Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00347
Date Issued: 12/09/2009
LT G D. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
?_. Parcel: 2S111DB04200
Jurisdiction: Tigard
Site address: 9105 SW SUMMERFIELD CT
Subdivision: Lot: 0
Project: Astrup
Project Description: Replace shower.
Owner: FEES
ASTRUP, BERT R & JOYCE F Quantity Description Date Amount
9105 SW SUMMERFIELD COURT
TIGARD, OR 97224 1 ea Tub /Shower /Shower Pan 12/09/2009 $12.51
PHONE: 503 - 624 -5426 1 12% State Surcharge - 12/09/2009 $8.70
Plumbing
60 ea Minimum Fee Adjustment - 12/09/2009 $59.99
Contractor: Plumbing
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 Notificat • • - - • er. 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 to 0 C b ailing 503.246.6699 or 1.800.332.2344.
Issu =d By: ' Permitte Signature: ,�.� ` osir
Call 503.639.4175 by 7:00 a.m. for an inspection that bu • ess 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.
-503 691 2328 Rayborns Plumbing 04:12:38 p.m. 12 -08 -2009 1 /2_
Plumbing Permit Application RECEIVE D
-sue - e.
>: I;OIZ ul r.ICM.r t `tiI �, -,
DEC 0 � 2009 ..-e '- �
Building Fixtures : �. �
repig City CI of Tigard Received
_ �7
13125 SW Hall Blvd., Tigard. Date/BY: /'J Sr 0 T, Permit No.: i f Ua OR 9722 OF TIGARD Plan Review `
x• i 0 Phone: 503.639.4171 Fax: 503.5981..
• - 1 Date'B y: Other Permit No.:
:, Inspection Line: 503.639.4175 LDING DIVISIp .
I'.t':: 1; ?( Dale Ready /By: �1pw See Page 2 for
i3 + Internet: www.tigard- or.gov Notified/Method: - /
/ Sup •lemeatallnfarmatlon • :,4:m,.: TYPE OF WORK: • FEE' SCHEDULE.'
❑ New construction ❑ Demolition For special information use checklist.
Descri.tion • . Ea. Total
Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION . SFR (1) bath 312.70
19ti1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
CI Accessory building ❑ Multi- 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: Catch basin or area drain 18.76
ll If ' ..._ ' di.. Drywell, leach Tine, or trench drain 18.76
City/State /ZIP: 7 l,r ,� 0 /L u y Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: � \J Project name: i t
r Manufactured home utilities 50.03
Cross street/directions to job site: Manholes
6s - s -- a 7 Rain drain connector
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear fl.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
• 1 r1: ' a.! 1 a •. . - Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER I ❑ TENANT Expansion tank
Name: k5 -171.A4r Fixture/sewer cap 25.02
Address: � " / Floor drain/floor sink/hub 25.02
(.1� •` r • • • C Garbage disposal 25.02
City/State /ZIP: A (/ J`- ?Z2- Hose bib 25.02
Phone: . ) , r .. s' Fax: ( ) Ice maker
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap
Business name: Medical gas (value: $ _ ) Page 2
Primer
Contact name:
Roof drain (commercial) 12.51
Address:
Sink/basin/lavatory I 25.02
City/State/ZIP: Solar units (potable water)
Phone: ( ) Fax: : ( ) Tub/shower /shower pan 12.51 / 1.-"Ft
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater
Business name: 1 , 1 A / ► r ,/ Jiii..ira l Water P tP in 8/ DWV 56.29
Address: ftraMfjIIIIIMII • Other. 1
City /State /ZIP: .--- _.,. , i' 1 ill i i lif A . Subtotal Biel
Phone: 71 ) 1 _ it
1 �, ^.'
,11 g
/ Plumbing ic. no.: �
�s . . errnit fee)
Authorized signature:
�, 1 application expires if a permit is not obtained within I80 days
,' / � 1' i �� Date 1 . L - Thb permit PP after it has been accepted as complete. y
*Fee methodology set by Tri- Cuunty Building Industry Service Board.
I:` Building .Permits`PLMU -I ermitApp.dor 10 440- 4616T(10'02.COM/WEB)