Permit
n CITY OF TIGARD PLUMBING PERMIT
>s COMMUNITY DEVELOPMENT Permit#: PLM2009-00303
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/22/2009
Parcel: 2S 102AA02200
Jurisdiction: Tigard
Site address: 9125 SW CENTER ST
Subdivision: Lot: 0
Project: Meyer
Project Description: Change tub/shower and repipe water lines from galvanized to wirsbo.
Owner: FEES
MEYER, A H & INGRID Quantity Description Date Amount
9125 SW CENTER ST
TIGARD, OR 97223 1 ea Tub/Shower/Shower Pan 10/22/2009 $12.51
PHONE: 56 da Misc Other Fee 10/22/2009 $56.29
1 12% State Surcharge - 10/22/2009 $8.70
Plumbing
Contractor: 4 ea Minimum Fee Adjustment - 10/22/2009 $3.70
RAYBORNS PLUMBING INC Plumbing
PO BOX 69
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: Permittee Signature:
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 10:52:47 a.m. 10 -21 -2009 1 /2
' Plumbing Permit Application
Site Utilities � D FOR OFFICE: last: ONE)
CI of Tigard Received i ,
ill g r ry p Date /By: w / d1 /I. Permit No.:/ a /tn /► g
• 13125 SW Hall Blvd., Tigard, OR 97223 C T 2 1 L��J Plan Revie LTl �rI ��7
1 Phone: 503.63 Fax: 503 Other Permit No.:
Date/By:
Inspection Line: .. D ate Ready/By: r HI See Page i< n K n I ti Li 5036394175 CITY OF TIGARD ge z for
Internet www.ttgard- or.gov ILD
BU / orma
- L7 d) f ��v��� Notified /Method �� Supplementallnf nun
.. ,a `. .. . TYPE OF WORK - _ .. •l * SCH -.
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. I Ea. I Total
® Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
.- : ;':j CATEGORY , OF- Cor sr tuCTION . SFR (1) bath 312.70
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler(sq. ft.) Page2
JOB SITE INFORMATIQN AND LOCATION Site utilities:
Job site address: 9125 SW Center Street Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/ZIP: Tigard OR 97223
Footing drain (no. linear R.: _) Page 2
Suite/bldg. /apt. no.: I Project name: Meyer Manufactured home utilities 50.03
Cross street/directions to job site: 655 E4 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear R.: _) Page 2
Stonn sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: 1 Lot no.: _ Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRRTION OF.. WORK • . :. ; Backwater valve 12.51
Clothes washer 25.02
Change Tub /Shower to Shower. Repipe Water lines from Galvanized to Wirsbo Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
i. ,.., ' ®. PROPERTY' OWNER 1 .0 TENANT - - - Expansion tank 12.51
Name: Meyer
Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 9125 SW Center Street
Garbage disposal 25.02
City /State /ZIP: Tigard OR 97223 Hose bib 25.02
Phone: (503) Fax: ( ) Ice maker 12.51
0 APPLICANT I ' ' . - ' ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: 5 ) Page 2
Business name: g
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax: : ( ) Tub /shower /shower pan 1 12.51 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Rayborn's Plumbing Inc Water P(I
i p to DWV 1 56.29 56.29
Address: P.O. Box 69 Other: 25.02
City /State /ZIP: Tualatin, OR 97062 Subtotal 68.80
Phone: (503 ) 692 -4139 Fax: (503) 691 -2328 Minimum permit fee: 572.50 72.50
CCB Lic.: 87852 Pli bing Lic. n.: 34 -166PB Plan review (25% of pennit fee)
State surcharge (12% of perrnit fee) 8.70
Authorized signature ,�a �i�� I TOTAL PERMIT FEE 81.20
Thi permit application expires If a permit is not obtained within 180 days
Print name: Kenneth A. Provancher Date: 10/21/09 after it has been accepted as complete.
'Fee methodology set by Fri- County Building Industry Service Board.
1 \Ruildinv , Pennies' P LNU- Pmm;App.doc 10.01 440.4616T(10 \tWERI