Permit
v
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit PLM2010-00033
A 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/26/2010
Parcel: 1 S125DB08700
Jurisdiction: Tigard
Site address: 7167 SW LOLA LN
Subdivision: Lot: 0
Project: Remax Equity
Project Description: Repipe water in crawl space only.
Owner: FEES
REMAX EQUITY GROUP Quantity Description Date Amount
7167 SW LOLA LN
TIGARD, OR 97223 56 da Misc Other Fee 01/26/2010 $56.29
1 12% State Surcharge - 01/26/2010 $8.70
PHONE:
Plumbing
16 ea Minimum Fee Adjustment - 01/26/2010 $16.21
Contractor: Plumbing
RAYBORN'S PLUMBING INC
19990 SW CIPOLE RD
TUALATIN, OR 97062
PHONE: 503-692-4139
FAX: 503-691-2328
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuanc if work is susp ed for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utili otification Center. Thos rul a e set forth in OAR 952-001-0010 through OAR 952-001-0100. You may obtain a copy of the rules
or irect questions to OUNC by c ing 503. 46.6699 or 1.800.332.2344.
I sued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
• Plumbing Permit Application ^ , \ , •
Building Fixtures � � ^ V , � " ---7 - , IA_� I.OR OFFICE USE ONLY
City of Tigard JAN ti 6 2010 Date /By: Rev I RED (v G !' J �D /O -erg 33
14 Permit No.:
a 13125 SW Hall Blvd., Tigard, OR 97223
C iew
Pho 503.639.4171 Fax: 503.598.1960 O 1 `gyp D Plan , Other Permit No.:
q\/ R ,,Date/By:
T I L. K D Inspection Line: 503.639.4175 Ck 1 I D` � I`�`,o spate Ready /By: .1 . ® See Page 2 for
Internet: www.tigard- or.gov 1 ll kl V Notified/Method: 1, Supplemental Information
TYPE OF WORK V FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. I Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
® I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 7167 SW Lola Lane Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard OR 97223
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: l Project name: Remax Equity Group Manufactured home utilities 50.03
Cross street/directions to job site: 655 CI Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 1 2.51
Clothes washer 25.02
Repipe water in crawl space Only
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 7167 SW Lola Lane
Garbage disposal 25.02
City /State /ZIP: Tigard OR 97223 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Pagc 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub/shower/shower pan 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Rayborn's Plumbing Inc
Water piping/DWV I 56.29 56.29
Address: P.O. Box 69 Other: 25.02
City/State /ZIP: Tualatin OR 97062 Subtotal 56.29
Phone: (503) 692 -4139 Fax: (503) 691 -2 28 Minimum permit fee: $72.50 72.50
CCB Lie.: 87852 Pjmbing Lic o.: 34 -166PB Plan review (25% of permit fee)
/, ; ` ` State surcharge PERMIT fee) 8.70
Authorized signature: . ; /l ` / TOTAL PERMIT FEE 81.20
Print name: Kenneth A. ' ovancher Date: a72Srfti� This permit application expires if a permit is not obtained within ISO days
after It has been accepted as complete.
V-46A9 `Fee methodology set by Tri -County Building Industry Service Board.
\ 1:\ Building Permits\PLMU - PermitApp.doc 10!01/09 440- 6616T(10'02'COM/WEB)