100' 38.00
Issuance, a copy -11„, c L c f, is q106 2- C /Z, 13 9 •
of all licenses are Oregon Const. Cont. Board Licit Exp. Date Sewer •each additional 100 32.00
required if 2 O
E 7 S 2- 12 //i /qN dV Water Service - 1st 100' I 38.00 36'0 Q '
expired in COT Plumbing tic. OP Er Ratio / kth2) Water Service - each additional 200' 32.00
database 3 - / r , P(') )/ '3 1 6 `' Storm a Rain Drain - 1st 100' 38.00
Name Storm & 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/Stato Zip Phone Residential Backflow Prevention Device' 19.00
(Irrigation timing 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 Not Connected to a Fixture 11:50
Residential • Commercial 0 _ Catch Basin 11.50 •
Additional description of work: 4,•,,m 11 ut wA'(-rR 1 5€9.4 teQ' insp. of Existing Plumbing 50.00
'pct h e w /14.12,1 Ld c f, o n -Kis G r l X. _ per/hr
-
50.00
Are you capping, moving or replacing any fixtures? Specially Requested Inspedlons
per/hr
per/hr
Yes 0 No 0 Rain Drain. single family dwelling 45.00
It 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 TOTAL : ;� � s; r - nk �F_ ,
� '�;
I hereby acknowledge that I have read this application, Ural the Information Isometric a riser diagram Is required if Quantity Total is > 9 + I ' :5 ° -' =':`
given is carrert, (hat I am the owner or authorized agent of the owner, and 'SUBTOTAL i4E 10 VIKA 50 et
that plans submitted are in compliance ••. with Oregon State Laws. • _, i � _ I ` lA t_
Signature of Owner/Agent \ Data '3- a �
Contact /
Person t � . Na ( Phone "PLAN REVIEW 25% OF SUBTOTAL gl li #31_' r'" il`Lop
_ W /0 c. � 01� --I/t S i/ �/ Z'Y f 3 Required a' u axture Sty. total Is 9 :ate s,S% r' q - ' 1' ' ' �
'l. 1 _. i 7 ,Ty71 '" --1 B_ 1,HI �, I TOTAL x, : _•� = u/
t ` ^ �Ainy„?'s '.wilr 6•,7rtr..;�; "�i . � c lt' r d p 0'1! p` • • .� 7
i _ ° ,,'. - ` .f ' ,. r ,1 . 7 `- • 'Minimum permit fee Is $50 + 5% surchar e, except Residential B • ow
1'. '11 O , __ I •1,;1•f =) •: rats • . P 9 P
I.., ' a 1 I i ,I n t r t (' i , -; ,� _` Prevention Device, which is $25 + 5% surcharge
' . . r 71 - l � � ,��,; • ►t �;ti , 4 r . ! ; 4 (` ' -� �1�1 • �`,; ,�� ; . All New Commercial Buildings require plans with Isometric or riser diagram
and plan review
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Ltdalatronmslptumapp.doc elves
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CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171
BUP
Date Requested rt 19 AM PM BLD
Location / 0 6 6 1 --()ceAuciS ---- cc Suite MEC
Contact Person Ph b 9 a I7 CLLO ,(26 3ses
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain
Crawl Drain Inspection Notes: SGN
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
&SS PART FAIL
LUMBING
PofTBam
Under Slab
Top Ou
4: 1=010
Sani ary Sewer
Rain Drains
PART FAIL
' HANICAL
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 [ I 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: [ ] Unable to inspect - no access
ADA
Approach/Sidewalk Date 1R
Inspector Ext
Other
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.