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Permit CITY OF TIGARD PLUMBING PERMIT 0 COMMUNITY DEVELOPMENT Permit #: PLM2010 -00362 T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/03/2010 Parcel: 2S110DD05700 Jurisdiction: Tigard Site address: 10660 SW HIGHLAND DR Subdivision: SUMMERFIELD NO. 4 Lot: 157 Project: Fletcher Project Description: Installing (2) shower pans. Owner: FEES FLETCHER, GILBERT J & ARLENE F Quantity Description Date . Amount 10660 SW HIGHLAND DR TIGARD, OR 97224 2 ea Tub /Shower /Shower Pan 11/03/2010 $25.02 PHONE: 1 12% State Surcharge - 11/03/2010 $8.70 Plumbing 47 ea Minimum Fee Adjustment - 11/03/2010 $47.48 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 $81.20 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.669• •r 1.800.332.2344. Issued By: - Permittee Signature: !c> ` s CaII 503.639.4175 by 7:00 a.m. for an inspection that business day. This permit card shall be kept in a conspicuous place on the job site until completion of the project. Approved plans are required on the job site at the time of each inspection. -503 691 2328 Rayborns Plumbing t 10:58:42 a.m. 11 -02 -2010 1 /2_ Plumbing P ermit Appl `� 1 � g 0 Building Fixtures 1:1- Pernik Na.: O F(112 11FFl( 1: l'`l. ONI 1 s V City of Tigard `` P Received // - j ;� • 131 SW Hall Blvd., Tigard, OR 97223_, 1 S \ DateS •: v - • - , 1 V Plan Review Phone: 503.639.4171 Fax:503.59$s� G Date/By: Other Permit No.: T I u A k n Inspection Line: 503.639.4175 \�O� \'` Date Ready By: fwo: RI See Page 2 for Internet: www.tigard- or.gov f1� Notified Method: 7 j XP Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For s erlalln orma use checklist. Description Qty. Ea. 1 Total dition /alterationheplacement ❑ Other. New I- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath I 312.70 21 - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.7R - ❑ Accessory building ❑ Multi - family SFR (3) bath 500.32 Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other: Fire sprinkler (_ sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: LO6d W N, k ii_ 0 f Catch basin or area drain 18.76 Drywell, leach line. or trench drain 18.76 City /State /ZIP f, ,, v cA © e Cri= Li Fooling drain (no. linear ft.: _) Page 2 Suite/bldg. /apt. no.: Project name: �t .lat 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: l Lot no.: Fixture or item: Tax map/parcel no.: Back(low preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 25.02 1 A, i "D SL P�-4 -� s Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture'sewer cap 25.02 Floor drain/Boor sink/hub 25.02 Address: 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: P v / % r 1 U ‘AA,N H . q ,\1\..c c Medical gas (value: $ _) Page 2 6 Primer 12.51 Contact name: m a \ t2 \A e �MCJ�� . 1 n D �� Roof drain (commercial) 12.51 Address: 1 l t DQ to Sink/basin/lavatory 25.02 City /State/ZIP: Jf7lr j.., ,,,,____ D r at1O6D Solar units (potable water) 62.54 Phone: ( 503 ) li 9D_ q 1 3 of Fax: : (503) ‘5;v_ Tub /shower /shower pan rs 12.51 v� E -mail: AA' Urinal 25.02 25.02 E-mail:,/4& i rn S �Q w� Water closes 25.02 CONTRACTOR r Water heater 37.52 Business name: ea 6 ,�// fit S RQ1A.�.",` , - Water piping/DWV 56.29 Address: fe .>, _5/ G onto J 9 Other. 25.02 City /State/ZI ! (Jt t ,,...__. 0 r ari 06 Subtotal Phone: - 3 ) (9-_ v/ 3 Y Fax: (: fj a gy Minimum permit fee: $72.50 ?) t 51) CCB Lic.: 6 - Plumbing Lic. n..: 3 _Lc Plan review (25 %ofpermit fee) ,. ' >'r� / ' State surcharge ( 12% ofpennit fee) 1.7 Autho signature: ` /�� ►ta TOTAL PERMIT FEE ✓ $' i ,lj � �� i Print name: �� Date://_,2_/0 I This pe rmit applic ation expires if a permit b not obtained within ISO days i /'It' after it bas been accepted as complete. •Fee methodology set by Tri County Building Industry Service Board. 1: B uildineermits:PLMU.PennitApp.doe 1001 09 440- 4616T(10 WEB) tirnki✓urr( L. sty how