Permit • - 4r c c Le - work S LN
CITY TIGARD LUMBING PERMIT
COMMUNITY DEVELOPMENT • PERMIT #: PLM2007 -00371
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/17/2007
PARCEL: 2 S 112C B -00402
SITE ADDRESS: 15220 SW 81ST AVE ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: LAM
Project Description: Run new water line. 9/24/2007 ADD backflow device and expansion tank, fees waived per Building
Official.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:4111111
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 55 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
CAHN LAM
15220 SW 81ST AVE. Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 8/17/2007 $72.50
[TAX] 8% State Surcha 8/17/2007 $5.80
Phone : 503 -956 -1080 Total $78.30
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 ' : Hi' / t// Permittee Signature: P/9/9/1‘614-1-
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.
.�` Aug. 16 2007 9:32AM Rayborns Plumbing No, 6579 P. 1
P
Tl _ \}
-1 u�nbine Permit Application
FOR OFFICE USE ONLY
City of Tigard Receiv
13125 SW Hall Blvd., Tigard, OR 9722 t I Dat ®/13y: O I 63- S(,(� Permit No.: 1 700 Phone; 503.639.4171 Fax: 503.598.1960 //ra,a PlauReview �3
24- Hour Inspection Line: 503.639,4175 A 1 b 1 ', + bate/By: Other Permit No.:
n us date Ready/By: �„T,x;
� s t, NO fied/Metliod -► i ®Sea Pare 2 for
Internet: www ci.tigard o
V ' � a ar '1? i �i� lY f a � I{ c ?'r xXt t b � ' R i e / ! Supplemental Information
+..; �i .P.� i..:-0; ;+" x i r a ; . a r i �_'t , <Y J .4Ey, n l ' , ; •` T
^'} ,. 1 &r . ,� ".�._.tit44. :.d,(x r �L w i /. `. 1' .l � fW r t l i i),'=(.4•4' , :E t P fi S 5 �r � c id
Ut WV■emo Won For information u s e h : k ` � m„ � s
❑ New construction B
For special u se checklist
Ali Addition/alteration/replacement ❑Other: Description I Qty. I E1 Total
y r f :� w ,,; Y A �`& Tyusr k? i »� r A � . New 1- 2- family dwellings (includes 100 ft. for each utility connection
�. 31ra .'r +Il l' ism. - E ` 73 1 .f0, 0 '.+: p g,l 1 (Ii 4N t " ''Mm' . 4 £ connection)
-.. ,..._ a, "pea 5 ,. .- '�. K r''nO SFR (])bath 24920
S I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath
350.00
❑ Accessory building ❑ Multi-family SFR (3) bath 399.00
Each bath/kitchen 45.00
❑ Master builder ❑ Other;
s
€ i a i ,, p ,^" ry tri ` �W 1 Np, a S c Fire sprinkler ( s ft. I
rn; ]I' S a e ll t 6 t 9 a �q' p 9 ) Page 2
Y•; Y, . � ,�ak rs site ut
Job site address: j S 22.0 c4.- SY ¢i .v
City/State/ZIP: 1 n
Catch basin or area drain 16.60
_44:. _44:. ` q
7 L'. Drywall, leach line, or trench drain 16.60
Fooling drain (no, linear ft.: ) Page 2
Suite/bldg./apt. no.: Project name:
Cross street/directions to job site:
Manufactured home utilities _ 1 10.00
Manholes 16.60
7 Rain drain connector 16,60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: `15S - ) Page 2 SS
Tax map /parcel no.: Fixture or item
ly,1 := SPA ,P,,20„74„ " ,MI.IF t t 4 (; " o RIPE M Absorption valve 16.60
l : i a 2 w. i } 3 6 i { }16MF
a.(M } r . a RC" p
s 1 �= r. s , , �, a Backflow preventet
Page 2
e-ri-n. 7�.._
i_,
t' j' ` • Backwater valve 16.60 -
Clothes washer 16.60
yt Dishwasher 16.60
C �aY1,lt rrrf '7, ,1L v Sfv 6Y { m n, ""° Drinking.fountain 16.60
' r a' 1 t 0,a r ®xa i v ste m . +4 ' `' ' ia r `4'. '.sl f 1 IT� ^ y,� f AT tar. . Ckr
, >+ x`17, a � Y
Name: ( 4
Ejectors /sump 16.60
Address: Expansion tank 16.60
�S �a ws`1 rr U Fixture/sewer cap
']'r. 0 '3 L - 16.60
City /State /ZIP:
// � ��" �" � _Floor drain/floor sink/hub 16.60
Phone: ( U ) C
S o pZ� Far ( ) Garbage disposal
�"�i �1 N,,, 0• r"rP : -1 i . s(,. ., y +xr._ v. 3 s� 16.60.
Silt ;t.Arahi^..j 3r3 � s;w0.L { �ata , ii° s� :�": *�r °' � �) q, • / Hose bib 16.60
.�..a ,�1_ ti�' f „I,„, •� r'1. ice maker
Business name: y. I , m 16.60
[� �/ � f Y (nterccptor/greasc trap 16.60
i
Contact name:
Medical gas (value: $ ) Page 2
Address: ) ,5 20 $ ( d p �
�' Y�cr Primer 16.60
City /state /ZIP: To-.., ti OA. U Roof drain (commercial) 16.60
Phone: (9_,) ) C54 _, 4,-,(1 Fax: : g' 0( _27 2 If, 5ink/besin /lavatory 16.60
E-mail: r Tub /shower /shower pan
_ .4 16.60
if �,� ' M t� �� t'r +.! ,r , c ,� �'� S " erl �iir� Gr >.
�, Urinal 16.60
w., � . r., Wate c loset 16.60
Business name: ' v r�S r.
Ci Water heater 16.60
0
Address: C cc,/ etP�> Other:
: 5` S,'
City /State /Z1 1 x A. 7‘; ‘-‘ ( A � Z ?22 y Subtotal . 5
Phone: (5'C.,1) 6 2 Z- er7 i Fax: (So ) Minimum permit fee: $72.50
�? � Z Residential backflow minimum permit fee: $36.25 72 So
CCB Lie.; 8 `f S'S2__ P umbing Lie. no.: Plan review (25 /o o
8 � � , �G�P of permit fee)
Authorized signature: \��� - State surcharge (8% of permit fee) S-`
r TOTAL PERMIT FEE 2 8-7;
Print name:
•e-�_ V ' 4 f•if. , - a Date: 8'-/c .. 7 l ` This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
Id $lPrrmla3 API M -Fermi gDD. dos oaros "Fee methodology set by Tri- County Building Industry Service Board.
440 - 45 6T(I0 /02/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007-00371
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/17/2007
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 9/3/2008 7:01AM PAGE: 38
SITE ADDRESS: 15220 SW 81ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: LAM
DESCRIPTION: Run new water line, 9/24/2007 ADD bacl4low device and expansion tank, fees waived per Building
Official.
OWNER: LAM, C-AHN PHONE #: 503-955-1080
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503-692-4139
Inspection Request Scheduled For: Date: 9/312008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 074964-01 603-692-4139
Corrections /Comments/ Instructions:
De.) Ut.:•e_ r< 14(4130 • /J "re e-'1" Re r(A E,Lc 6,-
LX
PASS Li PARTIAL APPROVAL Li CANCEL fl NO ACCESS
fl FAIL Li CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: CJ tiviaLA Date: C I 1 3 ) o r Phone #: (503) 718-
CITY ZFyTIGARD
••• -
BUILDING DIVISION PERMIT #: PLM2007 -00371
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8117/2007
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 A-
INSPECTION WORKSHEET FOR DATE: 8/12./2007 TIME: 7 :01AM PAGE: 42
SITE ADDRESS: 15220 SW 01ST AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: LAM
DESCRIPTION: Run new water line.
OWNER: LAM, CAHN PHONE #: 503 -956 -1060
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 - 682 -4138
Inspection Request Scheduled For: Date: 8/122007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 055550 -01 503-692-4139 N
Corrections /Comments /Instructions: •
I 1.- A„'z ✓ 5i e.v ∎`ca: pvdv &
Co Cir CV ( C o �, J � 0- Co .Jr:VvA 0 "--/(- -,/ I
6v t'•CaVVirb D % C. L.0 F 10 t,./ R16 C c� ,v\ ,may ,J O -1 rcA„,
i A e. W a -\-a 1\A ' a,/ )4(4 /01 t4 t/:da--N .S a) J V" 2 6 o3
I PASS PARTIAL APPROVAL I I CANCEL n NO ACCESS
n FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: J V �'''"' ( Date: e i + l2 z•) Phone #: (503) 718-