Permit CITY TIGARD PLUMBING PERMIT
P ERMIT #: PLM1999 -00377
DEVELOPMENT SERVICES DATE ISSUED: 11/17/1999
13125 SW Hall Blvd., Tigard, O R 97223 (503) 639 -4171
SITE ADDRESS: 10585 SW WALNUT ST PARCEL: 2S103AA -01901
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 004 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
HELMER, GARRY L BARBARA S
10585 SW WALNUT
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 p.ermit 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: `?'n G;�.0 -� K-L
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
.1
CITY OF TIGARD Plumbing Permit Application Plan Check II .
13125 SW HALL BLVD. Commercial and Residential Redd By ;r
TIGARD, OR 97223 • Date Recd I l N 1
(503) 639 -4171 Date to P.E.
Print or Type Date to DST •
Incomplete or illegible applications will not be accepted PerrhusPcpq f9g9 -377
Related SWR fi
Called
Name of Developmenurro)ect i 40CF.;„:.g...1 MIZ I gg - 'r
Job Sink 11.50
Address St reet Address T Suite Lavatory • 11.60
• 1 5 RS SIN Loci in H Tub or Tub /Shower Comb. 11.50
131(19 i C0y/Slalo I Zip
� qCn Shower Only • 11.50
Name v /n� Water Closet I 11.60
t l e L- Zit-. e2 G Dishwasher . . 11.50
Owner Mailing Address Su Garbage Disposal • 11.50
Washing Machine 11.50
City /Slate Zip Phone Floor Drain/Floor Sink 2" - 11.50
Name - 3" 11.60
4' 11.50
' Occupant Mailin Address ' Suite Water Heater O conversion 0 eke kind ' 11.50
Gas piping requires a separate mechanical permit. , ,
City /Slate Zip Phone Laundry Room Tray 11.50 •
Name - Urinal 11.50
q 6G Q h' f pz M b I /l c„ Other Fixtures (Specify) 15.00
Contractor Riding Adds .,s Suite C/
Po. 8 0 6 1
Prior to permit City /Slate Zip Phone Sewer - lst 100' 38.00
issuance, a copy Tti ry Lcl{ r i-. q 106 672..- LS 9
of all licenses are Oregon Conet. Cord. Board Lice Exp. Date Sewer -each additional 100' 32.00
required If �j T 2 S . :I./hi/ i Water Service - let 100' I 38.00 3 s'6 o
expired In COT Plumbing tic. 0 Ex Rate c, Water Service - each additional 200' • 32.00
database 3 ! _/ r , P 6 1 31 f )-(1° Storm I Rain Drain - let 100' 38.00
Name Storm 8 Rain Drain : each additional 100' 32.00 •
Architect Mobile Home Space 32.00
or Mailing Address Suite ` Commercial Bad( Flow Prevention Device or Anti- 32.00 •
• Pollution Device
Engineer city/Stale Zip Phone ^ Residential Beddow Prevention Device' 18.00
(Irrigation timing devices require a separate
Describe work to be done: restilded energy permit.)
New 0 Repair 0 Replace with like kind: Yes 0 No O Any Trap or Waste Not Connected to a Fixture 11:50
Residential • Commercial O _ Catch Basin 11.50 •
Additional description of work: c• A 0 & -t tA tt S•€ 1P 1 e �• insp. of Existing Plumbing 60.00 J
+v hltW M.2+19.- cq-,0n 4C/P- c ill . per/hr .
Are you capping, moving or replacing any fixtures? Specially Requested Inspections 50.00
45.0 perihr
Yes 0 No 0
Rain Drain, single family dwelling 45.00
If yes, see back of torm to Indicate work performed by Grease Traps 11.50
. . fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN IiICREASED SEWER FEES. QUANTITY TOTAL 1, nli $1..,I
I hereby acknowledge that I have read this application, that the Information Isometric cs miser diagram Is required if Quantity Total is > 9 1 J • :2 ` . .1'."c;,:
given Is correct. that I ant Hie owner or authorized agent of the owner, and . ", st a{
SUBTOTAL : ; y aF 1
that plans submitted are in compliance with Oregon State Laws.
+i t 7
' 1:51 -
S
A 110
ignature of Owner/Agent Date 8 M : URCHARGE ik`1 1. !
Contact Person Na / Phone "PLAN REVIEW 25% OF SUBTOTAL r 1'cl , �' ro •
�/ Gl WQ_ / /-G 6 , h 6' A. 2_ - / ' Required on d a rdire total Is . e 4- t , s
.A. � 9 only � qty.
,- y .� • • °� Rib z: 5 - iSF 4
I. ' ° . ;V t . a, :,•., i - r ., �i��_- E- TOTAL l -''' it °= -
;...�� ` r' !3 ,= - ' 4 v�3 ` 1 r cEy! ;rF }i ,;
14-1'14,t1.00.4.•, r/ L
sue I
t ? sal , 1 i ` °�� �,�y ; 4 1 3 � " 'Minimum permit fee Is $50 + 5% sii t Residential Bade
rchar e, except I
imar
i n , , t: r . a P l. P 9 P
tf xt s l; " � �z Prevention Device, which Is $25 + 5% surcharge
b.. f '}�_ "All New Commercial Buildings require plans with Isometric or riser • Iegrem
and plan review
kuldsVonnslplumapp.doc 612109 •
•
' CITY OF TIGARD BUILDING INSPECTION DIVISION :—.771)La-7
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
'7 to PA Date Requested ` t AM - PM
Location 1 D J�� �� ~ Suite
Contact Person Ph (, ' ' L/137
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 •
UMB N
Post Beam
Under Slab
To• •
Sanitary Sewer
Rain Drains
Fib
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 [ ] 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 �/ '
Other ' Inspec / Ext ,
Final
PASS PART FAIL D NOT EMOVE this inspection record from the job site.