Permit ' ►• - -
CITY OF TIGARD PLUMBING PERMIT
PERMIT #: PLM1999 -00384
j 1 k DEVELOPMENT SERVICES DA TE ISSUED:
�= 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 10620 SW WALNUT ST PARCEL: 2S1026C -02005
• 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
FRISBIE, OWEN P JR AND
ROXANNEL
10620 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 copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: / Permittee Signature: OA/
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 8
13125 SW I IALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date Recd
(603) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit F(,wl lfgl -oo 3,q
Related SWR
Caned
Name of DevelopmenUProJed 1 t g � f - 2
Job Sink 11.50
Address Street Address , Lavatory 1 1.50
6Z
[a a 5 W G i &V Tub or Tub /Shower Comb. 11.50
Bldg aZ Cily/Slato Zip .
�r Shower Only 11.50
Name ` r � Water Closet 11.60
121 cd l . 1 Q 1 Dishwasher 11.50
Owner Mailing Address / ' Suite Garbage Disposal 11.50
Washing Machine 11.50
CitylSlale Zip Phone Floor Drain/Floor Sink 2" 11.50
Name 3" - 11.50
4' 11.50
Occupant Mailing Address Suite Water Heater 0 conversion 0 like Mod 11.50
_ Gas pipinj requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray ' 1 1.50 •
Name L Urinal . 11.50
iC AY 60 Qh n 1 S i'I II ahb int � , Other Fixtures (Specify) 1500
Contractor Mailing Addicts Suite (J
Po. 60k 67
Prior to permit City/Slate Zip Phone Sewer - 1st 100' 38.00
issuance, a copy Tt , 9 Lccf-, i, q lO6 Z 612,- Li 9 ,
Sewer -each additional 100' 32.00
of all licenses are Oregon Const. Cord. Board Licit Exp Date _
required If e f P S Z 11 �y !, Water Service - 151100' 1 38.00 38:6 0
expired In COT Plumbing I.ic. a Exp. [Late Water Service - each additional 200' 32.00
L/
database 3 - / 6‘ P 8 Storm & Rain Drain - 1st 100' ' 3 8.00 '
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/State Zip Phone Residential Backflow Prevention Device' 18.00
(Irrigation timing devices require a separate
Describe work to be donor 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 0 Commercial 0 _ Catch Basin 11.50 •
Additional description of work: ce,.. no a wq fuz s-efr -y t>r /L, insp. of Existing Plumbing 60.00
pfd n it to 1142111Z Ld Cgt 0 n 'Fc C 11 ¥ , perlhr
Are you capping, moving or replacing arty fixtures Specially Requested Ins •
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 TOTAL ^ Fr i'�t '" `
I hereby acknowledge brat I have read this application, that tine information Isometric or riser diagram ram is required if Quantity Total is > e u dk " 3, " 1 f
given Is correct, that I am tine owner or authorized agent of the owner, and •SUBTOTAL ";E t 't ; -" w
__t plans submitted are in compliance with Oregon State Laws. _ :5 ' ti _- ��° __ - •
Signature of Owner /A 9 Data
Owner/Agent + ' y
I 12 URCHARGE `i1 :: l 1 : . o ,
iv- e • '`I.
Contact Person N a ,_ Phone • 'PLAN REVIEW 25% OF SUBTOTAL �t1: 'n ' 1: ' 9 t
,bp N' d q t - f /3 Required only if tbdure . total is > 9 ° j 3 * N ^'
'77.1:r. Li A - .. s s -
• I ti'1j ' ;p1.7 f ; � f -T r,' 1- a �F TOTAL '
,;' J �. ' 3r f 7 ,,� 6 . 3 E _ , r # ,: 1t� l > i`, •Minimum permit feels $50 + 5% surcharge, except Residential Baddtow
i ) � � , I i 7 , u 1 € f 1 4 F ��f z _ Prevention Device, which is $25 + 5% surcharge � �', ) /
I • by ` - 'n . - •r C. ` • '1' . irj1_� i '� 1 1_' i fP, } .,,tt` "All New Commercial Buildings require plans with isometric or riser diagram
and plan review
•
•
1.1ds1aVorinslplumapp doc 612/09
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CITY OF TIGARD BUILDING. INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 .
' BUP
Date Requested (
I AM PM BLD
Location Lb (.0 `a--0 ( � S" -Suite MEC
Contact Person Ph qi PLM col °(, °I O d 334
Contractor Ph SWR
BUILDING Tenant/Owner ELC .
Retaining Wall E LR
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 ART FAIL
itCUM0 i .
Post & Beam ( rtil
Under Slab
Top Out -
OrLL�i`1a
Sanitary Sewer • „,�
Rain Drains
Fl...- ..'
A$$ PART FAIL
M CHANICAL
Post & Beam
Rough In
Gas Line '� , ,b
Smoke Dampers i
Final - ,
• PASS PART FAIL r
ELECTRICAL -
Service •
Rough In i
UG /Slab -
Low Voltage I
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 [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
Fire Supply Line
ADA /
Approach /Sidewalk Date kg Inspector % 1 / !� Ext
Other
Final ” i !
PASS PART FAIL ' _ DO OT REMOVE this inspection s reird from the job site. / .