Permit II
q CITY OF TIGARD
PLUMBING PERMIT
: ; o COMMUNITY DEVELOPMENT Permit #: PLM2010 -00258
T [ c A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/06/2010
Parcel: 2S112CB00600
Jurisdiction: Tigard
Site address: 8200 SW ROSS ST
Subdivision: Lot: 0
Project: Hoggan
Project Description: Connect existing house to new water service, approximately 30'. NOTE: HOUSE MUST BE
DISCONNECTED FROM WELL.
Owner: FEES
HOGGAN, RICHARD E /GAYLE A Quantity Description Date Amount
15233 SW 81ST AVE
TIGARD, OR 97224 30 If Water Service 08/06/2010 $62.54
PHONE: 503-639-1259 1 12% State Surcharge - 08/06/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 08/06/2010 $9.96
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 $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility N • ' cation Cen - Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
or di ct questions to OUN •y calling 503.246.6699 or 1.800.332.2344.
Iss •dBy: k .� ` Permittee Sign •.�
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
-503 691 2328 Rayborns Plumbing 12:31:38 p.m. 08 -06 -2010 1M
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503691232$ Rayborns Plumbing 11:23:50 a.m. 08435 -2010 1 /2mnewas
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Plumbing Permit_pnlicatio . -° - . ` .
Site Utilities `' a 0.
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City Of Tigard P�CI ��
• 13125 SW Bolt Blvd., Tigard, OR 97227 d /l'i.�T��� r i �Q�QO! Il
Phone: 503.639,4171 Fax: 5413.598,1960 .... .. ' r ': • ' "iti
I®peetioa Lime 503.639,4115 Datet9 : Other Permit We.;
Internet: www,dgard-or.gov Date aeagwgy ,:e See rap 2 for
NntifsedAllsetbnd: Sv •.. ... al alternation
TYPE OP WORK
1FRE" SCHEDULE
❑ New construction ❑Demolition For . dal; , ?maims use ? bark //q
® Addition/alteration/replacement ❑ Otter Des " •u • Fes. Total
New 1- 2 -4imii dwell! .•. (inckxla 100 H. far mach util• connection)
CATEGORY OF CONSTRUCTION Milliii. 312.70
® 1 -and 2- Family dwelling ❑ Coramattai/indusorial 437.78
1:1 Accessory building ❑ Multi-family SPR (3) huh 500.32
ID Mater builder
Path additional bathJkitohon 23.02
�] Other; Fire rinkler
JOB SITE INFORMATION AND LOCATION mP �� ft) Poge2
Site mill ■ ;
lob site address: 5200 9W Rosa Catch basin or arm drain 18.76 MEM
City /State/ZIP: Tigard, OR 97224
Dal verll. leach line, retrench drain
Suite/bldg./rm. stn,: Project name: Noggan Footiregdmim(nn.litteorn. ) Pogo
Manufactured ttorncutifirtea Nig 50.03 ii =
Cross strecUdireclions to fob site Ran and Ross Manholes
16.76
Rain drain connector ■ ., 18. Mil
- - - ~ Saniwry xewex iron? ft.: _ ) Page 2
Storm awe (no, linear ft.: ____) r P 2 MEI
Subdivision: Weer servire(no.lineerlt,: , lex Page
Lot no,;
Tax map/parcel r1o,: Backlbw • revere? LB
DESCRIPTION OF WORK eadtwatetvatvc 1231
•
New Wateraervice 41 L � //� Dishwa washer r 25.02
�� Dhnwaehcr 25.02
/ I * Drink: , fountain 25.02
25.02
I$ PROPERTY OWNER I ❑ TENANT E. .. - 12.51
Name RiekNeggaa Featurdaawercap 25,02
Address? 15233 SW 81 Ave _"— Floor drain/floor ainitJllub 25.02 IN
City/State/ZIP: Tigard OR 97124 — Casbigedrapttaal .
Nom 25
bib 25.02
Phone (503 )639.1259 Fax: ( ) Ice stalker
12.51
❑ APPLICANT ❑ CONTACT PERSON Imaueptodgtmactrap 2502 Mil
Cosiness aortae: Page
Contact name: 12,31
Address: �` "' Roof drain (committal)
„___. ... IMINIMIni
City/Slar/ZIP: Birdt/b4dm/la�amy 62.54 25 02
Sularw in (potable water) 62.54
Phone ( ) Fax:: ( ) Tub/showodsIWwerpan 12.51 NEM
E-mail: Urinal r
25,02
CaN771ACTOR,
Water clout 25.n2
Business name? Raybora'1 Thumbing }ac Water homer 37,52
Address: P.O. Rol 69 Waterpiping/DWV 5629
Oho: 25.02
—
City /State /ZIP: Ts: dart, OR 97068
Subtotal 12.54
Phone: (503)6924139 Fax: - ∎ )691.•2328 Minimum
S permit fee. $7230 72.50
• CC8 Lit.: 87853 P y ingLic. nn.: • 106PB Plan review (23% of permit fee)
• Authorized signature: State urt:harge(12 %ofpermitfeel 8.70 '
���• L/ TOTAL PERMIT F
•
Print name: Kenneth A. Ptovaacrer ff 81.20 '
_I Datc: Peal 0 7 - h amok appaeerlon mare. a x aermu b net obnilund .?hide t tb darn
filer it hat yawn accepter in eompleR•
'Fee methodolog me hy Tri•County Building; Iadw.try Sena bard.
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