Permit CITY OF TIGARD PLUMBING PERMIT
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` COMMUNITY DEVELOPMENT Permit #: PLM2010 -00222
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/14/2010
Parcel: 2S 111 CA05600
Jurisdiction: Tigard
Site address: 9440 SW LAKESIDE DR
Subdivision: Lot: 0
Project: Rossman
Project Description: Replace tub /shower unit.
Owner: FEES
ROSSMAN, JO Quantity Description Date Amount
9440 SW LAKESIDE DR
TIGARD, OR 97224 1 ea Tub /Shower /Shower Pan 07/14/2010 $12.51
PHONE: 1 12% State Surcharge - 07/14/2010 $8.70
Plumbing
60 ea Minimum Fee Adjustment - 07/14/2010 $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 ByJ� =C Permittee Signature:
D`i/ /9-70/46 /ems /v
Cali 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 09:07:39 a.m. 07 -12 -2010 1/20®
Plumbing Permit Applica [ : i � ."T
Building Fixtures ► r►u t11 l ir� I t , 1:, ().1 \' -
City of Tigard JUG 1 3 2010 v
y g Received �7
Date'B : 7 / h ` Permit No. a f,2 - / 7 0 ��1--
13125 SW Hall Blvd., Tigard, OR 9 i 1 -) � �� l / o[ • r `�}�� Plan Review Other Permit No��O ���3 �/
Phone: 503.639.4171 Fax: 503.598R-40 1' P . By: Li
11 ;':1;n:6, Inspection Line: 503.639 BUILDING DIVISION Date/By. Ready/By: �� See pple Page ental 2 for t
... Internet: www.tigard- or.gov Notified; Method: le • Sumlnfurmation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. j Ea. I Total
ddition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
5 - . nd 2- fancily dwelling ❑ Commercial /industrial SFR (2) bath 437.78
J SFR (3) bath 500.32
❑ Accessory building
❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. 0.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: yy O � J r Catch basin or area drain 18.76
/� Drywell, leach line. or trench drain 18.76
City/State /ZIP:
Gf u r 0 r q /�`. li Footing drain (no. linear ft.: ) Page 2
Suite /bldg. /apt. no.: J 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
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item: -
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/�
/ / r Clothes washer 25.02
Grey /Qee ' ,b/ / �Ls€ r 0 IA l 4 Dishwasher 25.02 •
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Floor drain/Boor 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: pQ rK S /4.,m, h i kt 14 t- Medical gas (value: S _) Page 2
A/ / 9 Primer 12.51
Contact name: i t /1 40//. I Roof drain (commercial) 12.51
Address: /gor ,Sp/ e / ;k , R�J Sink/basin/lavatory 25.02
City /State /ZIP: - , ` Or Q O6-a Solar units (potable water) 62.54
Phone: (�3 ) 6 7_ _ LH 3 q Fax: : (.-,63) C a j -� .3�q Tub /shower /shower pan / 12.51
E -mail: /fore ,-, terns. t!O te- Urinal 1 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: R a/ 6 0114 1 . PlV l ` ._ Water Pg/
i P m DWV 56.29
Address: • % i • C 4 Other: 25.02 •
City /State /ZIP' _ ,t; permit . a 6 Subtotal
�/
( �3 ) � �� y p i (5 3 6 4 / - ea+ MinimuMinimum rmit fee: 572.50 "2 g _ 5'o
Phone: ,? Fax: v ) ,�
6 Plan review (25% of pennit fee
1 CCB Lic.: , . 5Z 'lumbi , ic. no.: 3 - t 6 P
..- State surcharge (12% of permit fee) k
Authorized signature: / ��r / TOTAL PERMIT FEE
Date:t" /^ This permit application expires if a permit is not obtained within 180 da)i
- • / i / l /t;/ after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1 Building• Perms' I- PermitApp.dor 10 01.0 4 40-- 016T(10112 WEB) V/ ze)