Permit (4) 1 '
AR CITY OF TIGARD PLUMBING PERMIT
�� DEVELOPMENT SERVICES PLUMBING
PLM2001 -00280
` 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 6/29/01
SITE ADDRESS: 09710 SW TIGARD ST PARCEL: 2S102BA -00600
SUBDIVISION: NO.TIGARDVILLE ADDITION AMEND. ZONING: I -P
BLOCK: LOT: 059 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Backflow preventer.
at FEES
Owner:
Type By Date Amount Receipt
MULL, GREGORY S AND PRMT CTR 6/29/01 $72.50 27200100000
GEORGE E 5PCT CTR 6/29/01 $5.80 27200100000
19350
19350 SW POMONA DR
BEAVERTON, OR 97007 Total $78.30
Phonerl:
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 503 - 692 -4139 Final Inspection
Reg #: LIC 87852
PLM 34 -166PB
J 'i ._
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:,-,(C l --- Pe Signature: / � I
•
C I (503) 639 -4175 by 7:00 P.M. for an inspection needed e next business day
10 %13%00 FRI 10:48 FAX 503 598 1960 CITY OF TICARD RI 002
Plumbing Permit Application _ . , ,
e Date received: A _ o f Permit no.: i jn 0,0/ - aD t..yiy, City of Tigard Sewer permit no.: Building permit no.:
- -" Address: 13125 SW Hall Blvd, Tigard, OR
City of Tigard Phone: (503) 639 -4171 Project/appl. no.: Expire date:
Fax: (503) 598 -1960 Date issued: i n! %i Receipt no.:
Land use approval: Case file no.: Payment type:
TYPE OF PELRMLT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial 0 Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service Other: &.K.r L J
JOB SITE INFORMATION FEE SCIIFDULE (for special {uforn aliou use checklist)
Job address: q7 lo SL,.J -- rirE t ILO sr, Description Qty. Fee(ea.) Total
Bldg. no.: I Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: (Block: I Subdivision: SFR (2) bath
Project name: k,a9T..L.La!MATT£ •J_ TIC SFR (3) bath
City /county: T .Ae,Q I ZIP: Each additional bath/kitchen
Description and location of work on premises: 64-e.< 4. j Site utilities:
ree reLEGA-c ev4 Q ANA. -rE14. Catch basin/area drain
Est. date of completion/inspection: _Drywells/leach line /trench drain
PLUMBING CONTRACTOR Footing drain (no. lin. ft.)
Manufactured home utilities
Business name: . :. 0 ' Manholes
Address: I , 0, : OX Fig Rain drain connector
City: 4 q14 4. 7 . 1mA t I State:041 ZIP: ?7d6 Sanitary sewer (no. lin. ft.)
Phone: Fax: Storm sewer (no. lin. ft.)
X3,64 y139 I 5ar 6g(�E - mail:
CCB no.: gnS2, I Plumb. bus. reg. no: 3y // Water service (no. lin. ft.)
City /metro lic. no.: J gp,., _ Fixture or item:
Absorption valve
Contractor's representative signature: _,.. , I Back flow preventer
I
Print name: �+L Date: _ _, . 01 Backwater valve
CONTACT PERSON Basins /lavatory
Name: J_ I 14TrgAroAl Clothes washe
Address: oitQk A 9
Dishwasher •
y u AL AI , I Dj&l 97062 Ejectors/sump
fountain(s)
City: „� Sta ZIP: Ejectors /sump
Phone: Fax:g Z E -mail: Expansion tank ,
Fixture /sewer cap
Floor drains /floor sinks/hub
Name (print): Garbage disposal
Mailing address: Hose bibb
City: [State: I ZIP: Ice maker
Phone: 'Fax: 1E-mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Ptimer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as per ORS Chapter 447. Sink(s), basin(s), lays(s)
Ownet's signature: Date: Sump
Tubs /shower /shower pan
Urinal
Name: Water closet
Address: Water heater
City: I State: I ZIP: Other:
Phone: I Fax: I E -mail: Total
' Not all jurisdictions accept credit cards, please call jurisdiction for more information.' Notice: This permit application Minimum fee $ T .
t] Visa ❑ MasterCard Plan review (at expires if a permit is not obtained _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ Sr gO
Expires TOTAL $ _144,3_0_
Name of cardholder as shown on credit card accepted as complete.
$_
Cnrdholdcr signature Amount 440 -4616 (61OO /COM)
llo�
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested 7'3 AM PM BLD
Location D 9 7/G S(A/ / if vd St' Suite MEC
Contact Person Ph OZ - (7 / 3 7 PLM mod/ - tea 2 E 0
Contractor 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 /)TPrOVr C� C/ e4rGc. c -t Q O es -e 4i c
Drywall Nailing
Insulation / '
Drywal �) ��O f�/ 7 V ^� C! fa il ( c"�. (> a tP -e�
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLU
Post & Beam
Under Slab &We T fad
Top Out /
•
Water Service
Sanitary Sewer
Rain Drains '
. % S - ART FAIL
��� ICAL
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 — 2 — . 3 r� Inspector s (/ L �'lke ' E
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.