Permit C ITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2006 - 00420
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 10/3/2006
PARCEL: 2S 101 AA - 09700
SITE ADDRESS: 12587 SW 68TH AVE ZONING: MUE
SUBDIVISION: PP1996 -024 LOT: 001 JURISDICTION: TIG
Project Description: Cap hub drain, add 2 water closets and 2 lays. 11/28/06 changed address (from 12585 68th Ave)
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: B FLOOR DRAINS; 1 TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MARK NIELSON
7150 SW HAMPTON Description Date Amount
STE. #228 [PLUMB] Permit Fee 9/12/2006 $83.00
TIGARD, OR 97223 [TAX] 8% State Surcha 9/12/2006 $6.64
Phone : 503 -582 -5777 Total $89.64
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -4139
FAX 503- 691 -2328
Reg #: 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 or 1.800.332.2344.
Issued By: Permittee Signature:
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.
_Sep. 12. 2006 10:00AM _R Plumbing No. 6230 P. 1
•
Plumbing Permit Application '- 1.OR (.)FFICE USE O N'L1
City of 'Iagard C Deeei
13125 SW Hall Blvd., Tigard, OR 97223 SEP 06 PPan RRevi 0 b db Permit No. Lode ..- y2.0
Phone: 503.639.4171 Fax: 503.598.1960 ia:a: `-'2 Date/By: Other Permit N 2;406 . e=I g
24 Hour Inspection Line: 503.639.4175 I , j i if o :,,,,,...4......11.1 ' Date Ready/By: r"''' El Sere Page 2 for
Internet: www. ci.tigerd.or.us
:VT e r a a - R Nonfied/Malttod Supplemental Iaforwetlon
i i i -L
r ,� 7'4 _ •-'-' t '„ 1 - -( C [ t, c. ' fi 1 C I S , ' c '1:',..-.,'.:.;- i tr c r j Fit- ,....7:::'''::`.:;:."5 1
❑ New construction ❑ Demolition FO special in/6rmuaion use chseklist
ddition/altuation/replacement ❑ Other:
Description Qty. Ea. Total
,., - �s x -. 1- Y � (includes R for
New �famll dwelli in es 100 reach utility
*wf t t t. `d lie 1 / ,' e) t L , .1t-L:. '' (
: t...1... - g SFR (1) bat 24920
❑ 1- and 2 - family dwelling ommercia1Pmdustrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
O Master builder ❑ Other: Each additional bath/kitchen 45.00
f77:7 - ; i ; . y ,. . `.i � 1 , .f Llt( - ;-7,--,-...-7:-7 , ,:17:2. , :-,1-',-; < ,t.l: l ( 9 ft.) I
_ Fire sprinkler s . ft. Page 2
,:" Site afflatus
Job site address: ) ZS 8'S" S W 6 g' ke . Catch basin or area drain 16.60
City/State/ZIF -77 or AP Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: �A-• 4� L,� Footing drain (no. linear ft.: _ Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector I6.60
Sanitary sewer (no. linear (t.: ) Page 2
Storm sewer (no. linear R: _) Page 2
Subdivision: I Lot no.:
Water service (no. linear ft.: ) Page 2
Tax map /parcel no
Fixture or Item
�-- T - Absorption valve 16.60 •
,. ..� _ _ _ .I. ,, - Bsckflow preventer Page 2
. �,. �, „ •� Backwater valve 16.60
Lod Clothes washer 16.60
Dishwasher 16.60
7 i �) S.�s:. ,
. j l -,..7. ; -:1 ' -
;,7 t - --, Drinking fountain 16.60
4 .
-....,. ,..... .. :.F. . , . _ . . < . _ ..
.. ._ .t . .. . ........ ._ _. _ . .: , _.73.,..__ .2, Ejectors /sump 16.60
Name. Expansion tank 16.60 _
Address: Fixture/sewer cap 16.60
City/State/ZIP: Floor drain/Boor s' ub / 16.60 /6 , 4
Phone; ( ) F ax; ( ) Garbage disposal 16.60
rTzLtr,71---7 a s .f t; , I : s S t I , Hose bib 16.60
.. ';1 .7 ,. .._.,.. ..... .. .� -t ..; ',',.i:
,_ ,1...,,'-____:.
___-',_ .. aker
-
' , .. .`. .. __ �" Ice m 16.60
Business name:
ItLiMS f %,aabr. Interceptor /grease trap 16.60
Contact name: &, D Medical gas (value: S ) Page 2
Address: I4cj70 SW C %ade RI Primer 16.60
-
7 Or p94./ 97D6? _ Roof drain (commercial) 16.60
City/State/ZIP: �, % 1
Sink/basin/lavatory z 16.60 3 , 20
Phone: (503 ) 692, - y/33 I Fax: : (Sd3) 64/ -232.7 Thb/shower /shower pan 16.60
E-mail: y() Itizybcet corn
r -7,r� 1 s ....r3 11 r ^ ,1 rr' ., -
}� h T' i f 'j , - _ j Urinal l 6.60
+!:,.: �i . . .. +1 . !.., < ..: . ,: , _ ' .;_..> .. - Water closet 16.60 3 • I ,2
0
• Water heater 16.60
�.
Other.
Subtotal ,itff0-
CitylState/ZIP:
`7 Q A a 47 AZ
I � Minimum permit fee: 572.50
Phone: (Sb3 ) 69Z - Si/39 Fax: (503) 61) - t.321? t.321? Residential backflow minimum permit fee: S36.25 *
CCB Lic.: ' 78 s' 7_ ' Plumbing L'c. no.: 3v- /,O,9 Plan review (25% of permit fee)
Authorized signature: ���� State surcharge (8% of permit fee) 4,./if �� �/'�/ TOTAL PERMIT FEE .;•► �,.
Print name: R4 6 y Der�r;f tannlk Date: 9 : / L 06 Thia permit appllcatiou expires if a permit is not obtaiae . within
180 day after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
! • �
islsuiking ■pertaluaLtd- PUmitApp.doa 06/05 4404616T(lo /o2/COI.t/WEn)
CITY OF TIGARD
BUILDING DIVISION -• PERMIT #: PLM2005.0U420
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/3/2006
Phone: (503) 639 -4171 At
Inspection Requests (24 Hrs.): (503) 639 -4175 07 I I..
INSPECTION WORKSHEET FOR DATE: 11/20/2006 TIME: 7:01AM PAGE: 36
4251'7
SITE ADDRESS: -3W 66TH AVE CLASS OF WORK:
SUBDIVISION: PP1996 - 024 LOT #: 001 TYPE OF USE:
PROJECT NAME: NF_ILSON
DESCRIPTION: Cap hub drain, add 2 water closets and 2 lays. NEILSON
OWNER: NIELSON, MARK PHONE #: 503.582 - 6777
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 -692 -4139
Inspection Request Scheduled For: Date: 11/20/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 040020 -01 503 - 692 -4139 N
Corrections /Comments /Instructions:
i
7
C z g „..2. A. ,
[V PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED '
lector: r Date: U 1 ( Phone #: (503) 718- 2-17/
CITY OF TIGARD
BUILDING DIVISION #: PLM2006-00420
- 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/3/2006
Phone: (503) 639 -4171 , 0 1 4 001 1
Inspection Requests (24 Hrs.): (503) 639 - 4175 '
INSPECTION WORKSHEET FOR DATE: 11/16/200 TIME: 7:00AM PAGE: 57
Ps
SITE ADDRESS: 42685 SW 68TH AVE CLASS OF WORK:
SUBDIVISION: PP1996 LOT #: 001 TYPE OF USE:
PROJECT NAME: 1T LSON
DESCRIPTION: Gap hu drain, add 2 water closets and 2 lays. NEILSON
OWNER: NIELSON, MARK PHONE #: 503.582 -5777
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 -692 -4139
Inspection Request Scheduled For: Date: 11/16/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 039855 -01 503-692 -4139 N
Corrections /Comments /Instru k
Y J
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS . 1') FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Z u�" `� Date: 1 1 „ o ` Phone #: 503 718- ° A
Inspector: ( )
CITY OF TIGARD .
BUILDING DIVISION - J PERMIT #: PLM2006-00420
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/3/2006
Phone: (503) 639 -4171 eaV
Inspection Requests (24 Hrs.): (503) 639 -4175 1 �..
INSPECTION WORKSHEET FOR DATE: 10/4/200 TIME: 7:0 PAGE: 45
(5"K7
SITE ADDRESS: _12IRv, SW 68TH AVE CLASS OF WORK:
SUBDIVISION: PP1996 - 024 LOT #: 001 TYPE OF USE:
PROJECT NAME: NEILSON
DESCRIPTION: Cap hub drain, add 2 water closets and 2 lays. NEILSON
OWNER: NIELSON, MARK PHONE #: 503 - 582 - 5777
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503- 692 -4139
Inspection Request Scheduled For: Date: •1014/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 037640 -01 503 -692 -4139 N
Corrections /Comments / Instructions:
`PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 1 Date: / 6 / 1/ ( 1.
Phone #: (503) 718- "-