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Permit
• • CITY TIGARD PLUMBING PERMIT rA' DEVELOPMENT SERVICES PERMIT #: PLM1999- 00378 • , . ,•��! DATE ISSUED: 11/17/1999 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 SITE ADDRESS: 10625 SW WALNUT ST PARCEL: 2S103AA -01902 SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5 BLOCK: LOT: 005 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 HATANAKA, BARRY RURIKO • 10625 SW WALNUT Total TIGARD, OR 97223 • • 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 copi s of these rules or direct questions to OUNC by calling (503) 246 -1987. Issued By: j Permittee Signature: G . Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day • 1 • CITY ©F TIGARD Plumbing Permit Application Plan check 0 13125 SW I TALL BLVD. Commercial and Residential Recd By It l / -1( 9q TIGARD, OR 97223 Date Recd • I< (603) 639 -4171 • Date to P.E. Print or Type Date to Dg Incomplete or illegible applications will not be accepted Pemal oU/+i ��kq G�3 Related SWR r3 Called Name of DevelopmenUProied -i & „". P =`'lliA�l , p ..,,.._ .' c , .. Job Sink ` n - �:_ , '�: '-=� �4� � - s �; .1 � *� t t.o Address St reet 6 Address sc./ (,JG� s • Suite Lavatory 11.50 11 Tub or Tub /Shower Comb. 1 1.50 Mai ft t Cily/�Slale� tip Shower Only 11.50 I ! `� � Water Closet Name 1 1.50 01 4 M. tat k a Dishwasher 11.50 Owner Mailing Address 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 /Slate Zip Phone Laundry Room Tray ' 1 1.50 • • - - Urinal 11.50 Name Other Fixtures (Specify) � a 6o Qn's P/ t4 4,b i r i ry) _ 15.0 Contractor Meiling Addi .- - s Suite /.o. 8ok 01 Prior to permit City/Stale Zip Phone Sewer - 1st 100' 38.00 issuance. a copy /1.4 c Lq{ r ;+. r 0, Z 6 ?Z -4 9 of all licenses are Oregon Consl. Cont. Board LIc.f Exp. Date Sewer -each additional 100' 3 2.00 required If e f- P S -L ) 2 / /( /q q 0 Water Service - 181100' I 38.00 35: a expired In COT Plumbing 1.Ic. re Ex Rat Water Service - each additional 200' 32.00 database 3� -/ • r f 15 i I 1 i 1 2.scj Storm 8 Rain Drain -tat 100' - 3 8.00 Time . Storm & Rain Drain - each additional 100' 32 00 Architect Mobile Home Space 32.00 - Or Mailing Address Suite Commercial Badc Flow Prevention Device or Anti- 32.00 • _ Pollution Device Engineer City/Stale Zip Phone Residential Bachflow Prevention Device' 18.00 (irrigation timing devices require a separate Describe work to be done: restricted energy permit.) New 0 Repair 0 Replace with like kind: Yes O No O Any Trap or Waste Not Connected to a Fixture 11.50 Residential • Commercial 0 - Catch Basin 11.50 - Additional description of work: Cohn n Q ct W Ct+eg, S'Q,¢ P I1C Q, - insp. of Existing Plumbing 50.00 +c) MQw 11 Lc) cctfrO, 4C/ft- c l _ perihr Are you capping, moving or replacing arty fixtures Specially Requested inspections 50.00 Yes 0 No 0 per/ r h Drain. single family dwelling 45.00 0 If yes, see back of tot to Indicate work performed by Grease Traps , 1 1.50 . fixture. FAILURE TO ACCURATELY REPORT FIXTURE WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL s Via: , ±: I hereby acknowledge that I have read this application, that the information Isometric or riser diagram to required if Quantity Total is > 9 1•' , - �;'a - given Iplans submitted In compliance with Oregon State Laws. Laws caner, and 'SUBTOTAL rtkv fi r: f ,. .. a I _ , _��! =kilt a Signature of Owner /Agent Date SURCHARGE 3=iG" ° � - umili Contact Person Name II�r / /- - o°fY -- `�� "PLAN REVIEW 25% OF SUBTOTAL _ t ^� / it 6+o Phone 25% h �l! n r' / [ VIE , . q di h S i{/3' Required only it adrre total is > 9 2 t_ "� ' - f ' ... • .- , 1 1 5 : y Te mr , i t r• ; ,3 } 1 �` F nr'1 : r,' TOTA { i l � y " _ � ° /- ge `, �' ` J " 1 r � i �� t F t L , 1t 1 •Minimum permit fee Is $50 + 5% surcharge, except Residential Badcfl { i , i 1, 1 i ' f ' }' Prevention Device, which Is $25 + 5% surchar e "All New Commercial Buildings require plans with Isometric or riser • agram and plan review • L>dalsVorrn•lplurnapp doc 6/2179 CITY OF TIGARD BUILDING INSPECTION DIVISION MST 24 -Hour Inspection Line: \ 639 -4175 Business Line: 639 -4171 \ BUP Date Requested l \Ck AM PM BLD Location_ j 6 (o Suite ME Contact Person Ph 6 '7 3— � ,� LM 19 9 Do 3 Contractor Ph SWR BUILDING Tenant/Owner V 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 T FAIL <P'CUMBING ost t -earn Under Slab • Top Out Sanitary Sewer Rain Drains • Fib� SPA f , • 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 % � Other Date Inspector ' y ' Ext Final PASS PART FAIL DO OT REMOVE this inspection record from the job site.