Permit CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00378
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 9/25/2008
PARCEL: 25111 DC -10200
SITE ADDRESS: 15575 SW OAKTREE LN ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.10 LOT: 555 JURISDICTION: TIG
PROJECT: HANKS
Project Description: Installing washing machine and ice maker for remodel.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
MICHAEL & HANKS
15575 SW OAKTREE LN Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 9/25/2008 $72.50
[TAX] 12% State Surch 9/25/2008 $8.70
Phone : Total $81.20
Contractor:
RAYBORN'S PLUMBING INC
19990 SW CIPOLE RD
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: A 010 11 41111P Permittee Signature: l25? /
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.
® 503 691 2328 Rayborns Plumbing 11:24:12 a.m. 09 -25 -2008 1 /3
ff 6 7 - G - f / s E F 4 A i e f } c k / S 6-79 t iks /
Plumbing Permit A licat?an t t ,,,t,,a° • „,,.- t . A 1 \ `,� „;
pp a � � a, m ' '^tI Illt (tl I l 1 01 Itil te a_
s Coq of Tigard Received � � •
IN
' 'r t Y g Da !�'i��'! . Permit No.: Ai- � ' tJ
- 13125 SW Hall Blvd., Tigard, OR 97223_ . E
Phone: 503.639.4171 Fax: 503.598 9 (i! 1. Plan Review
Date By: Other Permit No.:
`5,V t Inspection Line: 503.639.4175
DateR Ready/By: t ® See Page 2 for
�I Il \I�I
r i+d , Internet: www.tigard- or.gov �a Q[ ' ,
CITY OF 0 i r IGARD Notified/Method: ' i° Supplemental Information
TYPE O5 min nili ION FEE' SCHEDULE
❑ New construction ❑ Demolition For special information use checklist,
Description 1 Qty. 1 Ea. 1 Total
XAddition/alteration/replacement ❑ Other: New t- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath _ 249.20
P 41- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( , sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: /676 sub O aWy- e, L n Catch basin or area drain 16.60
City/State/ZIP: 7) d 9P �,f� Drywell, leach line, or trench dram 16.60
✓ j Footing drain no. linear ft.:
Suite/bldg./apt. no.: Project name: � g ( _) 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 ft.: ) Page 2
Storm sewer (no. linear ft: ) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
_ / DESCRIPTION OF WORK
Backflow preventer Page 2
Al 7C...il t° n Y` kW /?Lim /) rZ!m'd e-/ . Backwater valve 16.60
•J Clothes washer / 16.60 /4, 6
Dishwasher (6.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain (6.60
Ejectors/sump i 16.60
Name: /Yi ( i „/
/ r /1 Expansion tank 16.60
Address: Fixture/sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
❑ APPLICANT .CONTACT PERSON Hose bib 16.60
n Ice maker / 16.60 A . 60
Business name: i J�ar PiLeibi hie__
Interceptor /grease trap 16.60
Contact name: / SS /ne Medical gas (value: $ i ) Page 2
Address: / X L 9 Primer 16.60
City /State/ZIP: 7a n 6 , � T D a4
Roof drain (commercial) 16.60
Phone: Op3)69�- /39 Fax: : ,�/ -� 3 ?s Sink/basin/lavatory 16.60
Tub/shower /shower pan 16.60
E -mail: /7 ��� (r-,rl terns, CO /Y. Urinal 16.60
✓% • CONTRACTOR Water closet 16.60
Business name: R br3t / tkiC hie., , Water heater (6.60
Address: �0 4 6 01 , 4 9 Other: -
City/State/Z[P: / T Subtotal 33, �D
� ,�- o fii 9'7 -
/ Minimum permit fee: $72.50
'
Phone: 3) 6 q s - /.// 3 9 Fax: (5j3 a 3
3 ) 6 9r - .'8 Residential backflow minimum permit fee: 536.25
CCB Lic.: e .7 Fla, Plumbing Lic. no.:3 y-a 6 Pig Plan review (25% of permit fee)
State surcharge (12% of permit fee) « o
Authorized signature: � TOTAL PERMIT FEE I g1, ap
tdv
Print name: /27,..... ,C! Date: This rmit a lication expires if a permit is not obtained within
j /L � �o� $ / Pr PP P P
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1: lnuildint \Permita\PLM- PernutApp.dnc 06/26/06 440 -4616T(10 /02/COM/WEB)
CITY OF TIGARD - .
BUILDING DIVISION PERMIT #: PLM200 8-00378
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/2512009 Phone: (503) 639- 4171 >Ii
Inspection Requests (24 Hrs.): (503) 639 -4175 -±�i► I I ..
INSPECTION WORKSHEET FOR DATE: 10/212(108 TIME: 7:00AM PAGE 25
SITE ADDRESS: CLASS OF WORK:
SUBDIVISION: 1.,'75 SW OAKTREE IA LOT #: TYPE OF USE:
SIJMMERFIELD NO.10 t
PROJECT NAME:
HANKS
DESCRIPTION: Installing washing machine and ire maker for remodel.
OWNER: HANKS MICHAEL & CAROLYN PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE # 503-692.4139
Inspection Request Scheduled For: Date: 1012/2005 Pour Time:
Code # Inspection. Description Confirm # Contact # Message
320 Plumbing rough -in 07620T01 503 -E92 -4139 Y
Corrections /Comments /Instructions:
X PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 11 V Date: JO I2, 1'l i Phone #: (503) 718 -