Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00317
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 6/26/2006
4,A1.4k PARCEL: 2S110BA - 06800
SITE ADDRESS: 12036 SW WILDWOOD ST ZONING: R - 2
SUBDIVISION: SHADOW HILLS NO.2 LOT: 051 JURISDICTION: TIG
Project Description: Bathroom remodel.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 2 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
KEN & MELA DAWSON
12036 SW WILDWOOD ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/26/2006 $72.50
[TAX] 8% State Surcha 6/26/2006 $5.80
Phone : Total $78.30
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -4139
FAX 503 -691 -2328
Reg #: LIC 87852
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 will expire if work is not started within 180 days of
issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: Permittee Signature: cz
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.
Jun. 23. 2006 3:12PM Rayborns Plumbing No. 3779 P. 1
Piumbin Permit A
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13125 SW Hall Blvd., Tigard, OR 97223 plan Review Phone: 503.639.4171 Pax: 503.598.1960 JUN 2 3 20 i, >•. Othor Permit No.:
24- Hour Inspection Line: 503.639.4175 ' l .. - 1 i Date Re
Internet: www.ci.tigard.or.us CITY OF TIG • .- - i -- �' - ' NoteRd / Job ® Se eme nt lInf
_ Notified/Method: U Supplemental Information
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❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
S Addition/alteration/replacement ❑ Other: New 1- 2- famlly dwellings (includes 100 ft for each utility connection)
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1 {x c31 ' 1,It SFR (1) b 249.20
yi.j- and 2- family dwelling ❑ Commercial/industrial Y SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other
at,' t ,-�,- l.:77 t,�.,, , n i t{ r„ y< , „ . I tr .T Fire sprinkler (� sq. R) Page 2
ills" W1 � ._ �� +' A ug 77+NA Ell. R t [ ffi L i l l .v I-
..0.t...c.rr .,fir c F'> , , i.. iw .t.,,4 ., ..!;:. :,,..r: i 13,3.k,.,r.,;S .. w3a„ r.>...: , , i - :,., 1 ,'. Site utilities
Job site address: ,'OCO / t Z) 1)// � Catch basin or area drain 16.60
City /State/ZIP: VjQ_r 97 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Pr oject name: Footing drain (no. linear ft.: _.) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear R: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water service (no. linear R.: ) Page 2
Fixture or item
Tax map /parcel no.: t Absorption valve 16.60
n' R 1 7FF P y s r rfic f +.3' °� p F , . . rs L ;, c 70, t I r E P j , 4 r ; i,A 2�T -;,- p t L { --
3 � c ,,,,,. , ,� t.iLTr t 13,. 'l ,.. =5r,`s ria ,l. rt: . l tr? ,
r „)rdit. � ;, 4„,,.'' .,, '.tg4..-.t1 ." 1 i•i;1;11::.1L.L.s:. Backtlow preventer Page 2
A . ,"�/hv j 09,-/-ritA � Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
l- a ,e S t , dr 9 ,( Xn f' l i` 71T+'Jt �.T! .,tmi'clr'Ta.1 i i f t T ! I i t 37 1 r, riiaf is i' t Atli' tc l' �-- Drinking fountain 16.60
ci i js . r�1rt.=,7_ i� 1 i }, :: :: � 'ABC- .ti - ,n1 a irt r E l - r W 3 liT'7.... 3
\ ` Ejectors/sump 16.60
Name: 2 U . Ca r l r K•��h..t_ 1-- 1-Vv.sAr., Expansion tank 16.60
Address: _ d - ■lti K// , `_ , , - Fixture /sewer cap 16.60
City /State/ZIP: 77,d 2 /r OR 9 '� Floor drain/floor sink/hub 16.60
Phone: ( ) "" -� Fax: ( ) Garbage disposal 16.60
m c F ,�"- eg i � t r K i"7"` 7 r. r1c i� . ,r * Nose bib 16.60
5 a(,? 4 - �r..� :.: . r_sf 1
5 ce t -P z i i
r .4tr , �P ' +'.rr r, t K. , F-t. r ;, c ,...n:..�� Ice maker 16.60
ES _ a . Interceptor /grease trap 16.60
Contact name: / , ,i � _! : - Medical gas (value: $ ) Page 2
Address: / fg.O.P i Primer 16.60 J
City /State/ZIP: 7�'q +i1 ode_ Roof drain (commercial) 16.60 t10
Phone: (-3 69.2 - I Fax:: 6523 4g� c23c28 Sink/basin/lavatory
16.60
Tub /shower /showewe r pan 16.60
E -mail: rn(Ss -fir' _ S i Ph- Urinal 16.60
7 1 11 ? � fM i V; i � .. i �J�t li 4ill'ft .,7,C F-0 r f'� 7 i
��7 ,1
3 5. ,�!tc Water ,,,,,:,,..� . �..{fialii,2 i:TrI t r....r ( ater closet 16.60
Business name: Aft , .lei l i Water heater 16.60
Address: PA yak 69 Other:
City /State/ZIP: 7170_444 OR j 7P��6..v- Subtotal �GJ ��
ne: F� /J- 9/37 /
Fa. :, 6/�� g-3 Minimum p pc permit fee: $36.25 7
Pho
F ) Residential backflow minimum mtit fee: l $36.25
CCB Lic.: 8-78_5.--,_ Plumbing Lit. no.: 3. /AC P8 Plan review (25% of permit fee)
State surcharge (8% of permit fee) . 1780
Authorized signature:
:.wt■ !/ TOTAL PERMIT FEE c ✓?vim
Print name: `i 'ik. - i Date: • l This permit application expires if a permit is not obtelaed within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
I:1 8uitdiesTermiu \PLM- ParmitApp.doc 06/05 440d616T(O0N2/COM/WEB)
CITY OF TIGARD , ,. P .—
BUILDING DIVISION '` PERMIT #:200 603/ 7 1
13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED:
Phone: (503) 639 -4171 k ogidP +�
Inspection Requests (24 Hrs.): (503) 639 -4175 ^'� I..
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: I d 0 3 ( (�(),, t..I 0-6-� CLASS OF WORK:
SUBDIVISION: L ()T #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: (— D:7 _ p Pour Ti e: 4 a
Code # Ins ection Description Confirm # Contact # Messag
S
1,L(Avvi9v...-iVi.?„..
l 0 - 7 7
Corrections /Comments /Instructions: ! I
FR - , SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: �' Il l Date: ' A Phone #: (503) 718 2 /
I
i
CITY OF TIGARD ...
BUILDING DIVISION PERMIT #: PLM2006.00317
13125 SW Hall Blvd., Tigard, OR 97223 ' DATE ISSUED: 6/26/2006
Phone: (503) 639- 4171 l rlii
Inspection Requests (24 Hrs.): (503) 639 -4175 `:_..
INSPECTION WORKSHEET FOR DATE: 7/18/2006 TIME: 7:03AM PAGE 73
SITE ADDRESS: 12036 SW WILDWOOD ST CLASS OF WORK:
SUBDIVISION: SHADOW HILLS NO.2 LOT #: 051 TYPE OF USE:
PROJECT NAME: DAWSON
DESCRIPTION: Bathroom remodel.
OWNER: DAWSON, KEN & MELANIE PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503- 692 -4139
Inspection Request Scheduled For: Date: 7/18/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 033170-01 503 -692 -4139 Y
Corrections /Comments /Instructions:
§--- e .._ — - - 32 L 3
- Allah
1 W 4Or - i.', 7 • _....-......0. 4 ,,,, .....„ `.
/ _ ,.
PASS X PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / Date: / I Phone #: (503) 718- 2 4121
CITY OF TIGARD • • ._
BUILDING DIVISION PERMIT #: PLM2006 -00317
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/26/006
Phone: (503) 639 -4171 (tl
Inspection Requests (24 Hrs.): (503) 639 -4175 ^'I
J
INSPECTION WORKSHEET FOR DATE: 7/20!2006 TIME: 7:04AM PAGE: 55
SITE ADDRESS: 12036 SW WILDWOOD ST CLASS OF WORK:
SUBDIVISION: SHADOW HILLS NO.2 LOT #: 051 TYPE OF USE:
PROJECT NAME: DAWSON
DESCRIPTION: Bathroom remodel. •
OWNER: DAWSON. KEN & MELANIE PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503692-4139
Inspection Request Scheduled For: Date: 7/20120°6 Pour Time:
Code Inspection Description Confirm # Contact # Message
399 Plumbing final 033346 -01 503-692 -4139 N
/Correcti @ /Co ents /Instructions:
klii `3, , - 0, s,
_IL? v
i,„A.4,,, fit•)' Cc au. 55 ss2.-G 5 •
e ‘\ ?6 PASS ❑ PARTIAL APPROVAL L ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
t i Inspector: Date: ' 7/ 1 4 O(P Phone #: (503) 718- Z 711
CITY OF TIGARD PLM2006-00317
BUILDING DIVISION PERMIT #: 6/26/2006
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 (I
Inspection Requests (24 Hrs.): (503) 639 -4175 . -� " ..
7/21/2006 7:01AM 68
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
12036 SW WILDWOOD ST
SITE ADDRESS: SHADOW HILLS NO.2 051 CLASS OF WORK:
SUBDIVISION: DAWSON LOT #: TYPE OF USE:
PROJECT NAME: Bathroom remodel.
DESCRIPTION:
DAWSON, KEN & MELANIE
OWNER: RAYBORN'S PLUMBING INC PHONE #: 503.692 -4139
CONTRACTOR: PHONE #:
7/21/2006
Inspection Request Scheduled For: Date: Pour Time:
Cosih# Ir i ppaRescription WIAMCA C SC§ - #1292 Message
Corrections/Comments/Instructions:
'PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: T' L / / ( Date: ,2 Phone #: (503) 718- .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006-00317
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/26/2006
Phone: (503) 639 -4171 14 I I
Inspection Requests (24 Hrs.): (503) 639 -4175 � ' ^'I I ..
INSPECTION WORKSHEET FOR DATE: 9/11/2006 TIME: 7:00AM PAGE: 33
S)
SITE ADDRESS: 12036 SW WILDWOOD ST CLASS OF WORK:
SUBDIVISION: SHADOW HILLS NO.2 LOT #: 051 TYPE OF USE:
PROJECT NAME: DAWSON
DESCRIPTION: Bathroom remodel.
OWNER: DAWSON, KEN & MELANIE PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503.692 -4139
Inspection Request Scheduled For: Date: 9/11/2006 Pour Time:
Code # Inspection Description Confirm # Contact # M- _
399 Plumbing final 036306-01 503- 209 -2292 S
Corrections /Comments /Instructions: -t )
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: C.bh t Date: T'/l `o Phone #: (503) 718- Z
. — —