Permit CITY OF TIGARD
PLUMBING PERMIT
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; DEVELOPMENT SERVICES PERMIT #: PLM2003 -00528
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� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/1/03
SITE ADDRESS: 09070 SW 66TH AVE PARCEL: 1S125DA-00200
SUBDIVISION: ZONING: R -4.5
BLOCK: LOT: JURISDICTION: TIG
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: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 100 ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: 1st. floor /basement water repipe (min. permit per Mike S.)
FEES
Owner:
Description Date Amount
WHALEN, VALERIE L
9070 SW 66TH AVE [PLUMB] Permit Fee 10/1/03 $72.50
TIGARD, OR 97223 [TAX] 8% State Tax 10/1/03 $5.80
Total $78.30
Phone : 503 245 - 7545
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 4139 Water Service Insp
Final Inspection
Reg #: MET 00001806
LIC 87852
PLM 34 -166PB
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.
Issued By : F�L� .4 / Permittee Signature: g t I,�� t,g
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Sep -30 -03 07 :40A Rayborn's Plumbing, Inc. 15036912328 P -01
•
Building Fixtures FOR OFFICE USE ONLY
Plumbing Permit Appli s EIVED
Date i B to% tie P „ : ; -
Ci ty of Tigard f {� Planning Appro Sewer
93125 SW Hall I 61vd SEP v 2UtJ Date, By Permit No. :
Plan Review Other
Tigard, OR 97223 Date / By : Permit No. :
Phone : 503 639 -4171 Fax 503 598j 6,t1OF TIGARD Post - Review Land use
inspection line- 503639 -4175 BUILDING DIVISION Date /By Case No. :
Contact Jurisdiction : t. / •
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❑ New Construction ❑ Demolition Description :.. r ::: 1 Q y I ach Total
r Addition/Alteration /Replacement u Other : . 5 ; �;�i 14.0
o/ Repair o Others : SFR (1) bath 5255.00 50.00
;r M :: •;; `� t ^ bath 5315.00 $0.00
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One & Two Family Dwelling u Commercial / Industrial SFR (3) bath 5375.00 50.00
o Accessory Building o Multi- Family Units ❑ Each additional bath / kitchen 5155.00 $0.00
❑ Master Builder ❑ Others : Fire sprinider - Sq Ft : . _ 2
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Job site address: 9070 SW 66'" Ave Catch basin or area drain 516.60 50.00
Suite : T Bldg / Apt # Drywall, leach line, or trench drain 516.60 50.00
Project Name : Whalen Footing drain (no. Linear Ft : ) • Page 2 50.00
Cross street / Direction to Job : Thomas Guide 655 H1 Manufactured home utilities (each) 5110.00 50.00
Manhole 516.60 $0.00
Subdivision: ILot no.: Rain drain connector 516.60 50.00
Tax map/lot/account ( parcel # ) : Sanitary sewer ( no linear ft : )• , Page 2 50.00
11E5� .
;:: Storm sewer (no linear It )• : Page 2 $0.00
1 floor / basement water repipe - Minimum permit per Mike Shears. Water service (no linear ft : )• , Page 2 $0.00
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Absorption valve 516.60 50.00
r ' s:• :i ;<.:% •:; Backflow preventer Page 2 $0.00
Name : Valerie Whalen Backwater valve 516.60 50.00
Address : Same Clothes Washer 516.60 $0.00
�Ity / State / Zip: Dishwasher 516.60 $0.00
Phone : - 7 S y 5 : Drinking fountain 50.00
,,,,., : :: ..; . ... ..:. ;.t. . ,s' ' >; <::::: s: % ax: :° •s'..,.. s f :`a : < - Jectors / sump $0.00
Drin 518 60
Name :r Expansion tank 516.60 50.00
Address : Fixture / sewer cap 516.60 50.00
.",ity / State / Zip: Floor drain / floor sink 1 hub 516.60 50.00
Phone : !Fax:: Garbage disposal 516.60 $0.00
r• <;,:;;>< r; >;; -:f: Hose Bib 15.00 $0.00
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Business name : RAYBORN'S PLUMBING Ice Maker 516.60 50.00
Address : P. O. BOX 69 Interceptor / grease trap 516.60 $0.00
City/ State/ Zip : TUALATIN, OR 97062 Medical gas (value : 5______)•* Page 2 50.00
Phone : 503 6924139 Fax : 503 691 -2328
CCB Lic : 87852 Exp: 12/03 Metro Lic : 01806 Exp : 7104 Primer 516.60 $0.00
(" ` Roof drain ( commercial) $16.60 50.00
Authorized 4/ J .if- h-G,`le.) Sink / basin / lavatory - 516.60 50.00
Signature : / JP Lic : 40T5JP Exp: 4/ 05 Tub / shower ! shower pan $16.60 50.00
Print name : Wayne Slebold bate : 9/30/03 Urinal 516.60 50.00
Water closet 516.60 $0.00
Water heater 516.60 ^ $0.00
Others : Water repipe 1 516.60 516.60
Notice : This permit application expires of a permit is not obtained within 516.60 50.00
Others : 180 after it has been accepted as complete.
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Permit Subtotal : 572.50
Minimum permit fee 572.50 / Res Backtlow 536.25: 572.50
Commercial Plan Review (25% of permit fee) :
State Surcharge ( 8% of permit fee) : $5.80
Total Permit Fee : - 578.30