Permit rf.`:
A CITY OF TIGARD PLUMBING PERMIT
� DEVELOPMENT SERVICES
PERMIT #: 6/7/00 000186
r�'ll 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/7/00
SITE ADDRESS: 10585 SW WALNUT ST PARCEL: 2S103AA 01901
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 004 JURISDICTION: TIG
CLASS OF WORK: OTR 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: 100 ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Connect of existing single family residence to newly installed sewer lateral. No reverse plumbing.
Reimbursement fee paid.
FEES
Owner:
Type By Date Amount Receipt
HELMER, GARRY L BARBARA S PRMT DEB 6/7/00 $50.00 0002772
10585 SW WALNUT 5PCT DEB 6/7/00 $4.00 0002772
TIGARD, OR 97223
Total $54.00
Phone 1:
Contractor:
TED MCBEE EXCAVATING INC
11428 NE SCHUYLER
PORTLAND, OR 97220 REQUIRED INSPECTIONS
Phone 1: 939 -5246 Sewer Inspection
Reg #: LIC 110314 Final Inspection
Q/
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 opies of these rules or direct questions to OUNC by calling (503)246 -1987.
Issued B /7� -��'Z Permittee Signature: x ��
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
CITY TIGARD Plumbing Permit Application Plan eck#
13125 SW HALL BLVD. Commercial and Residential Recd
TIGARD, OR 97223 Date Rec'd Co - ?-00
(503) 639 -4171 Date to P.E.
Print or Type Date to D
Incomplete or illegible applications will not be accepted Permit # GN -einlgj
Related SWR # elfrO db/ 2„3,
Called
Name of Development/Project FIXTURES (individual) QTY PRICE AMT
Job Sink 11.50
Address Street Address ,' 1 ,\ Suite Lavatory 11.50
I 9 4 g5 5 UJ 1 V6 Tub or Tub /Shower Comb. 11.50
Bldg # CiCity /Sta a Zip Shower Only 11.50
Name
` % Or- Water Closet 11.50
(")S e t . L) N VNN Urinal . 11.50
Owner Mailing Address RR Suite Dishwasher 11.50
W 9 54 IJ S u.P Garbage Disposal 11.50
City/ State Zip Phone
Washing Tray 11.50
Na
Na Washinshin g Machine /Laundry Tray 11.50
Floor Drain/Floor Sink 2" 11.50
Occupant Mailing Address Suite 3" 11.50
4" 11.50
City /State Zip Phone
p Water Heater 0 conversion 0 like kind 11.50
Nae (► r(� � (,Ltf- 05 /1Jd Gas piping requires a separate mechanical permit.
T _ m - y .Srr: 9 INC-. - • • N MFG Home New Water Service 32.00
Contractor Mailing Address / Vg. 6.. / �tJ� MFG Home New San/Storm Sewer 32.00
o /V-1-- _ k�
, TN-
[ It Hose Bibs 11.50
Prior to permit Ci tate p ( Phone Roof Drains 11.50
issuance, a copy � r i/ � 7a-.� u � �C
Drinking Fountain 11.50
of all licenses are Oregon ons Cont. Board Lic.# Exp Dare
required if 4/9 9 i ) t--56 4 ' )/ Other Fixtures (Specify) 15.00
expired in COT Plumbing Lic. # Exp. Date
database , -31-) 6 P13 l() g /-g/
Name
Architect Sewer- 1st 100' I 38.00 350t
Or Mailing Address Suite Sewer - each additional 100' 32.00
Water Service - 1st 100' 38.00
Engineer City /State Zip Phone
Water Service - each additional 200' 32.00
Describe work to be done: Storm & Rain Drain - 1st 100' 38.00
New 0 Repair 0 Replace with like kind: Yes 0 No 0 Storm & Rain Drain - each additional 100' 32.00
Residential }B( Commercial 0
Additional description of work: Commercial Back Flow Prevention Device 32.00
\
/� Residential Backflow Prevention Device' 19.00
�OY1(n4 ( � C I4 Ss ui t. Catch Basin 11.50
Are you capping, moving or y eplacing any fixtures? Insp. of Existin PIu(r!bin or Spe¢N ly Req ste 50.00 60
Yes 0 No 0 Inspections sing e 7LU Ftniao per/hr �J�
If yes, see back of form to indicate work performed by Rain Drain, singe family dwelling 45.00
fixture. FAILURE TO ACCURATELY REPORT FIXTURE Grease Traps 11.50
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL
I hereby acknowledge that I have read this application, that the information Isometric or nser diagram is required if Quantity Total is > 9
given is correct, that I am the owner or authorized agent of the owner, and *SUBTOTAL b Q that plans submitted are in compliance with Oregon State Laws.
SI re of Owner/Age Date
0 NR - b- et at 6 _ 0 ? _0D 8% SURCHARGE , O1/
Contact Person Name Phone r
4 k`g-- 99 �^.2c "PLAN REVIEW 25% OF SUBTOTAL -
a I, OUSE 1� ° a ;$4 ,' . m Required only if fixture qty. total is > 9 TOTAL 9s °/
= f ." OU 250 , . .. . .=_ . d
L O , 285.00 1 1 ' t:4,,,.7:- :
0 - ncludes u mbin g xtures n r e dwell n and the first s " *Minimum permit fee is $50 + 8% surcharge, except Residential Backflow Prevention
00 feet of sa %- / sewer lie e'+ a d .sere ce . Device, which is $25 + 8% surcharge
"A11 New Com mercial Buildings require plans with Isometric or riser diagram and
Trfa
r plan review.
I \dsts \forms\plumapp doc 11118t99 /. � X4 40 4 4
019 V
PLEASE COMPLETE:
Fixture Type Quantity by Work Performed
New Moved I Replaced Removed /Capped
Sink
Lavatory
Tub or Tub /Shower Combination
Shower Only
Water Closet
Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray
Washing Machine
Floor Drain /Floor Sink 2"
3"
4"
Water Heater
Other Fixtures (Specify)
•
COMMENTS REGARDING ABOVE:
I tdstsVorms\plumopp doc 11/18/99
1, I invoice
JAMES GIIIF I'I'IIS EXCAVATING. INC.
N ,2�' - / F Date -� 3 `" Ca O
Addres- ei • 4i. 24 ,i4 -. Sri Phon 9 -3 9 ='� q 1-
Cit - Initial Terms On Acct.
State O Zip Code ' '`K 6 s
Price Amount i
...�adYyY / ,
M . r__ __ _._ , __ ,.- . _._____._..
n, 7-el5
, \
* NOT RESPONSIBLE FOR LANDSCAPING
*A service charge of 1 1/2% per month will be charged on all past due accounts.
A fee of $10.00 will be charged on all returned checks. Not responsible for attorneys fees.
Total. 25 °�'°
Approval
By:
Customer Signature
P.O. Box 1136 •Canby, OR 97013
C CB #104320 (503) 263 -8038 • . Pager (503) 818 -9368 ?unou
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested ( °// (- 1/ 00 AM C (D M BLD
Location (O S D S (A)_Q11,( Jet Suite MEC
Contact Person Ph q9-)q -- 52 PLM Z00
Contractor Ph SWR WOO (O
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
Post & Beam � � C10v`
Under Slab
Top Out
Water Service As
• anitary Sew - ��
Rain P rains /L i
Final
4 PART FAIL
A NICAL
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 r Ext
Final
PASS PART FAIL ° O N • T REMOVE this inspection record from the job site.