Permit CITY TIGARD PLUMBING PERMIT
�,� y; PERMIT #: PLM1999 -00383
� DEVELOPMENT SERVICES DATE ISSUED:
`' 13125 SW Hall Blvd., Tigard, OR 97 (503) 639 -4171
SITE ADDRESS: 10640 SW WALNUT ST PARCEL: 2S1026C -02002
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
OLSEN, KENNETH E
OLSEN, SANDRA L
10640 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: "yy( 6.+:,
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
ChY OF TIGARD Plumbing Permit Application Plan Check 9
13125 SW I TALL BLVD. Corrlrnercial and Residential Reo'd By
TIGARD, OR 97223 Date Recd II 1 y y
(603) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permit* Pt-i4/ /Y94-00
Related SWR il
Caned
Name of DevelopmenUrrojed iF IME.1��.1. , ��i 71 11F1
Job Sink 11.50
Address Street Address i _ / Suite Lavatory 11.50
1 o 6 0 SW 4 ` h ot Tub or Tub /Shower Comb. 11.50
Bldg 8 1 City/Slate A Zip Shower Only 11.50
-rl, „, ad Water Closet 11.50
Name -
6 L ` Kkvi vi /- f ( Dishwasher 11.50
Owner Mailing Address Suite Garbage Disposal • 11.50
Washing Machine 11.50
City/Slate 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 kind 11.50
_- Gas piping requires a separate mechanical permit.
City /State Zip Phone Laundry Room Tray 11.50
•
Name LL� P. Urinal 11.50
(A 66 Qh S /' Z IA Alb 1 f1 i Ocher Fixtures (Specify) 15.00
. Contractor M iling Addicts Suite �
P.0. 0 ok 6
Prior to permit City/Stale Zip Phone Sewer - 1st 100' 38.00
Issuance. a copy 'r r, Lc i_ ti 4062- 672. - 09 Sewer - each additional 100' 32.00
of all licenses aro Oregon Const. Cord. Board Lid 8 Exp Date /�� _
required if e f P 5 Z j2 / (r. /q q d ` Water Service - 1st 100' I 38.00 3 e 0
expired In COT Plumbing tic 9 Exp. ate ' �c�� Water Service - each additional 200' 32.00
database 3 C/_/ 6 6 P 8 1 15 I J)._$ Storm & 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 Badc Flow Prevention Device or Anti- 32.00
• Pollution Device
Engineer City/Stalo 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 IIII 11.50
Residential • Commercial 0 Catch Basin 11.50 •
Additional description of work: e-oun R 0 Ct wq-ht. S€R IL Q..
insp. of Existing Plumbing 50.00
fd AQw A4.4÷41... 1 .+PIL c r-4. , perAv
•
Are you capping, moving or replacing any fixtures? Specially Requested inspections 50.00
• erlhv
Yes 0 No 0 Rain Drain, single family dwelling 45.00
If yes, see back of lot in to Indicate work performed by Grease Traps 11.50
. fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL ?p7
'L`_' 21 ''F 'i
I hereby acknowledge that I have read this application, that the information ., ,'_.;, -
Y 9 PP Is ometric Of daer dia, ram la re • aired if Quantity Total i4 > 9 • '�u'ti =, •� ,,.y.. , �=
given is correct, that I am the owner or authorized agent of the owner, and . e 1., '
SUBTOTAL +rr'; _ a �
_ that plans submitted are in compliance with Oregon State Laws. }'�!� `�, s ", II •
' Signature of Owner /Agent r Data ' ._,
8 ,8�6 SURCHARGE '�I� e r • "sue r
Contact Person Name Phone "PLAN REVIEW 25% OF SUBTOTAL psi' �c. •. ,g` k '''i -;' -''
<';. 4 .
1/�/A /� 6 # Re•uired d lhdtae totall:> 1 � �' +'�
1' , .
u t Tom"- - °'uT x -r=r - - ->�
e IL ' , : fi , t , TOTAL x'F�e i `�
t r I o � ,rl i ? , Y -,�,. 5, rE } a �I t } {I t yIiut i - i,,, vo
f. _ 11 1 ti 1 . r .1..- " � . '
t
N ; • , o`pi,' I 0,0014 ,1- _ �I{ vici- # ' -- ,1: x f. �', 'Minimum permit fee Is $50 + 5% Surcharge, except Residential Ba 'ow
U.1 r' ,i. „ t . , A ;1 i x , a, €if c : Prevention Device. which Is $25 + 5 °,6 surcharge
•� g - ?r `'AA i ,' a, lilt ,;h�, ° _.,Yi , , ' ;,: r 1 ,,: ;� "All New Commercial Buildings require plans with Isometric or riser diagram
and plan review
1.1d3lsvonws tumapp doc 612199
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection, Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 1 ( I1 AM PM BLD R`'\
Location ) () (9 L t 1) Le-) St Suite MEC
Contact Person • `" Ph Co ?a 4 (3y' PLM 19 of 9, Qc 3
Contractor A ' 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 rPAkT FAIL
<P1UMBINC,
Posteam
Under Slab
Top Out
mater Se
Sanitary Sewer
RR ' Drains
4' !` PART FAIL
MECHANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
. ELECTRICAL
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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 Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA t%
n0q # . 1
Approach /Sidewalk Date \\ \ I Inspector Ext _
Other
Final 1 •
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.