Permit CITY TIGARD PLUMBING PERMIT
PERMIT #: PLM1999 -00381
� �i� A DEVELOPMENT SERVICES DATE ISSUED:
' 13125 SW Ha Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12320 SW TIEDEMAN AVE PARCEL: 2S103AA -01906
SUBDIVISION: COTTONWOOD PLACE ZONING: R -4.5
BLOCK: LOT: 009 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
MARTIN, RICHARD E .
12320 SW TIEDEMAN AVE
TIGARD, OR 97223 Total
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 •
ORIGINAt
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 copi f these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: Permittee Signature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
i
CITY OF TIGARD Plumbing Permit Application Plan Check it
13125 SW I iALL BLVD. Commercial and Residential Recd By
TIGARD, OR 97223 Date Recd I l (1 9
(603) 639 -4171 Date to P.E.
Print or Type Date to DST
Incomplete or illegible applications will not be accepted Permits -U o3cP/
Related S R •
' Called
• Name of DevelopmenuPro)ect 1 : JXT • ;,,; . E liij ' u -1l 'r e,. yu A,,• -w atrt. r -•? ' ,3 '
Job Sink 11.50
Address Street Address , . Suite Lavatory - 11.60
- L1 -2 -0 SwTe Tub or Tub /Shower Comb. 11.50 •
Bldg* CAStalo Zip Shower Only 11.50
• l 1 r1 'I 1 ( a R Water Closet 11.50
Name -
A" f 2 .
^ of a:+ l -� Dishwasher -- .11.50
Owner Mailing Address Suite Garbage Disposal • 11.50
Washing Machine 4 11.50
City /Stale Zip Phone
Floor DrainlFloor Sink 2' 11.50 '
Name 3" 11.50
4' 11.50
• Occupant Mailing Address Suite Water Heater O conversion 0 like kind 11.50
Gas piping requires a separate mechanical permit.
City /Slate Zip Phone Laundry Room Tray - 11.30 •
Urinal ' 11.50 4
Name 0 t y .
q 6G R_ il l /' Z lit /42 1 Ac O t her Fixtures (Specify) 15.00
. Contractor Meiling Add' .,s Suite of
(o. B ok 65 _
Prior lo permit City /Slate Zip Phone Sewer - 1s1 100' 38.00 '
issuance, a copy Tin c ? q 4 Q6 Z 692 -H ii q Sewer - each additional 100' . 32.00
of all licenses arc Oregon Const. Cont. Board Lic.f Exp. Dale _
required U O T 1 S '. )Z i /ii g Water Service - let 100' I 38.00 3 s?o 0
expired in COT Plumbing 1.1c. 0 Ex . (, 4 ,/ Water Service - each additional 200' • 32.00
database 3 t - I . PC 1 9 3 1 � 00 1 Storm & Rain Drain - 1st 100' - 38.00
Name II (r I . Storm & Rain Drain = each additional 100' 32.00 •
Architect Mobile Home Space 32.00 I
or - Mailing Address ' Suite Commercial Back Flow Prevention Device or Anti- -t 32.00
• Pollution Device '
Engineer city/State Zip Phone Residential Backflow Prevention Device' 19.00
(Irrigation liming 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 •
Addillonal description of work: Cl a Gl 1 (zUll - Fax ,rQ,fl- IL ft.. . of Existing Plumbing A 60.00
+c) f1 Q W M2'lR, Lo egtr o n -Fig- c 11 y , . per/hr
Are you capping, moving or replacing any fixtures? Specially Requested Inspedlons 50.00
per/hr
Yes 0 No 0 Rain Drain, single family dwelling 45.00
If yes, see back of form to indicate work performed by Grease Traps - 11.50 `
. fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESUI.T IN IiICREASED SEWER FEES. QUANTITY TOTAL ' Rgo • n '':
I hereby acknowledge that l have read this application, that the Information Isometric or riser diagram la required t Quantity Totally > 9 ° _r .g '�
given correct, that I am the owner or authorized agent of the owner, and 'SUBTOTAL t y ; t(t p lIg j • "' 50 >t
- that plans submitted are in compliance Oregon Stale Laws. f . ,u. - .II_
Signature of Owner/Agent � �I� Qn �� y Date g SURCHARGE '3`il - t , p �G ._ -
Contact Person Name .• a i �r:: -J1 •r=
P hone r.._.,
n !
PLAN REVIEW 23 25% OF SUBTOTAL : ., 1 _ :�� �� .�:.. 1. �_
(.v /`� • a 602. r , t p q Z ' z { 13q Required only if 11'4uro qty. rota) Is 9 ir . ; & �! ; , + .. 4'
r 11 f. , i i i,�- ... r? := q .' ; j� , -rt i t �' , ` r '' TOTAL i _ ' = , .
4.:, > r , ° =. 1 fi x; • { f 4 f - • :"-:',,..:7., : rif,;. Minimum perm
it reo Is $50 + 595 surcharge, except Residential Backfl • . "'T 2- � n• n ,; 1 ' t ' i t # 4 , ' i . i:'. • . '' - � �' ft Prevention Device. which Is 525 + 5% surcharge
45 1�;� �r t .., • t ! ,-� I Q' € ' t :' :n:' "All Ilaw Commercial Buildings require plans with isometric or riser din • m
�l and plan review
•
Lhdatsvonastplumapp.doc 6/2/79 •
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CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 6394175 Business Line: 639 -4171
BUP
Date Requested />/ 3k' AM / PM BLD
Location /../-3c2-6 .5 t) 7 e Suite MEC
Contact Person I hi/ ■_■-dt l A2, Ph 0 4'l 3, PLM (qQ — 00 3f /
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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
To I . : sanar. t.
at
Sanitary Sewer
rains
'tom 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
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
Approach /Sidewalk n ,, 5
Other Date 2 I 1 Inspector `)/2 Ext_ L'
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site. .