Permit CITY OF TIGARD PLUMBING PERMIT
- COMMUNITY DEVELOPMENT Permit #: PLM2009 -00336
} 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/20/2009
TIGARD; g Parcel: 2S114BA13800
Jurisdiction: Tigard
Site address: 16270 SW COPPER CREEK DR
Subdivision: COPPER CREEK NO. 4 Lot: 103
Project: Scorby
Project Description: Install tub /shower.
Owner: FEES
SCORBY, GARY L Quantity Description Date Amount
16270 SW COPPER CREEK DR
TIGARD, OR 97224 1 ea Tub /Shower /Shower Pan 11/20/2009 $12.51
1 12% State Surcharge - 11/20/2009 $8.70
PHONE: 503 - 684 -9561 Plumbing
60 ea Minimum Fee Adjustment - 11/20/2009 $59.99
Plumbing
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Permittee Signature: r
Issued By: � � g QN / ��/r7 L/ �- ,9-77ll
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.
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11:49:58 a.m. 11 -20 -2009 1 /2
- 503 6�1 2328 Rayboms Plumbin/2----,
Plumbing Permit Application R ECEI V . M . Bu ildin Fixtures a • • , , , , ; �
NOV O r . . 4..• --1' .. 44 A t, Ai .d 1.. tY'N "
- ,' City of Tigard well /0z C Permit No �.t, q 3,30 / -G �/ o ��
•
13125 SW Hall Blvd., Tigard, OR 97223
I G Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TI view ' kr -
Other Permit No.:
';' �I � ' Inspecti I on line: 503.639.4175 BUILDING DI (S ,
1, 1 Internet: www.tigard or.gov �` , y1 a / B1rod: i g I mental information
■
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special in ormaiion use checkllsc
Description Qty. Ea. Total
Addition /alteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 31 2.70
X - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.
Each additional bath/kitchen 25.02
12 Master builder ❑ Other: _
Fire sprinkler (` sq. ft. I Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
ob site address: (6 _ Q 5 W c pee C C r e.e V 0 t" Catch basin or area drain ! 8.76
City/State/ZIP: E a.V,,,t. or
Suite/bldg. /apt. no.: I Project name: 7 a a t- 1
Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: ) Page 2
M Manufactured home utilities 50.03
Cross street/directions to joh 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: l.ot no.: -
Flxtu re or item:
Tax map /parcel no.: BackOow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
T� b / s t� o w Clothes washer 25.02
(vl S4�& . -- Dishwasher
25.0..
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank
12.51
Name: (Ca ( -1 t S, c2 ,. b \ b
Floor cap 25.02
I / [0 St..� u
Address: p (cP 0 e r 6 V J1, 25.02
P l V Garbage disposal 25.02
City /State /ZIP: C2 - Z f2- 2s.nz
t1 Hose bib - '
Phone: (c ) 6 4 _ i f S 6 I Fax: ( ) Ice maker 12.51
❑ APPLICANT ((�� ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Ray to r tn, 5 P t V w\A0 J t,1
Medical gas (value: S _) Pa e 2
Primer 12.51
Contact name: m }e 0 t,,.,.
,,,, Roof drain (commercial) 12.51
Address: `Ctctci O < • `Q _ 1 _
c r d `�- c/� Sink/basin/lavatory 25.02
City /State /ZIP:l' ,..., ; ti..� 0, C.t 11 0 6 I. Solar units (potable water) 62.54
Phone: 0j03 ) 69 D_ - It ( Cf. ( Fax: : (�;c.: -!.) G a 1 - a 3 ag Tub /shower /shower pan f 12.51
i
E- mail:A /� r �,
«yLQ�S_Co v- Urinal 25.02
t � CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: p, [IA. # V
Q tl Water piping/DWV 56.29
ry
Address: 1 v1 C{ \# S- C i VAC. C t o Other: 25.02
City /State /ZIP: '1
a \0. \ _V\_ .11 el, q 7 0 61 Subtotal
i , Phone: 3 �q� /13 y (03) b P '�(,
( ) Fax: G "L I a 3 � Minimum permit fee: 572.50 ° ?�
LC _ Lic.: I Plumb Lic. no.: Plan review (25 %ofpetmit fee) '7° �
State surcharge (12% of permit fee) t
a • 5 Plumbing 3y -
Authorized signature: i . -
. TOTAL PERMIT FEE
Print name: ,44, � Dat / _� v _ D
Ms permit application expires if a permit is not obtained with SO days
/u after it has been accepted as complete. /
*Pee methodology set by Tri- County Building Industry Service Board. ^ 0//
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