Permit II CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00339
13125 S W Hall Blvd., Tigard OR 97223 503.639.4171 Date issued: 10/20/2010
TIGARD Parcel: 2S111DC13200
Jurisdiction: Tigard
Site address: 15915 SW OAK MEADOW LN
Subdivision: Lot: 0
Project: Skorupa
Project Description: Install tub /shower
Owner: FEES
SKORUPA, WALTER A & MARIAN M Quantity Description Date Amount
15915 SW OAK MEADOW LN 1 ea Tub /Shower /Shower Pan 10/20/2010 $12.51
TIGARD, OR 97224 1 12% State Surcharge - 10/20/2010 $8.70
PHONE: Plumbing
60 ea Minimum Fee Adjustment - 10/20/2010 $59.99
Plumbing
Contractor:
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: DN-\ 1 9 r/ o z . / e
/L1ul 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 11:13:49 a.m. 10 -18 -2010 1 /2.
Plumbin Permit A lic ' ?MD
Building Fixtures
City of Tigard )C.1 1 1 9 7ikO Receives P ermit N u G
IN
13125 SW Hall Blvd., Tigard, OR 9 223 ��pQ�(� Date*: �d ld � /d ' (�Q 3�• /
Phone: 503.639.4171 Fax: 503. � ^TI GAR Plan Review
1' a. M Date/gy Other Permit No,:
Inspection Line: 503.639.4175 V, "II IV
I I t ,:\ t I l - NGD Date Ready!By1 hi : la See Page 2 for
Internet: www,tigard- or.gov 313 T 11 Notified/Method: en br I Supplemental late mrtion _
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use check /1st
Description 1 Qty. 1 Ea. 1 Total -
ja Addition/alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
1 -and 2-family dwelling SFR (2) bath 437.78
Y g ❑ Commercial /industrial
❑ Accessory building ❑ Multi- family SFR (3) bath 500.32
ID Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler ( sq. R) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: _
Job site address: /� /6 5 w O k M Q a GOI.�J L Catch basin or area drain 18.76
FoYWell, leach line, or trench drain 18.76
City/State/ZIP: ..--.1...., C{ week Q r Gt 7 D.:- 9
- t Footing drain (no. linear ft.: __-) Page 2
Suite/bldg. /apt. no.: 1 Project name: .5 i e "fr 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: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31,27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
In 61-(LA 1 dS (d w e. r Dishwasher
25.02
Drinking fountain 25.02
Ejectors/sump 25.02
,$0 PROPERTY OWNER l ❑ TENANT Expansion tank 12.51
Name: / .5/..< D2 u fig Fixture/sewer cap 25.02
Floor drain/floor sinlv'hub 25.02
Address: s
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: '`✓ 6 r IA S d v taa, b' 1...�1( I (C- Medical gas (value: S _) Page 2
� '/ Y Primer 12.51
e J a
Contact name: Ak f vtJJ% t
Address: t 1 S W C; eo1 e n Roo/ ( si n la story (commercial) 15.01
1 RA Sink/basin/lavatory 25.02
City/State/ZIP: . I +i iA D r - C OO 6.._ Solar units (potable water) 62.54
Phone: (, -;) 6.9 - L. Cf Fax: : (50 6 q j - aj� Tub/shower /shower pan / 12.51
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
1 Water heater 37.52
Business name: kv° ° r14 S N4 u'� \ v k N �/�� Water P
17 i r p
DWV 56.29
Address: `et r5 e_,...."1 vote Other. 25.02 -
City /State/Z121° cl.. ∎ it_ 0 r c ' 06 Z Subtotal
1
hone ( ) C12-49,9 Fax: ( CO) 6 k 1 a3 Minimum pennit fee: S72.50
b. g Plumbing Lic. no.: �_ Plan review (25% of permit fee)
o
UUU'vv 3 t l t 6 6 L Sta te surcharge 12% of it fee) ^ ate. _. r8 ( R )
Authorized signature: r'�J/ TOTAL PERMIT FEE
i t
cat
Print name: I\\ ` Date' This permit appliion expires If a permit Is not obtained within 180 days
�a + t' h !GOn . 1 ^ , .. :, 0 _ fig I O after 11 has been accepted as complete. /
'Fee methodology set by Tri.County Building Industry Service Board. ✓/
I- Budding Tennits`.PLMU -Penn itApp.dor 10.0109 440.46IbTI10(0''COM,WEBI 2�
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