Permit y CITY OF TIGARD PLUMBING PERMIT
1111 COMMUNITY DEVELOPMENT
Permit #: PLM2011 -00002
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/05/2011
Parcel: 1S134DC11300
Jurisdiction: Tigard
Site address: 11530 SW GALLO AVE
Project: MERCER Subdivision: CASCADIAN PLACE Lot: 2
Project Description: (3) hose bibs.
Contractor: RAYBORN'S PLUMBING INC Owner: MERCER, SCOTT D &
19990 SW CIPOLE RD MERCER, VALERIE GAY
TUALATIN, OR 97062 11530 SW GALLO AVE
PORTLAND, OR 97223
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
3 ea Hose Bib 01/05/2011 $75.06
Specifics: 1 12% State Surcharge - 01/05/2011 $9.01
Plumbing
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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 -0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.198 2344.
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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 11:41:56 a.m. 01 -05 -2011 2/2 __m.
Plumbing Permit Application
Building Fixtures ! ° " rt,lz urrl(i 1
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City of Tigard .„ .i: ® Permit No.: PliNti i� b�
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13125 SW Hall Blvd., Tigard, OR 97223 \ c 9teview
:1 B Phone: 503.639.4171 Fax: 503.598.1960 � ....,,<(‘ c \ Other Permit No.:
1 �, is n Inspection Line: 503.639.4175 s \ SO Dat NotiPee Rea d Metho d: S S
Internet: www.itgard- or.gov 0\ �O \'` turn- See Page 2 far
`` �� upplemental Information
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TYPE OF WORK V ' FEE* SCHEDULE
❑ New construction ❑ Demolition For special informadon use checklist
Description I Qty. I Ea. I Total
Addition /alteration /replacement ❑ Other. New 1- 2- family dwellings (includes 100 ti for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- family SFR (3) bath 00.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler ( sq. fl.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: // 6 ‘44/ 6 d LL p 4 e. Catch basin or area drain 18.76
•" (,v tt 1
/'1 Dryweli, leach line, or trench drain 18.76
City/State /ZIP:
D � Q � 1 •-) Footing drain (no, linear ft.: _) Page 2
Suite /bldg. /apt. no.: Project name: 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: 1 Lot no.: Fixture or Item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
/ 4 s� // Nos b ‘, ' S Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address:
Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
'El-APPLICANT ❑ CONTACT PERSON Interceptor, /grease trap 25.02
, Business name: 10 r v Medical gas (value: $') Page 2
- • J.,. •
�/,y� / I .
LA L.. NI Primer 12.51
Contact name:
- Roof drain (commercial) 12.51
Address. \4p,q .44w G �ole
Sink/basin/lavatory 25.02
City /State /ZI'
f 0 6 Solar units (potable water) 62.54
Phone: (S2)3 ) 6 _ lit 3 4 1 Fax: : (503) G Lt t ..:D.4.6 L . Tub/shower /shower pan 12.51
E- mail: 4c/ie Q rely Laovµ S. Lai"--- Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: kz, t , 'S e L
uwtb�LA Waterpiping/DWV 56.29
Address: . o / , /„ e , Other. 25.02
City/State /ZIP: N. 0 Y 170 C �... Subtotal /O �
Phone: (Q3) /c� _ i.11 3 !' Fax: ( " c i - a3D_g Minimum permit fee: $72.50 7 h J
l/ 1 ;} Plan review (25% of permit fee)
CCB Lic.: g ' 7 / Plumbing ' . no.: 3 _ 1 + ` 1 ,
State surcharge (12% ofpennit fee)
Authorized signature: ��/� -- TOTAL PERMIT FEE I (--
Print name:... f_' u l� Date: / - 3 // This permit application expires if a permit is not obtained with 180 days
v � after it has been accepted as complete.
"Fee methodology set by Tri -County Building Industry Service Board.
I. Building. Permits,PLMLI- Penny App. doc 10 01 09 410- 161bT(10'07.COM WEB)