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Permit a CITY OF TIGARD PLUMBING PERMIT • COMMUNITY DEVELOPMENT Permit #: PLM2010 -00012 T I GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/08/2010 Parcel: 2S110AD90071 Jurisdiction: Tigard Site address: 14984 SW 109TH AVE Subdivision: CANTERBURY WOODS CONDOMINIUM Lot: 71 Project: Conerby Project Description: Add toilet, replace tub /shower. Owner: FEES CONERBY, JAMIE L Quantity Description Date Amount 14984 SW 109TH AVE 1 ea Tub /Shower /Shower Pan 01/08/2010 $12.51 TIGARD, OR 97224 1 ea Water Closet 01/08/2010 $25.02 PHONE: 1 12% State Surcharge - 01/08/2010 $8.70 Plumbing Contractor 35 ea Minimum Fee Adjustment - 01/08/2010 $34.97 RAYBORN'S PLUMBING INC Plumbing 19990 SW CIPOLE RD TUALATIN, OR 97062 PHONE: 503 - 692 -4139 FAX: 503 - 691 -2328 Type of Use: SF 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 issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct • • -stions • •UNC by calling 503.246.6699 or 1.800.332.2344. Issu:d / I Permittee Sign. re: / _. —1 "'l " l — r 1�� 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. C. ....503 69: 2328 Rayborns Plumbing 03:01:10 p.m. 01 -07 -2010 2 /2 Plumbing Permit Application Building Fixtures RECEIVED h t11t t)rrlt r I tit (..I.. City of Tigard Resrve ed i Permit No.: .. • 13125 SW Hall Blvd., Tigard, OR 97223 Dat ©`�� " " ���� -040/2 Phone: 503.639.4171 Fax: 503.598.I96� AN 20 � 0 Plan Review Date/By: Other Permit No.: I I ( : \ I: i I Inspection Line: 503.639.4175 Date Ready.'By: Eli See Page 2 for Internet: www.tigard CITY OF TIGARD Notified/Method: t ® , Supplemental Information TYPE OF Woo I1 DING DIVISION Fee* SCHEDULE • .. ❑ New construction ❑ Demolition For special Mformation use checklist. Description I Qty. I Ea. I Total Addition/alteralion/replacement ❑ Other: New I. 2-family dwellings (includes 100 ft. for each utility connection) . .: . • •. CATEGORY OF CONSTRUCTION . . . . SFR (I/bath 312.70 ❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 ❑ Accessory building ulti- family SFR (3) bath 500.32 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: / L, C1 'L/ 5 w i o4 t L-- A V C Catch basin or area drain 18.76 City / State/ZIP: � r ' y rj y Drywell, leach line, or trench drain i 8.76 ow. © r Footing drain (no. linear ft.: _ ) Page 2 Suite/bldg. /apt. no.:# Project name: Manufactured home utilities 50.03 Cross street/directions to job site: 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: Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 3117 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 R e Oa. T,..., La 51,,,,,... e Ni _ Dishwasher 25.02 A ri... T e 1 c 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: Garbage disposal • 25.02 City/State /ZIP: Hose bib 25.02 Phone: ( ) I Fax: ( ) Ice maker 12.51 ❑ APPLICANT I ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: t Medical gas (value: S _ ) Page 2 r u 0 Yw- B v.cl Primer 12.51 Aj ek + ei � Contact name: t� �,� J Roof drain (commercial) 12.51 Address: 1 (,t't(,( 0 S C\ ?CA 4_ 'kCL Sink/basin/lavatory 25.02 City/State /ZIP: -- T v 0...\ eA.E , s,\_ O f CO 0 61 Solar units (potable water) 62.54 Phone: (so3) ‘9,... _ 4' 3 C( Fax: : (c03) 6 q 1 . 23 a 2 , Tub/shower /shower pan / 12.51 12.51 Urinal 25.02 E -mail: /l ate @ rcYbt,rv`s CO . w-- Water closet / 25.02 CONTRACTOR 0 25. 00' 1 1 Water heater 37.52 Business name: R gVboY►ti5 1 VvM✓Jv T Water piping/DWV 56.29 Address: \ gs ci 0 5 u CI \e , R . - 2...... Other. 25.02 City/State/ZIP: l ual ; D r 611 0 C Subtotal Phone: (So ) G q _ (.-l` 3 c Fax: (1503 ) ( ct l a 3 g Minimum permit fee: 572.50 ?,2 .5U CCB Lic.: S 5 • ..._ Plumbing Lic. no.: _ . if. Plan review (25% of permit fee) -�"" , State surcharge (12°0 of permit fee) g Authorized signature f/ / / -- '. // TOTAL PERMIT FEE r /� 'Ibis permit application expires If a permit is not obtained within 180 days Print name: AA f ki ��� ` � k Date: _ 7 - �v after It has been accepted as complete. •Fce methodology set by Tri -County Building Industry Seri' � p� T �rd. O I:•nwldincTermas,PLMU remitApp.doc IQ/DI/09 440- 9616T( I 0 (0:/CO%LWEB) V