10710 SW FAIRHAVEN WAY 0
y
J
0
Sn
L
D
TN
i
D
C
m
z
n
i
i
10710 SW FAIRHAVEN WAY
CITYOF TI OA RD PLUMBING PERMIT
GEVELOPMFNT SERVICES PERMIT#: PLM2003-00309
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171 DATE ISSUED: 6/27/03
SITE ADDRESS: 10710 SW FAIRHAVEN WAY PARCEL: 2S103DD-00433
SUBDIVISION: FAIRHAVEN COURT ZONING: R-3.5
BLOCK: LOT: 005 JURISDICTION: OG
CLASS OF WORK: REP GARBAGE LP670SALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PRE`/NTRS:
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: 55 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Replace 55' of water service.
�— _FEES
Owner:
��— Description Date Amount
CHAMBERLAIN, JOHN A AND
DEBRA A (1'LUM13l Permit Fee 6/27103 $72.50
10710 SW FAIRHAVEN WAY [TAXI ti tiurtc'Tax 6/27103 $5.80
TIGARD, OR 97223 Total $78.30
Phone :
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN. OR 97062 REQUIRED INSPECTIONS
Phone : �1t3-692-4130 Water Service Inap
Final Inspection
Reg#: MET O()()()1806
LIC 87852
I'LM 34-166PB
This permit is issued subject to the regulations contained in the Tigard Municipal Cone, 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 Susperaac:
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Issued By: ��1 f + .�'i Permittee Signature:
Call (503) 6394175 by 7:00 P.M. for w ;nspection needed the next business day
i
Plumbing Permit Application —
Date received: Lo Permit no.: __--
City of Tigard Sewer Permit No. - Building Permit No
13125 SW I full Blvd. I'igurd,UR 97223 I Proiect/Appl.No. Gxpirc Date
Phone:503 639-4171.Fax 503 598-1960 I Dale.issued By Receipt No.
Land Ilse Approval Case File No, Payment Type
U 1 &2 family dwelling or access<nv U Comrnereial/industrial U Multi-family U Tenant imptt,vcrncnt
U New construction Add ition/alteration/repla �•mct U Food service U lhhcr:
.lois address: 10710 SW I-airhaveu Way Di-scription tlty Fee r oral
Bldg. No.: New 1&2 family dwelling only:/+ 11H)ft
Soitc no.: SFR(1)Bath $249.20
Tar map/tax lot/account no.: SFR(2)Bath 5350
Lot: Block. Subdivision : _ SFR(3)Bath S3+9
Bach additional hath/kitchen S
Project name: Chamberlain Site utilities:Catch basin/area drain $1600
City/county: Tigard /,ip 97 J2; Dry wells/leach line/trench drain $
Description and Location of work. Nett' Waterservice footing drain(no.Lin.A) S
Manufactured Home utilities.each S4040
Date of Conipletion/inspection Manholes S
lif Rain drain connector S
.Sanitary Sewer(no,of fincar feet) 100, hS5 00
Business name : RAYBORN'S PLUMBING Storm Sewer (no.of linear feet)Io()' 855 tut
Address : P.O. BOX 69 Water Service (no.of lin.:ry feet)I(X)'(35') I 855 n0 S
Citi : TUALATIN State: OR Zip: 97062 Fixture or Item
Absorption valve 516.01
Phone : 503 692-4139 Fax : 503 691-2328 14uLk flow prevenlet $27.55
E Mail Address: WaynerrPRaybotns.com Bnckwnter valve 516.60
Basins Lavatory S16M
CCB no. : 878$2 Plumb. Bus. No. : 34-166PB clothes Washer $16.60
City/Metra Lic. No.: 001806 DishNBshcr 516.60
Drinking Fountain(s) S16.60Contractor's signature : (,,,
Ejector/sump $16.60
print name: Wayne Siebol U;nc 3,/27/03 Exppnsiot,Tank 516.6(1 ~—
Fixture/sewer cap S 16 60
Floor drains/floor Rinks/I lub $16.60
Name: Chamberlain Garbage Disposal 816.61)
Address: 10711)SW Fairhaven Way I lose Bibb $16.60
lee maker $16.60
City : Tigard State UR Z,tp: 97223 Interceptor/Grease trap $16.60
Phone : 003)793-8102 Fax Primer $16.60
Roof drain(commercial) $16.60
Sinks(s),Basin(s),I av(s) $16.60
Notice : Thi.;permi',application expires if a permit is not obtained SumP $16.60
«illlin 180 days after it has been accepted as complet: 71d,q'shower'sho%%cr pan $16.61
I lrinal _ S 16.60
Include Fixture fee breakdown sheet. Water Closet $1660
Commercial permits require Scwer Tall sheet Water heater
S 16.611
l)they S 16,60
TOTAL 55
Residential Backflow Minimum Fee$72.50 72 51)
Visa charge on credit card authorization sheet. minimum$36.25. Plan reyriew to 25%
Commercial requires 2 sets of
Iso/riser. State charge .08% 5 tt0
Total 78.30
CITY OF TIGARD 24-Hour
BUILDING Inspection Line: (503)639-4175
MST _
INSPECTION DIVISION Business Line: (503) 639-4171
8UP —
Received _ -____ Date Requested___ ,34' AM —PM _ BUP —
Location — _- lam_ - __. __ Suite------ MEC -.-
Contact Person L_ Ph( ) .1-- PLM s
2 - c
Contractor ____ —.__ ______. Ph( ) — ._ _ SWR
BUILDING Tenant/Owner _ —____ ELC
Footing ELC
Foundation Access:
Ftg Drain `t'i � � �.� ELR
Crawl Drain
Slab InspectiNotes:' SIT
Post& Beam
Shear Anchors
Ext Sheath/Shear --
Int Sheath/Shear
Framing -- - -------- -- -- - ---
Insulation
Drywall Nailing -- ---- --- - _ —.._—
Firewall
Fire Sprinkler -- ---
Fire Alarm
Susp'd Ceiling
Roof
Other
Final
_PASS PART FAIL. —
PLUMBING
Post& Beam
Under Sla --- --- — — ----
Rough Int�2JL
Water Servide ----
Sanitary Sewar
Rain Drains --- -- --
Catch Basin/Manhole _
Storm Drain --
Shower Pan
Other. -
Final M—
PA S PART FAIL
HANICAL - - -
Post& Beam --
Rough-In -- ---
Gas Line
Smoke Dampers —
Final
PASS PART FAIL --
ELECTRICAL
Service
Rough-In ---
UG/Slab
Low Voltage ------- .....
---- --- -
Fire Alarm
Final Reinspection iee of$ --required before next inspection. Pay at City Hall, 13125 SVV Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE:_.__-- -___ _...T `-� Unable to inspect-no access
Fire Supply Line + i^
ADA
Approach/Sidewalk
Date . ' '_ Inspector ` ' ------ Ext
--�-
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL J