Permit CITY OF TIGARD
PLUMBING PERMIT
xtatwo DEVELOPMENT SERVICES PERMIT #: PLM1999 -00390
r fil 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 11/18/1999
SITE ADDRESS: 10675 SW TIEDEMAN AVE PARCEL: 2S103AA -01904
SUBDIVISION: COTTONWOOD PLACE ZONING: R-4.5
BLOCK: LOT: 007 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
MARTINI, ROBERT C AND
VIRGINIA M
10675 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
Final Inspection
Reg #: LIC 000878•
PLM 34 -166PB
1R\G\tL
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: '1-vvq
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
•
CITY TIGARD Plumbing Permit Application • Plan Check it .
13125 SW I TALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date Recd
•
(503) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permn lei 9 "0038
Related t WR $
Called
• Name of Development/Pulled 1 4/XT In N.; I "- = ;EC,.' : ; ; _ •aft l's * r o r FTP'1•.
Job Sink 11.50
Address Street Address Tr i h Suite Lavatory 11.50
. O 6 E' .5 Wan Tub or Tub /Shower Comb. 11.50 •
Bldg # I City /Sla.tto Zip Shower Only • 11.50
-1-\ I_/ G Water Closet - 1 1.50
Name RA
IA
Ma I QT� A I Dishwasher _ . 11.50
Owner Mailing Address Suite Garbage Disposal • 11.50
Washing Machine 11.50
City/Slate Zip Phone . 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 ' 1 1.50 •
• - Urinal 11.50
Name n s Other Fixtures (Specify) 15.00
Contractor Mailing Addicts
Po ' Suite
Bo, 5
Prior to permit City /Slate Zip Phone Sewer -1st 100' 38.00
issuance, a copy Tt , el Lei l r i- y 446"7._ 67z -NC 9 Sewer -each additional 100' 3 2.00
of all licenses aro Oregon Const. Cont. Board Llc.i Exp. Date -
required if e : 6 S Z l'2 /� /q q Water Service - 1st 100' I 38.00 38',6 0
expired In COT Plumbing t.ic. x Exp. (late Water Service - each additional 200' • 32.00
database 13L1-/6‘t Storm 8 Rain Drain -1st 100' - 38.00
Name Storm & Rain Drain =each additional 100' 32.00
Architect Mobile Home Space 32.00
Or Malting Address Suite Commercial Back Flow Prevention Device or Anti- _ 32.00
• Pollution Device
Engineer CityISlate 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 11:50
Residential • Commercial 0 Catch Basin 11.50
Additional description of work: Cow, n p a Gu4+%tt se9' ' leg, Insp, of Existing Plumbing 60.00
'1"O A e LA/ M2'fi4tt_ La ccit 0.^ 4<,R, c r -f v , per/hr
Are you capping, moving or replacing an fixtures? Specially Requested Ins 50.00
perai r/ttr
Yes 0 No 0 Rain Drain, single family dwelling 45.00
If yes, see back of fotin to Indicate work performed by -
Grease Traps 11.50
. . fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL tl v ram Is required if Quantity Total is s. 9 :T _ s; y O ..t.& ti
_
I hereby acknowledge that I have read this application, that the information Isometric or riser die re Qua ' • '` ' "kt
_ :ir� :,.
given Is carved, that I ant the owner or authorized agent of the owner, and 'SUBTOTAL. j �°I >r `11� 7 � ', _'
that 0 Owner/Agent submitted are in compliance with Oregon State Laws. Bate
S� t
Signature of Owner/A ent +l'
.
t CtA ^4--- � L t /l /99 SURCHARG g i =r.� .. 0 Contact Person ame Phone •• e =51! r��-
n PLAN REVIEW 2S /e OF SUBTOTAL : � � I�` �:
+vA r-� / i(o bot -in's y Required on d Ihlure . . total is > '= - .7 .
,: ; :.: ,
Ill I,�-z. j. :r:' i :. TOTAL aiiI.- :,;i•., " u
„ ; " � �, ..,1,:i::.
x r } ! 3 � Minimum permit fee Is $50 + 6% surcharge, except Residential Be
{{f b d �1 ip,) ti r _ ti ; i � ! V ,• _ Prevention Device, which Is $25 + 5% surcharge me
'.'1 t' �sl4' . t 1 lt r f i e r l , { tttralai , �.. ,, IN -All New Commercial Buildings require plans with Isometric or riser diagram
and plan review
•
LldyteVonnslplumapp.doc 617179
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
1/ BUP
Date Requested /d/3 / AM PM BLD
Location /0 (0 15 5J �CQ Ate-' Suite Suite MEC
Contact Person K 1�1NYl S i L,fl ht - '
/ a — `
Ph eO '9/l 39 PLM l� 9 /-CD 33.6' Contractor (J 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 PART FAIL
PLUMBING
Post & Beam
Under Slab
To
Water Servi
anifary Sewer
g R • ' Drains
i
S PART FAIL
C HANICAL
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 P- _ Inspector 111 Ex
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.