Permit Ai AYE �' �� ® PLUMBING PERMIT
PERMIT #: PLM2008 -00122
� � COMM UNITY DEVELOPMENT
t DATE ISSUED: 3/25/2008
fTIG 13125 SW Hall Blvd. Tigard, OR 97223 503.639.4171
°` �'' "" PARCEL: 2S104DB -00300
SITE ADDRESS: 13159 SW BROADMOOR PL ZONING: R -4.5
SUBDIVISION: AMESBURY HEIGHTS LOT: 003 JURISDICTION: TIG
PROJECT: TSURUTA
Project Description: Installing (2) plumbing fixtures and (1) hose bib.
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: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
!SAO TSURUTA
23 HILLSIDE Description Date Amount
EAST HANOVER, NJ 07936 [PLUMB] Permit Fee 3/25/2008 $72.50
[TAX] 12% State Surch 3/25/2008 $8.70
Phone : Total $81.20
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- I66PB
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: �� 7,��iiXc�l/
Amy
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.
Mar. 24. 2008 11:54AM- Rayborns Plumbing No. 1719 P. 1
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Plumbing_PermitApplicatiora t X f ,:() ( Isl.. ()\,. •
City of Tigard -
ECEIVEilifinfiff015 a� • 13125 SW Hall B ' f *+ lvd., Tigard, OR 9
P Phone: 503.639 4171 Pax: 5035';.P60 F
Inspection Line: 503.639,4175 tVI A R 2 L U u $ ,
I
Date Ready/By: /ad.: Id SCC Page 2 for
nternet; www.tigard -or.gov - e'.. .. f• • .. T1TE wO r iL .1$3 'qbge y .. - •FEE SL DTII.E
❑ New construction ❑ Demolition For :pedal lnjormakon use checklist
C, Addition/alteration/replacement E) Othe.r
. Descri i tion Ki11.1.13. Total
New 1- 2-family dwellings (includes 100 ft. for each utility connection)
t t
- and 2- family dwelling ❑ CammerciaUindustrial 350.00
0 Accessory building ❑ Multi- family bath 399.00
- Each additional bath/kitchen
El Master builder El Other 45.00
Page 2
' JOB $frE; INPO1 AT)<ON AND LOC,4TiOPi :;
Job site address; / SW 4 1 ad . r'' �� • Catch basin or area drain 16.60
City /State/ZIP! e.% , . L 9 .0.2 Drywell, leach line, or trench drain 16.60
.. _ .. name: Footing drain (no. linter 8.: ) page 2 -
• . Manufactured home utilities 110.00
Manholes 16.60
Storm Rain drain conpector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Page 2
Subdivision: Lot no.: '
Tax map /parcel no.: ' Item
»E5CRWTJO1� O FWOR1c s o
B ckfl w proventcr Page 2
r Backwater valve 16.60
Clothes washer
Dishwasher 16.60
d t , t , ® Drinking fountain, h
Name Ejectors/sump L6.60
Expansion tank .1.1 16.
Address: s Si • h Fixture/sewer cap 16.60
::; tate/ZIP S , f e. A 7 .. 16.60 -
t✓ 4 Fax: ( ) • 16.60 ME
0 M. PI,ICAPTf CO MT P iti3OPf 16.60
Business name: A , Zorn i ., c 16.60
Interceptor/grease trap 16.60
COIItsct name;
.. I/ _ air Page 2
Address: : O 4' - 16.60 FrifIlef
9 -
City /State/Z1P: T:r. , • A" ; 7 .04 . 16 -60
Phone 3) G - Z_ 3 - ` Fax: ig G '7.--.7. 3 , . �� 16.60 pm'
pan .' 16.60 nil
E•mail w i h^O
Urinal ME I6.60
CONtE s OR
' •n .': 16.60
Business name: , s : is . ' / ` , C. Water heater 16.60
Address: 'e A . r. Other:
City/State/ZIP: -- _ ,
.- t ' , r-.z• 7 ac.- :0
Minimum permit fee: $72.50
backflow ., .S Plan review (25% of permit fee)
Authorized ignature: i� ,r j State surcharge (12 %ooFpermit fie) $ 7
TOTAL PERMIT FEE EglIM
Print name: j �/, i j Date:. Q , This permit application ex pire s if a permit is not obtained within
180 days after it llae been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I: \auadinsTecmital.,M-PemmAap.doc n6/26/O6 440- 4sierpWovcomium)
CITY OF- TIGARD
BUILDING DIVISION PERMIT #: PLM2008-00122 _
13125 SW Blvd. Tigard, OR 97223 DATE ISSUED: 3/25/2088
Phone: (6b3) 639 -4171 '�- '� �
3
Inspection Requests (24 Hrs.): (503) 639 -4175 _� � _...
`INSPECTION .WORKSHEET FOR DATE: 3/2612008 TIME: 7:OOAM PAGE: . 49
SITE ADDRESS: 13159 SW 13ROAf)MOOR PL _ 2 CLASS OF WORK:
. ISUBDIVISION: AMESBURY HEIGHTS LOT #: 003 TYPE OF USE:
PROJECT NAME: TSURUTA
DESCRIPTION: . 1rmslalling (2) plumbing fixtures and (1) hose bib.
OWNER: TSURUTA, 1:3.AO PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 - 697.4139
Inspection Request Scheduled For: Date: 3/2612008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 . Plumbing rough -in 067317 -01 603- G92 -e1139 Y
Corrections /Comments /Instructions:
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: OIA,4,,1/4,4\\ 4 Date: .3 116 6 O7) Phone #: (503) 718-
10/8/2008
Case Activity Listing__ �/✓ l 1:28a3aivt
CCEL Case #: PL 0 8 -00122
Assigned Done Updated
Activity Description Date 1 Date 2 Date 3 Hold Disp To By By Notes
PLM1010 Application received 3/24/2008 None RECD BTT 3/25/2008
BTT
PLM1020 Permit created 3/24/2008 None DONE BTT 3/25/2008
BTT
PLM 1030 Check for parcel tags 3/24/2008 None DONE BTT 3/25/2008
BTT
PLM 1260 PLM signature on 3/24/2008 None DONE BTT 3/25/2008
application BTT
PLM1280 Issue permit 3/25/2008 None DONE BTT 3/25/2008
BTT •
PLM2320 Plumbing rough -in 3/25/2008 3/26/2008 3/26/2008 None PASS JW 3/26/2008 067317 -01 — 503- 692 -4139 — VM -
STI Y
7. iflri
61j
4/Ve/O 6
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Page 1 of 1 CaseActivity ..rpt