Permit CITY TIGARD PLUMBING PERMIT
r� DEVELOPMENT SERVICES PERMIT #: PLM1999 -00386
AV 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED:
SITE ADDRESS: 10540 SW WALNUT ST PARCEL: 2S1026C -02001
SUBDIVISION: NO. TIGARDVILLE ADDITION ZONING: R -4.5
BLOCK: LOT: 024 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
AUER, JULIA A +
EDWARDS, PATRICIA H
10540 SW WALNUT ST 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
Reg #: LIC 000878 Final Inspection
PLM 34 -166PB
ORIGINAL
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: -7 a- 4 - 1 -e-er
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
4
CITY OF TIGARD Plumbing Permit Application Plan Check 8 .
13125 SW 1 IA11 BLVD. Commercial and Residential Recd By r
TIGARD, OR 97223 Date Recd Ii m -
(503) 639 -4171 Date to P.E.
Print or Type Date to DST •
Incomplete or illegible applications will not be accepted Permit f Plyl)(q 4 9 =oo
Related SWR 0
Called
Name of Developmenurroject 4 • _ •°- .. • 7 -.7
Job Sink 11.50
Address LDS Address r- Suite Lavatory 11.60
.LDS Q 5k.° W q ( Tub or Tub /Shower Comb. 11.50 •
Bldg t Cily /Sialo A � Zlp Shower Only 11.50
• Name n Water Closet 11.50 •
-
A 1te.•,2_ Dishwasher 7. . 11.50
O wner Mailing Address J Suite Garbage Disposal • 11.50
Washing Machine 11.50
City/Stale Zip Phone Floor Drain/Floor 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 - 11.50 •
• _ Urinal 11.50
Name A,p /
C't 60 Q h s /' » lq n1 `7 I /1t„ Other Fixtures (Specify) 15.00
Contractor MAiling Addicts Suite V
• (�u. 6o r 6l
Prior to permit Cily /Sl Zip Phone ~ Sewer - 1st 100' 38.00 I
issuance, a copy 71, c c-f-f- r ;, q 106 2 - 671 9 -
of all licenses are Oregon Const. Cont. Board Lic.f Exp. Date Sewer -each additional 100' 32.00
required it e f- fj S Z 11 "f /q q I _Water Service -1st 100' I 38.00 3 tp o
expired In COT Plumbing tic. 0 Exp. [late A Water Service - each additional 200' • 32.00
3 database / - / 611'6 I-31-MY ' Storm & Rain Drain -1st 100' 38.00
flame Slonn 8 Rain Drain , each additional 100' 32.00
Architect . Mobile Home Space 32.00
Or • Mailing Address Suite Commercial Back Flow Prevention Device or Anti- 32.00
Pollution Device
Engineer City /State 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 O Any Trap or Waste Not Connected to a Fixture 11150
Residential • Commercial 0 _ Catch Basin _ 11.50 •
Additional description of work: cow f1 0 of w q R S'Q,R,v lea. Insp. of Existing Plumbing 60.00 -
'1 At w / Lo c q$ 0 n -R c r -t y. per/hr
Are you capping, moving or replacing any fixtures? Specially Requested Inspections 50.00
per/hr
Yes 0 No 0 Rain Drain, single family dwelling 45.00
If yes, see back of totin to indicate work performed by Grease Traps 11.50
. fixture. FAILURE TO ACCURATELY REPORT FIXTURE
WORK COULD RESULT IN INCREASED SEWER FEES. QUANTITY TOTAL 'At 3PF'.'
I hereby acknowledge that I have read this application, that the information Isometric or riser diagram Is required if Quantity Total is i 9 .f ;",t,
given Is corned. that I am the owner or authorized agent of the owner, and . c, e t
SUBTOTAL gILIg,1141?ti ;' SO >t
_ that plans submitted are in compliance with Oreson Stale Laws. _ i__-�, . ii ,�h p�; nature Owner/Agent ent l-
g (..v g � h l � �'
Signature of �Q Date .�URCNARGE �- C :s�'r �C �
'�� 1
C.(')p.CXI / � /q q g i24 x _01 sir §^; V �
n ` ! _1 2 i ••• - k9 , -_ J
Ph no 'PLAN REVIEW 25% OF SUBTOTAL 1 1 f Illr� r�'.,,yyt�i
Contact Perso me I
A / 4, W �.1 3 .. t
G / S 64 z - y � ' Required only it lhdure qty. total is � 9 � =' "` �i;}''s ���
i` _ $ � E � �,, ;�-�. sT' 1.' 7 ` :' ;+ ate,}- ' j _ �-i ; , F TOTAL 7, a
i i X4 5 4.�t - !,,irj�'. -r . ,.
, ! ° y - - i ; I , i� is { h. k.�i 2 : i i v Ip ! }!( L• 0i .. /,u ..
;, ! d i , i h ;; F , r ,: E •Mi nimum permit fee is $50 + 5% surchar e, except Residential Ba ; ow
y �
L .r,r h a � t `j 7 t' _ t i , P 9 P • Fr . II •,, ' T. 1 , ; I •.f , 7• • ' � r ;. ' I R V zzi Prevention Device, which Is 125 s 5 °,6 surcharge
- D b,= - • T ° ; , 7 1 r ! t r ;1 3 '• All New Commercial Buildings require plans with Isometric or risor diagram
and plan review
•
lldshYormslpiumapp.doc 6/2/99 •
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171 • .
BUP
Date Requested ' n b 1 1\ 9 AM PM BLD
Location I 0 � � Z/7) �cLJG/YL J S' -Suite MEC
Contact Person Ph 6P c�- (3? - # ° 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
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final -
PAS e �RT FAIL
g ]
Under Slab
Top Out
Sanitary Sewer
Rain Drains
PART FAIL
" ANICAL
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 Date \V\ \\ 7 OTO 1 Inspector Ext
Other •
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.