Permit lh + CITY TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00165
T I G
AR
D DATE ISSUED: 4/21/2008
: 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112CB -06900
SITE ADDRESS: 15425 SW 81ST AVE ZONING: R -7
SUBDIVISION: ASHFORD OAKS NO. 2 LOT: 083 JURISDICTION: TIG
PROJECT: CAMBELL
Project Description: Replacing Tub /shower.
CLASS OF WORK: ALT 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: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CAMBELL, MARTA K
15425 SW 81ST ST Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 4/21/2008 $72.50
[TAX] 12% State Surch 4/21/2008 $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 --- Permittee Signature: /%� ' /C,d ,„
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.
Apr. 18. 2008 12:00PM Rayborns Plumbing No. 2375 P. 1
1 Plumbing fermitAppiica CEIVEb‘
1.1 /It i)rFICF r)
l . t. \1.1
City Of Tigard i 8 2. ij f ^ 8 Received
Date/ : / (y Pmt No ;
D � �L/ 4
IN i et 13125 SW Hall Blvd., Tigard, OR 9 P R �
I i
1 ' Phone: 503.639.4171 Fax: 503»4.0 " 1 i i Dat few Other Permit No..
i c . ,� r< n Inspection Line: 503.639.4175 II'' �Y Date x,e B
Internet: www.11 der, ov C' 1'x,4 r `0 l �! ady Y Aura. 1 ® See Page 2 for
$� B B li n' ri t t , `WA Notified/Method
' .'TYPE OF WORK •
I Supplemental
1P . $C1 DIILE me
a orgrn o
❑ New construction ❑ Demolition _ Forspedal lnkormalon use checklist
Description 1 Qty. 1 Ea. 1 Total
Addition/alteration/replacement [] Other. New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF %CODI'S' atrcTION SFR (1) bath 249.20
1- and 2- family dwelling 0 Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
0 Master builder ❑Other Each additional bath/kitchen 45.00
JOB SITE INFORMATION AND LOCATION Sire sprinkler L..._ sq. ft) Page 2
Site uhliges
Job site address: / C 1.1 ). ( S t.e. e 1 S + je. Catch basin or area drain 16.60
City/State/ZIP: T , 44`rJ Q t 1 �� Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: l Project name: 'ii 4 `( Footing drain (no. linear ft: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
• Sanitary sewer (no. linear R: _1 Page 2
Storm seer (no. linear ft.: _) Page 2
Subdivision: Lot no.: Water service (no. linear R.: ) Page 2 i
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
DE • OF .WORK . , B ackflow preventer Page 2
Pei ( e / � 11 C Li* r 4. Backwater valve 16.60
eX i 1 it „� Clothes washer 16.60 ..
,-- 11 Dishwasher 16.60
❑ PROPERTY `OWNPR �s Drinking fountain 16.60
❑ TE$ANT ^ l
Ejectors/sump 16.60
Name: /)7 y i n r?�lf Expa nsion tank 16.60
Address: ` E�
_ Fixture /sewer cap 16.60
City /State/ZIP: Floor drain/floor sink/hub 16.60
I ( ) Garbage disposal 16.60
Phone: ( ) Fax po
❑ APPLICANT , ❑ ,CQ . CT PER$b Hose bib 16.60
N
Ice maker 16.60
Business name:
Interceptoir /grease trap 16.60
Contact name: Medical gas (value: $ __) Page 2
Address: Primer 16.60
City/State/ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( )
• Sink/basin/lavatory 16.60
�-°- Tub /shower /shower pan 16.60 16.6 ()
E -mail: Urinal 16.60
CONTRAi*0R Water closet 16.60
Business name: t b 0 r , .$ 17 ! ht.�
Q �� i / n Water heater 16.60
Address: /7 a O S!t/ C i �� / - .
TU ..
Subtotal
City/State/ZIP: , /� 1<, r� 0 i q 7 0 6 ). _ Minimum permit fee: $7250
Phone: Q O3 ) C-,.2 - V / 3 4 , Fax: (,t 3) C cj -�j 3 back
flow Residential baeow minimum Qetmit 7d
fee: $36.25 .
CCB Lic.: Or) $'- D PlumbingLic.no.: 31..) _ 166 Pj3 Plan review (25% of permit fee)
Authorited signature: / /
State surcharge (12% of permit fee) 70
f " ..----
TOTAL PERMIT FEE
,�/ r
/d�
Print name: 1F i �- _ ._ _ Date: 9 -�-/- 081 This permit application expires if a permit is not obtained within
�` /L 180 days after it bas been accepted as comptete.
"Fee methodology set by Tri -County Building Industry Service Board.
1:\Bu6ding\P its1PLM -P rmitApp.doc 06/26/06 440.4616T00 /02/COM/wEB)
CITY OF TIGARD I
BUILDING DIVISION PERMIT #: PLM2008 -00165
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4f21/200B
Phone: (503) 639 -4171 ,,ut'� „1 61'llt
Inspection Requests (24 Hrs.): (503) 639 -4175 ..�!�i
INSPECTION WORKSHEET FOR DATE: 4/22/2008 TIME: 7:00AM PAGE: 11
SITE ADDRESS: 1E425 SW 81ST AVE CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 033 TYPE OF USE:
PROJECT NAME: CAMI:3ELL
DESCRIPTION: Replacing Tubich': wer.
OWNER: CAMf3ELL, MARTA 1 <, PHONE #:
CONTRACTOR: RAYE3OC;N'S PLUMBING INC PHONE #: 603-692-4139
Inspection Request Scheduled For: Date: 4/222/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
322 Shrfver pan 068736-01 503-692-4139 Y
Corrections /Comments /Instructions:
I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL _ CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: whil.../WV — Date: CH 2;21 071 Phone #: (503) 718-