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Permit v CITY OF TIGARD PLUMBING PERMIT .114 a COMMUNITY DEVELOPMENT Permit #: PLM2010 00294 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/07/2010 Parcel: 1S125DD08200 Jurisdiction: Tigard Site address: 9735 SW VENTURA CT Subdivision: WASHINGTON SQUARE ESTATES NO. 3 Lot: 90 Project: Hurt Project Description: Shower pan replacement. Owner: FEES HURT, JOHN C AND TERESA A Quantity Description Date Amount 9735 SW VENTURA CT TIGARD, OR 97223 1 ea Tub /Shower /Shower Pan 09/07/2010 $12.51 PHONE: 1 12% State Surcharge - 09/07/2010 $8.70 Plumbing 60 ea Minimum Fee Adjustment - 09/07/2010 $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: Aitiler 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 09:50:19 a.m. 09 -07 -2010 1 l2. Plumbing Permit Application Building Fixtures RECEIVED Km (}v11(.1. 1.4. (1 \I , City of Tigard Received Date : : 7 Ar Q -yip Permit No.: P um, , t o - . 13125 SW Hall Blvd., Tigard, OR 97M ,C tp Q 7 2.0}0 Plan Review ' V ' Phone: 503.639.4171 Fax: 503.598. KM r0 Date/By: Other Permit No.: Inspection line: 503.639.4175 Date Read B )u c: ® See P e 2 for I Inter www.tigard- or.gov CITY OF TIGAR Notified Medved: fQ Supplemental Information TYPE OF v1d,D1NG DIVISIO FEE* SCHEDULE ❑ New construction ❑ Demolition For speciallnforrnation use checklist. Description 1 Qty. 1 Ea. l_ Total O Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500.32 ❑ Accessory building ❑ Multi- family Each additional bathl itchen 25.02 ❑ Master builder 0 Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: g736.- ,SGrJ V e a? t V ✓� Catch basin or area drain 18.76 �! +' Drywell, leach line. or trench drain 18.76 City /State /ZIP: l l i U ✓eA © j 917;'031 3 g Footing drain (no. linear ft.: _) Page 2 Suite/bldg. /apt.no.: I Project name: Aldo_ 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: I Lot no.: Fixture or Item: Tax map /parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 /� Clothes washer 25.02 N C-� . ee V c' '.__. Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: i ✓� + Tkv 4 TC.t'tcy,t Fixture/seuercap I 25.02 1 Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City /State/ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 .OAPPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 t � 1 Medical gas (value: S _ Page 2 Business name: - ,l `p0 a vt, S t U vt..1,0 t (ti L Primer 12.51 Contact name: Ake4 . /./44, l b.._ R oof drain (commercial) 12.51 Address: /9qf' .sue Gi ft, (e_ . Sink/basin /lavatory 25.02 City/State /Z1P� Ifs Or alp 62- Solar units (potable water) 62.54 - Phone: (4t;b3) 0.3. - yt j et Fax: : (4 3 ) ,(Q►/ . ? ^ti g Tub:shower /shower pan I 12.51 E -mail: Urinal 25.02 -� e� Tay ,Gat, --_ CONTRACTOR Water closet 25.02 I Water heater 37.52 Business name: D S Fl is 'Ala% is IA L Water pipingiDWV 56.29 Address: /x 6 She/ C 4' Lt J Other 25.02 City/State/ZIP: :� / - d, q7,0 .7_ ____ Subtotal Phone. y�,ry, s ) (f/ ' . .► .J�' Minimum permit fee: 572.50 -)�,,.,l/ 1 6 7 ., y�3Y Fax: (�✓,j✓ Plan review (25 %ofpermit fee) , CCB Lic.: ' 7 s, Plu mbin: .Lic. no.: '� / 1 State surcharge (12% of permit fee) 7� r Authorized signature: ,r ' �+ . . TOTAL PERMIT FEE /"° �� g'(J �/ This permit application expires if a permit is not obtained wi n 88 days Print name: ,(�y� �. �te� after it has been accepted as complete. �^ *Fee methodology set by Tri- County Building Industry Service Board. I. BuildingtPa mgr PLMIJ.Permit App.doc 10 HA 440461bT(1P02'COM•WEB)