Permit CITY TICS ®D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 -00312
DATE ISSUED: 6/23/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 102 B D -00100
SITE ADDRESS: 09905 SW MCKENZIE ST ZONING: R -12
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT: 052 JURISDICTION: TIG
Project Description: Replace water service.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: El 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: 180 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ROMAN CATHOLIC ARCHBISHOP OF Description Date Amount
PORTLAND IN OREGON
2838E BURNSIDE [PLUMB] Permit Fee 6/23/2006 $101.40
, PORTLAND, OR 97214 [TAX] 8% State Surcha 6/23/2006 $8.11
Phone : Total $109.51
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: — 3),- Permittee Signature:
CaII 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. 22. 2006 11:04AM Rayborns Plumbing No. 3717 P. 1
Plumbing Permit Application -
FOR UhhIC'F USb, 01\T'.1� � � {
City of Tigard N E® Received /
13125 SW Hall Blvd., Tigard, OR 972BE Dat / �( �j `' Permit Na'7� \<2/166-0014L
Phone 503.639.4171 Fax: 503 - 598.1960 �� F , ti p Plan Review
2 2006 ��I Other Permit No.:
24- Hour Inspection Line 503.639.4175 JU 2 �� �` l�� ; , „ Dale Re
Internet www CI ttgard or us ,..1'.... Date ReadyBy. ruri ; ® See page 2 for
GA Notified/Method: '
w f ,. {, }- n t-rr' �-r-,- -,� V Supplemental Information •
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3 �- . �:�- fi. ;4 ` t < 1.>.I t e- € .s 7.5 , , ul , 1 c : , f y? . r 1 a k-- 1 Y e + r ,
t} ---_fi -... ) _o: , , yz; ,7 ;(.t ,...2,,,.1 y... ..`i. L : � Y �T � I d1jv { n.,., 2 �k i s it 't
1=1 New construction ❑ Demolition Ft" Veda' information use checklist u t
/. Addition/alteration/replacement ID DescrttGOn Qty. Ea. J Total
war ,��,, � New 1- 2-fa Lily dwellings (includes 100 R. for each utility connection)
+ �§u a v ^�i ; y 1 � 5- 1•r 1 -,..„ z,.„ ..,,,,I.,„ ,R !l - ^ -,^, ! r .. i'3 1;177
io n a - +G rP X1, r r a .4 {o i ! r i ? t e , r t� . l'= 1- rl t•?
, ial . stria) „( f, �.,...1• - SFR (1) bath 249.20
■
❑ 1- and 2- family dwelling _-• _ : merclaUindustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder Other: Each additional bath/kitchen 45.00
i.. {1 0 11x-7 W,'''`c i ,'11+r•t? ?ftf"' '7'_x19 i' ,.r , - TT Fires sprinkler S
1 k k ,. hli f i.1 ..:, rq:1!11 J 111 1 0/ 40 t) t (PR",? U tJ - 1g �31r �P � ! , ,V4 .f 1 y, P ( _ q• ft) Page 2 • S,,.ra a. 1�F .r. 11 .3n..,6•2_�i? 7if;...1..E . f 45:.,1:.. .;,..f SitC
Job site address: , 7 o,s ,sit) �C G. i :e 57 Catch basin or area drain 16.60
City/State/ZIP: j SyQ,�, QRes el ../ � �' Drywell, leach line, or trench drain 16.60
/Y I s Footing drain (no. linear ft.: ) Page 2
Suite/bldg./apt. no.: j Project name: Sr
Cross street/directions to job site: 7 Manufactured home utilities 110.00
•
Manholes 16.60
Pain drain connector 16.60
Sanitary sower (no. linear ft.; � Page 2
Story sewer (no. linear ft,: - ) Page 2
Subdivision: Lot no.: Water service (no. linear R.: /51e) ( Page 2 /0 /, yQ
Tax map /parcel no.: Fixture or item
'' trt^ -rx114 n, �
47.4.7/ , r r , Absorption valve 16.60
p�i ! ` { ¢ ♦$ 3 } ts ! nx 7:1 .`i'r j t t n " h t 11
r - tt} R ory ) F' 1 ) dl .7 + rr " 51 - . s i "'
`itC1 r,..2ig } 12 - , )1:, . } ^ - ..4 zc ' :t.t! .,!!._ , r(,. i•~,.? .1.. ;∎. ,: ...t .1'c � 7 t
Lf ) f [ / :L 13ackflow preventer MI Page 2
4r - let S 'rr/SC r o /ace 4t le 07 Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
3s .
Fa f ; , r rr t t t , v iz.w=ir r! t ! 1 �- - • blinking 16.60
p , ,. t^'�vF Nj1,d ,},4Z 1i/ G r Ii \ y ! 1p2, (,5 gfountarn
�,.,,1,.. -3 .. , t ,. :lc, ... 3I� `i te.1 -E7.i hi,e ,F... e?:,t '
., ._._,:.., , „ f , , _,Ejectors/sump 16.60
Name:
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
47 �` u� ;9 ^ t '� 1 � fTji�- / Si r 9 1 3-- -f ./ 1 47 1 .S ., , , Hose bib
l,,b, 1 r1 �� d 1644, r t 3 t I { cf lu ?p.i;i0l1i frt tc l� �R .4 (` tt 16.60
o ttL_..: Ni Tar i .; {.•,.• I. ,:E1i �-1:77., .KL% -JIL' ,.,. ; i ma
,. -.l. � F,.. 16.60
Business name: R2aybvr i. Plu„r1J
Contact name: Randy f Interceptor /grease trap 16.60
De d4.04,11 Medical gas (value. $ ) Page 2
Address: /595 SW Cr et j Primer 16.60
City/State/ZIP: 7 5 -1, o 9 Roof drain (commercial) 16.60
Phone: (5x3 64'Z- yis I Fax ::15 ) 4V -23Z7 Sink/basin/lavatory 16.60
E -mail: ra n al y @ /ticybo,„ s • corn Tub /shower /shower pan 16.60
Y v e Rm T , Urinal 16,60
.;.CT. t,. r ' f l ,u 1 u t t r t"" -, 7'} L h,. li
r�. ! i } l 3 T 7;, igig• i vl- tr a3�` i1 niMi t7i r ;ti� y ' , T t .. 11 1 `
i ;,rte 1 1 3� ,,, arx��t ,,,.1_'5=7., .! rz r?)Et. ,._._ ... z� ,r� 1 ,r� Water closet 16.60
Business name: Ra Gr. /15 ��uM b%b water heater 16.60
Address: 9 15 D so e o. P P Other:
city/State)ZIP: 7 /4 �5 .� . OA"' 9 7n t5 Z Subtotal /o�. yp
Minimum permit fee: $72.50
Phone: (S03) 65 Z ' yi.i) Fax: (503 ) - ' - L3 Zg Residential backflow minimum permit fee: $36.25
CCB Lic.; 8785 Z Plumbing Li cj,.• /6(, Plan review (25 %of permit fee) lirja
/ State surcharge (8% of permit fee) e ,
Authorized signature:
/ /I TOTAL PERMIT FEE .rsQl '
Print name: ti , y pecan on ( G Date; 6 - a Z-O This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete. ��Q . S/
*Fee methodology set by Tri -County Building Industry Service Bo
is\Building\Pennit \PLM- PcrmitApp,doc 06/45 441146 I 6T(1 0/02/COMMEB)