12483 SW KATHERINE STREET r�
w
N
w
m
Co
c�
�v
12483 SW Katherine Street
A CITY OF T I G A R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2002-00004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639-4171
DATE ISSUED- 1/8102
P/'•r-'CEL: 2S103BE-044'j0
SITE ADDRESS. 12463 SW KATHERINE S7
SUBDIVISION: BROOKW`\." ZONING: R ,.5
BLOCK: _ LOT: 044 _ JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER I;FATERS: CATCH BASINS:
FIXTURES__ LAUNDRY i RAYS: SF RAIN DRAINS:
v— S'NKS: �! URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES: 1
TUBISHOWERS: SEWER LINE: ft
WATER CLOSETS- 1 WATER LINT=
DISHWASHERS: RAIN DRAIN: ft
Remarks: Plumbing for rem,)del. 1 lav, 1 washer relocate, 1–w c. Other fixture is ice maker. _ T
FEES
Owner: „pe By Date Amount Receipt
LIEBERTZ, GERARD J I PRMT CTF 1/8/02 $72.50 27200200000
OOLORES A 5PCT CTF'. 118102 $5.80 27200200000
12483 KATHERINE ST
1�IGARD,D, OR 91223 Total_ $78.30
Phone 1:
Contractor: _
R, BORN'S PLUMBING INC
PO BOX 69
TUALATIN. OR 97062 REQUIRED INSPECTIONS
Rough-in Insp
Phone 1: 503-692-4139 Top-out Insp
Reg #: LIC 87852 Final Inspection
PLM 34-166PB
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 wai expire if work is not started withir 180 days of !�fsuance, or if work is suspended for more
than 180 days. ATTENTION. Oregon law requires you to fol,,)ov rules adopted by the Oregon Utility
Notification Center. Those rules are set forth it OAR 952-0001-0010 through OAR 952-0001-0080.
You may obtain copies of these rules or direct Iiiestions to CUNC by calling (503) 246-1987.
Issued By: _ ( `_"� = c ' --- Permittrye .'ignature: ~?
Call (503) 639-4175 by 7:00 P.M. for an inspection needed the next business day
Jan-01--02 i 2 : lop Raybc v-n' s P It-imti ing , Inc. 15036912328 P.01
Plumbing Permit AjZID Iftah " �-
ve— , Perrnir no
roc
rte erd:
Sowor Pornot No Ltuildinu 11gn t No _
City of bard y�/ I o ect plNo r-aIrC I;.,te __
13125 SWW Hall ll Blvd. Tigard.OR 972D I ate issued liy C r:_ k«xint No
Phone 503 639-4171.Pax 503 598-1960 Qyy up-�� do No`�_ Payntent",—
land(At Approval
I
1 &2 Ftm
tOv dwelling or accessory h7 Conuffioclalhndustnal U Multi-family J Tetuunt unpnrvctiuent
Addition/altent;on/replacernent U rood servtLr 0 Othcr
J New constru..tion
rhe
Job address. 12483 SW Katherine Street Description ler I.til
New 1 &2 family dwelling;only: /+ 1tN1 ft
Bldg. No. Suite no. SFR(1)Bath 924 a 20 0
SFR(2)Rath S35u 0
'fax map/tar lot!account no.. — S�yy 0
SYR(3)Rath
Lot: Block: Subdivision Fach additional bath/kitchen
Project t►untr tem'Lieberti Site Utilities: Catch basin/area drain no Il
lhy wells/leach line/trench drain 0
City/county : Zip S 0
Footingdrain(no 1.111R ) _
Description and Location of work Remodel Manufactured Homc utilities-each Sot,41) 0
- Marnholes S 0
Date.)I Comple(ion/inspection —-
Raul drain connector ___ 3 0
Stuutai :Sewer(no. of linear feet ) lila 355.1Q 0
",,sines name RAYBURN'S PLUMBING _ Storm Sewer (no of lima feet) 100' 555 t)u 11
Address P.U. BOX 69 _ Water'Service (no of linear feet)I00'` 355,00 0
Fixture or item :
City -1-UALATIN State:OR Zip: 97(162 Absorption valve $16.('(1 1
I'butte : 5113 691.4:zV Fax : 103 691-2328 Rack Row preventer $27 55 (►
Backwater valve $1060 0
E Mail Address Wayne(aDRayborns.com Rn4ins/Lavatory 1 316.(,0 16 6
CCR no. 871{52 Plumb Bus No. . 34-16613D Clothes Washer 1 $1. 61► 160
Dishwasher
$1660 0
('it, /Metro Lic. No 001811( 116A0 11
ihmking Fountain(s)
C'ontractor's signature . E ector/stun _ -- $16.60 r1
Print name: Wayne Siebold Date :1/7/02 Lx nsion Tank -- $16.61 0
Fixture/sewer ca $1660 0
l lrxn ctrainsl floor sinks/Ilub S1660 0
Name' (nulla ge Dis ,sal Si ri 60 11
Address Ilo-w-Ilibb _ S16.60 U
Ice maker I 516,60 Ih.b
City Statc OR Zip — $1600 0
Interceptor/Gteavr tra
Phone . Fax Pnmer SI6.a1 1
Riot dtarl(Coruio-miAl) $16 61► ll
Sinks(e),Basin(s),Lav(s $1660 0
Notice This permifit application expires a permit is not obtained Silt" 6(1
tn -_ $16 60 0
wtitWit 18t►days after it bits been accepted its complete. Tubs/showcrh_.,,wer pan - 516 60 tl
t lnnal _
Include Fixture fee brrakdown sheet Water Closet 1 $1660 16.6
Commercial permits require Sewer Tally sheet Water heater $16.60 tl
l)thct
51660 1
TOTAL 66.4
"Tigard Takes Visa for Payment _ Minimum Fee 550 72.5(►
Visa FFP Plan rcvieµ X730%
Cardhomer r. - ow. a�'horn State chat8i; 09% 5 80
CIGNA I 11R) 1: �— AtuountS �� 3 Tota) 'R Io
CITY OF TIGARD BUILDING INSFECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 6394171 --"
BUP _
Date Requested —�s!!d _--._AM_ _-_PM _ — BLD
Location 1�-__ Suite .!_ MEC
Contact Person _ —� _. Ph `---!_ PLM Zy 0 Z -U v Q v
Contractor_ —__--_ _ Ph --_ SWR
BUILDING Tenant/Owner —_ _ _ _` ___- EL(;
Retaining Wall ELR
Footing Access: FPS
Foundation - ------ -
Fog Drain — SGN
Crawl Drain Inspection Notes, ----------�--
Slab SIT
Post&Beam -----------
Ext Sheath/Shear -- ----- -- -- - ---
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall -� -
Fire Sprinkler -- — --- -------- - --- -- - --
Fire Alarm
Susp'd Ceiling
Roof
Misc: -- - ---
Final
PASS PART FAIL —`-- - - -
PLUMBING -
Post& Beam -
Under Slab
Top Out -- - -
Water Service
Sanitary Sewer -
Rgjp airs --
ina
PART FAIL.
R ---- - ---
ME,,-HANICAL —
Poet&Beam - --- -- -- --
rough In
Gas Line -
Smoke Dampers
Final -------.. - - —
PASS PART FAIL —
ELECTRICAL -
ServiceRough In
In
UG/Slab --_---_..-- -- —
Low Voltage
Fire Alarm --
Final
PASS PART FAILSITE _
Backfill/Grath 1g
Sanitary Sew it
Storrs Drain [ j Reinspection fee of$ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin Unable to Inspect-no access
Fire Supply Line ( ]Please call for reinspection R[: -. 1
ADA �t
Approach/Sidewalk Date �- �� �V Z- InSpeCtn� '51 ,// kwe Ext _
Other -
Final
PASS PART _FAIL DO NOT REMOVE this inspection record from the job site.
CITY OF TIGARD BUILDING INSPECTION DIVISION MST
24-Hour Inspection Line: 639-4175 Business Line: 639-4171 -B -
/ UP
- —Date Requested ( ` /Q PM BLD
Location___ / � G'/2.�-tits Suite ". MEC
Contact Person ,( CL'v ,-Q-, �1_ Ph f 'i 1 3C/ PLM L; Q C &q
Contractor 1.' 'i✓ Ph SWR
BUILDING tenant/Own r ELC
IRetaining Wall Et.R
Footing Access
Foundation V _ 1-Z,[� _ r4G�,-k,., 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
Mise
Final
PASS PART FAIL
PLUMBING
Post&Beam •
Under Slab
Water Service �w
Sanitary Sewer
Rain Drains
Final
ASS PART FAIL
ANICAI
Post& Beam
Rough In
Gas Line
Smoke Dampers
Fioal
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 RF ( ] Unable!o inspect noaccess
ADA
Approach/SidewalkC�
-_
Other Date �_ ( � �Z' Inspector. '1L____414-40,y —Ext
Final
PASS PART FAIL 00 NOT RIZMOVE this inspection record from the job site.