Permit CITY OF TIGARD PLUMBING PERMIT
F�1 � ' COMMUNITY DEVELOPMENT Permit #: PLM2010 -00081
T E G AR'D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/19/2010
Parcel: 2S110DD02300
Jurisdiction: Tigard
Site address: 10555 SW CENTURY OAK DR
Subdivision: SUMMERFIELD NO. 1 Lot: 30
Project: WALTH
Project Description: Replace tub with shower pan.
Owner: FEES
WALTH, CONRAD D & MEGAN Quantity Description Date Amount
10555 SW CENTURY OAK DR
TIGARD, OR 97224 1 ea Tub /Shower /Shower Pan 03/19/2010 $12.51
PHONE: 1 12% State Surcharge - 03/19/2010 $8.70
Plumbing
60 ea Minimum Fee Adjustment - 03/19/2010 $59.99
Contractor: Plumbing
RAYBORN'S PLUMBING INC
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 questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: `I kb A.,6 Permittee Signature: , p
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 Rayboms Plumbing 03:13:53 p.m. 03 -18 -2010 1 12
Plumbing Permit Application t; i a'
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Building Fixtures y rp. ^ & 41 , "' ~ ( �i 4 c)1< 1 i11;I :0 -` .1. >�1) n " .
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�5 Received
r r City of Tigard MAR .8 2013 Date1B : -M Permit N ,' ZO • 41. t.
� M a 13125 SW Hall Blvd., Tigard. OR 97223
®^ , Phone: 503.639.4171 Fax: 503.598 1960 . •
Plan Review
ia a, 7 (1 x.1,1 / � Date /By: Other Permit No.:
,:Te.t l ' . Inspection line: 503.639 1,1 I •1 ,
Date Ready/By: Jul lid Page
,:�jtfv ig:,,itg Internet: www.tigard or.gov P3Ldi! jir'a( :; J11 ) �; °iqa 1 Notified /ethod: Supplemental Information
TYPE OF WORK FEE' SCHEDULE
CV New construction ❑Demolition For special information use checklist,
Description 1 Qty. 1 Ea. 1 Total -
❑ Addition/alteration/replacement ❑ Other New 1 - 2 - family dwellings (includes 1 ft. for each utility connection)
• - CATEGORY OF CONSTRUCTION ti SFR (I) bath 312.70
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437,78
❑ 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: /
e;7 6 . S ,.,,/ L - e A 4:0 ✓ � pr. Catch basin or area drain 18.76
City/State/ZIP: "r C� D y Drywall, leach line, or trench drain 18.76
t q7 / 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
Stone sewer (no. linear ft.: , ^) Page 2
Water service (no. linear ft.: ^) Page 2
Subdivision: Lot no.: Fixture or item:
Tax reap /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/, �� Clothes washer 25.02
K P WO u E � a `, - Ir ToJ 1 V\.,} 6JJ.�L (Q�� Dishwasher
25.02
..1n i7 W F ✓ Q -_ - Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER 1 --~ ❑TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.0
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: R avr � p ��s V �` �\n{ Medical gas (value: $ ) Paget
7 Primer 12,51
Contact name: ✓1Jc F .ri- l ; Roof drain (commercial) 12.51
Address: a Ct 0 1 Q GL Sink/basin/lavatory 25.02
City/State/ZIP '
{ /al ,, iQ r 4 t70G 2 Solar units (potable water) 62,54 •Phone: (r,03 ) 6 7 a. .L.1J 3 q Fax: : ( ) 6-Qt �• .- Tub /shower /shower pan / 12.51
E -mail: 4,4 4'e 1
Ca, �0 rLt �r C awe. 1 Urinal 25.02
CONTRACTOR Water closet 25.02
^ Water heater 37.52
Business name: RJLy,riAS P F
C s (- Water pipingDwv 56.29
Address: ["�,"1.ttO , (� - ?2t 61/4. l Other: 25.02
City/State /ZIP.V � U 1 � `� k r co 0 6 . Subtotal
Phone: (3) `` q _ Li( 3 4 Fax: (o3) 6 ci t , 3 .1g Minimum permit fee: $72.50
1 Plan review (25% of permit fee)
CCB Lic.: �7 g5 '1
Plumbing lac. no • .- IG P13
State surcharge (12% of permit fee)
Authorized signature: ` �� � f /l�' . - -_ - TOTALPERMITFEE. IQ I •
Print name: ,/� / /��� . �� Date: 2 This permit application e has bs it a permit as ct obtained wi 1g0 days
/[/� / after it has been accepted as complete.
"Fee methodology set by Tri -County Building Industry Service Board.
I: Building'Permus PI.Mt)- Pe,maApp.dor 10.01'09 4404816T(IO/02 /COM/WEB) ' •.V
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