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Permit CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2010 -00278 T1GAAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/25/2010 Parcel: 2S103DA06300 Jurisdiction: Tigard Site address: 10920 SW PARK ST Subdivision: MIRA PARK Lot: 1 Project: Wolfrum Project Description: Replace tub /shower Owner: FEES WOLFRUM, J T DELANE AND ALICIA Quantity Description Date Amount 10920 SW PARK ST TIGARD, OR 97223 1 ea Tub /Shower /Shower Pan 08/25/2010 $12.51 PHONE: 1 12% State Surcharge - 08/25/2010 $8.70 Plumbing 60 ea Minimum Fee Adjustment - 08/25/2010 $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 By: Permittee Signature: / /VIC /9-7J/oG /C' �/r' �✓ 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 08:54:37 a.m. 08 -23 -2010 1 /2 • p ;7r) Plumbing P 1 " 4.7-7, " a" ` �` '" y ermit A pplication . _ c :� s i Building Fixtures AUG 2 4 I )R t)1 11r 1 l �j� O.1 \d `' City of Tigard Received � Tj 13125 SW Hall Blvd., Tigard, OR 97223 Cry 4 7 j ■Da Re v r7ZS �d !r r Permit No.. PLM ,2v /O _ .0007 /43 ■ Phone: 503.639.4171 Fax: 503.598.1960 BUILDING a' TtDat�B Inspection Line: 503.639.4175 Other Permit No.; 7 1l 1 t.'l� .: Date Ready /By: . Internet: www.tigard- or.gov r� for Notified/Method: i v l Supplemental Page 2 1 u atioa TYPE OF WORK FEE* SCHEDULE ❑ New construction I ❑ Demolition For special information use checklist iQ Addition /alteration/replacement j l ❑ Other - Cnption Qty. Ea. Total New 1- 2- family dwellings (includes 1 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) 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 0 Fire sprinkler ( R JOB SITE INFORMATI AND LOCATION �' ) Page 2 _ Site utilities: Job site address: /t?9� O S idi) ail 7/ �'„( Catch basin or area drain 18.76 City/State /ZIP: l� J 01(... /I � © F �r y� cif. Drywell, leach line, or trench drain 18,76 Suite/bld / t. no.: � � Footing drain (no. linear ft.: ) Page 2 gap I Project name: //�� ^ V�� 1 If Manufactured home utilities 50.03 Cross street/directions to job site: Manholes /_ _ � 18.76 (o S S-- & 1 Rain drain connector 18.76 Sanitary sewer (no. linear ft.: ) Page 2 Storm sewer (no. linear ft.: ) Page 2 Subdivision: Water service (no. linear ft.: ) Page 2 I Lot no.: Fixture or item: Tax map /parcel no.: Backtlow preventer I 31.27 DESCRIPTION OF WORK Backwater valve 12.51 p t Plel e. ,G 1.L/ /,' _ Clothes washer 25.02 W Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51 Name: WO ire Ctiri Fixturelsewercap 25.02 Address: / Q M n 5 !tJ Q Floor drain/floor sink/hub 25.02 v Garbage disposal City/State/Z1P: l� ,,f 25.02 V c d ` Ca / �j g p 74 a ? Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: $ ) Page 2 Contact name: Primer 12.51 Address: Roof drain (commercial) 12.51 Sink/basitv lavatory 25.02 City rState /ZIP: Solar units (potable water) 62.54 Phone: ( ) ( Fax: : ( ) Tub /shower /shower pan 1 12.51 i Z$`/ E -mail: Urinal 25.02 CONTRACTOR Water closet 25.02 • Business name: y� U k ,[ i L Water heater 37.52 0 / "7" (,ti</j1 to e- Waterpiping/DWV 56.29 Address: & other: 25.02 _ City/State /ZIP: [ U 0 ,) f,D/ 97i) 6,/.. Subtotal / 2$ Phone: (SO') 6f' -i�//39 Fax: ( leaf 6 */ - t23. rj Minimum permit tee: S72.50 "71 / le�S i \ t / 1 CCB Lie.: g" ' plu- �tn Lic. no 3/ r7 � Plan review (25 %o!'permit fee) Authorized signature: . r State surcharge( 12% of permit fee) 7„� l e^ �� TOTAL PERMIT FEE op Print name: This permit pp p p a �. attivj tt, 1 Date: 641 !d p mit a lication expires if a permit is not obtained within 180 days after it has been accepted as complete. *Fee methodology set by Tri- County Building Industry Service Board. 1: Building Pennits'PLMfl- PermitApp.dnc 1001.09 4 40-4610T(10'02 COM WEB)