Permit CITY OF TIGARD PLUMBING PERMIT
0 COMMUNITY DEVELOPMENT Permit #: PLM2010 00322
T i G A R C) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2010
Parcel: 2S114BD03800
Jurisdiction: Tigard
Site address: 16560 SW COPPER CREEK DR
Subdivision: COPPER CREEK NO. 3 Lot: 78
Project: Bremner
Project Description: Shower pan installation.
Owner: FEES
BREMNER, CAROL D Quantity Description Date Amount
16560 SW COPPER CREEK DR
TIGARD, OR 97224 1 ea Tub /Shower /Shower Pan 10/07/2010 $12.51
PHONE: 1 12% State Surcharge - 10/07/2010 $8.70
Plumbing
60 ea Minimum Fee Adjustment - 10/07/2010 $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. 144.
Issued By: Permittee Signature:
/PA1
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 03:43:29 p.m. 10 -06 -2010 1 /2-
Plumbing Permit Application \
Building Fixtures
li1/41c,,,;‘4 �0 1.1)K 014 I'SI: ()NIA ()NIA ti
City of Ti and Received •
.� 1 • 131 S W Hall Blvd., Tigard, OR 97223 s\ ` \ rq,SOo '8 to 's [ 8 Permit No.: PiAck to ....00 x
Phone: 503.639.4171 Fax: 503.598.1960 � �` � \t=\ a #Review
, te;By: Other Permit No.:
. I , 1 , Inspection Line: 503.639.4175 (`
Internet: Line: garl- or.gov �+ \ \N� O Date Riy: luris: I 65 See Page 2 for
` \,,, Notified' Method: - j (p Snppkmertal loforroatioo
TYPE OF WORK V FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Addition /alteratiotr/replacement ❑ Other: Description J Qty. Ea. Total
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath J 312.70
01- 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
❑ Other: Fire sprinkler ( sq. ft.) Page 2 1
JOB SITE INFORMATION AND LOCATION Site utilities:
C
Job site address: / /S‘O �' w Copper /" i Catch basin or area drain 18.76
[[ � �� � �
City /State /ZIP: -r'� 0. Drywell, leach line, or trench drain 18.76
V M r Q ry y
Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: Project name: , M* L . 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
Store sewer (no. linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map. /parcel no.: Backtlow preventer 31.27
A ` DESCRIPTION OF WORK Backwater valve 12.51
IA fat Q i. S k AwQY' . Clothes washer 25.02
Caw Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City/State /ZIP:
Garbage disposal 25.02
Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
R APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Ca r ` t Medical gas (value: $ ` ) Page 2
Contact name: Primer 12 51
Vi,, le_ fre,i4d Roof drain (commercial) 1251
Address: / 9'9d Sw G t / 1
�' 11 Q 01
Sink/basin/lavatory 25.02
City /State /ZIP:
1 tl ee.I U} • 0 r ef rj06 Solar units (potable water) 62.54
Phone: (bj03) 6q - q1 el Fax: : ( ) ) /y/ _ �. . Tub/sh /shower pan 12.51 4 , y
6 �.
E -mail: d e , , - ,e L._ „, Urinal 25.02
--- y Water closet
CONTRACTOR 25.02
Business name: a.+ I µ
( , Water heater 37.52
1
% Water piping/DWV 56.29
Address: a • 0 ' • .\ -
1
∎ Other 25.02
City/State/ZIP: va \o,_,\A ! . 06) Subtotal
Phone: (spa) 6'.•/1 - L 13 4 Fax: (5D3) 6 C'1 . '1 p Minimum permit fee: $72.50 . '7 6 Z 9j
CCB Lic.: g a 7 '� P u bing Li .: 3 x, •} 66 p t . Plan review (25 %ofpecmit fee)
Authorized signature 's�� »/
State surcharge(12 %ofpennit 1 5 '�
r� ./i ' TOTAL PERMIT FEE i i� g
Print name: ,� s - 0
This permit application expires if l
, s aPP P permit is not obtained within 180 days
Date:
after It has been accepted as complete.
/-♦ e 1 G L `I ��
*Fee methodology set by Tri- County Building Industry Service Want.
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