Permit ; ,` CITY OF TIGARD PLUMBING PERMIT
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4; a COMMUNITY DEVELOPMENT Permit #: PLM2010 -00218
;;:TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/13/2010
Parcel: 2S111CB01721
Jurisdiction: Tigard
Site address: 10250 SW KABLE ST
Subdivision: HOOD VIEW NO. 2 Lot: 20
Project: Dorr
Project Description: (1) clothes washer and (1) sink in Laundry room.
Owner: FEES
DORR, PATRICK M Quantity Description Date Amount
JANICE M, 10250 SW KABLE ST
TIGARD, OR 97224 1 ea Clothes Washer 07/13/2010 $25.02
1 ea Sink 07/13/2010 $25.02
PHONE: 22 ea Minimum Fee Adjustment - 07/13/2010 $22.46
Plumbing
Contractor: 1 12% State Surcharge - 07/13/2010 $8.70
RAYBORN'S PLUMBING INC Plumbing
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 503.246 609 :00.332.2344.
Issued By: 011 Permittee Signature: 1."71
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.
503 691 2328 Rayborns Plumbing i 1:26:21 a.m. 07 -OS -2010 :11_
Plumbing Permit Application >r N T,,-- "
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Building Fixtures
111 8 2) t r I (111 (>111< 1 l ." (1 \I l ;
City or Tigard
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a 13125 SW Hall Blvd., Ti a rd, OR 97223 , s'' Permit No /°
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I Phone: 503.639.4171 Fax: 503.598.1960 C\ 1 t . . 1 y F�iew Other Permit No.:
t 'I � Inspection Line: 503.639.4175 e 1 �� r �' •
r i 1�� Y
Internet: www.tigard- or.gov j Nate Ready /By: kris: DI See Page 2 for
NotifiedAfethod: re Su .•, lemmas! Information
TYPE OF WORK FEE" SCHEDULE
i ❑ New construction ❑ Demolition For special information use checklist
X Addition /alteration/replacement ❑ Other: Description Qty. ( Ea. Total
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
J, 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler ( sq. It) Page 2
Site utilities:
JOB SITE INFORMATION AND LOCATION g
es:
Job site address: /002 SO S' ) /�,ak... Catch basin or area drain 18 76
City /State /ZIP: Q4 .-d oe 97.2.4 y Drywell, leach line, or trench drain 18.76
Footing drain (no. linear ft.: -) Page 2
Suite/bldg. /apt. no.: Project name: Oh r1�
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: 1 Lot no.:
Fixture or item:
Tax map /parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Z e t, �� t s ett z... Clothes washer -, 25. � �
c./[�4/✓ Dishwasher 25.02
Drinking fountain 25.02 Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture /sewer cap 25.02
Address: Floor drain floor sinkhub 25.02
City/State/ZIP: Garbage disposal 25.02
Phone: ( ) Hose bib 25.02
Fax: ( ) Ice maker
12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas t value: $ ) Page 2
Contact name: Primer 12.51
Address: Roof drain (commercial) 12.51
Sink/basin/lavatory WM 25.02 QZ,
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub shower/shower pan 12.51
E-mail: Urinal 25.02
CONTRACTOR Water closet 25 02
Water heater 37.52
Business name: ✓ s r %one. J
�
er e
Water 25
V 2
Address: 10 h3G/r • . 0 2
Other: 25.02
City /State /ZIP: . , ' die 97x62_ Subtotal 5 j
Phone:,¢ Q ) 6 9Z - /3 - Fax: ('v3 6 9/ -x3.3 Minimum permit fee: 572.50
7
• r ' � C Lie.: 6 7tpS.2 Plumbing Lic. no.3�t4 6 /26 Plan review (25 "6 of p nit fee}
h State surcharge (12% of pemtit fee) ; , (�
`
Authorized signature: GQ4.2_
TOTAL PERMIT FEE 8 0 2. 0
Print natne:/ii ,., ,,�� Date:, /g��� This permit applkaHon espires if permit is not obtained within 180 days
�/�/ 1 after it has been accepted as complete.
*Feu methodology set by Tri- County Building Industry Service Board.
I. building Pamir PLMI; Pmntl App.Anc IO UI 09 145 -45 I ITI>0 -02 COM WEB)
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