Permit CIT r OF TIGARD PLUMBING PERMIT
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6:��I DEVELOPMENT SERVICES PERMIT #: PLM2005-00128
DATE ISSUED: 3/29/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S111AD - 13500
SITE ADDRESS: 15119 SW 91ST AVE ZONING: R -4.5
SUBDIVISION: MALLARD LAKES LOT: 001 JURISDICTION: TIG
Project Description: Replace water service.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
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: 60 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CAMERON, DUNCAN D + DEBORAH K
17984 SW FREDERICK LN Description Date Amount
SHERWOOD, OR 97140 [PLUMB] Permit Fee 3/29/2005 $72.50
[TAX] 8% State Surcha 3/29/2005 $5.80
Phone : 503- 803 -2068 Total $78.30
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Phone : 503- 692 -4139
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.
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Issued By: 17ejj Permittee Signature: IF)�pN
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
,
Building Fixtures
PlumbinE Permit ApblicatioruvED FOR OFFICE USE ONLY
U u1 WI UU Received .
City Of Tigard DateBY• 9 4. r -.1/ Permit N` t "'.) du /1
13125 SW Hall Blvd., Tigard, OR 97223NAA Plan Review
/ �yi A i l if .N i , ; O ther permit Phone: 503.639 -4171 Fax: 503 - 598.1960 2 �U� l Date/By: 24- Hour Inspection Line: 503.639.4175 I J I1 ba te Ready/By: � �°�'-'r ! 21 See Page 1 for
Internet: www.ci.tigard.or.us 1 t U-- Supplemental nus WY OF �flC Fcd/Method: inental tntorme Gan
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LI New construction ❑ Demolition For ipecial information use checklist.
Description 1 Qty, I Rs. i Total
Y Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
t' *hY > r Y'Y" v i t � ..^. c� 'F'�Y 1 t ^. ,:, e , ry ' ,
t : t,' ,, e its t7r ,7...rn.k ,, 3 (a d "� 14 r. SFR (1) bath 249.20
aSY � � ro R e r F d �{
fi ° �#.. -_ �i�„wil. l'.�: - �* n� ... 3r �; �t- 1 �rY��as*+^.�.c' �,, t3.{k � ;
[al- and 2- family dwelling ❑ Commercialiindustrial SFR (2) bath 350.00
El Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
�� r te „ t t � i fi s r , Fire sprinkler ( sq. ft) Page 2
�� } r R Z x A 1� !. 4. r � .. ? ,n. T 1:11:a + , , "I & '+ 3�_"Y.� g iS� tG F: ..!� Site utilities
Job site address: is' / / 9 tS 1,,j 7/ 6 -i- 4v- Catch basin or area drain 16 -60
City/State/ZIP: / q 4 - q e) � 7 7 a -7e- Drywcli leach line, or trench drain 16.60
/
Suite/bldg./apt. no.: I Project name: Pooting drain (no: linear ft.:� Page 2
Manufactured home utilities 1 10.00
Cross street/directions to job site: --
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.. __) Page 2
Storm sewer (no. linear ft.. ) Page 2
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Subdivision: f Lot no.: Water service (no linear ft ) Page 2
- Fixture or item
Tax map /parcel no
1tF + .. ^" iS z' , ^d G `T rr�. Tti' Z `4'7 v+F +err m' v- Absorption valve 16.60
> c,: 35 t r i �rl l r r i� 1Y .1 2 3Y 5P ��a I'' 1 1
i;' '�' "; At�M EVv". ``t r, a �S p r s?'':,e t:fa ti21i4;4 . " Backflow preventer Page 2
ii CI; q a (n_) 9 r S e LeV /c-e_ Backwater valve 16,60
Clothes washer 16.60
Dishwasher 16,60
!LL,r g- r- ;a."P,r. �crr+; >� :.n f;�. f!;ii'� "^'- �Me
:E iJ;:p �;.;'m�7F ". .':r:`"•s:,::, ! c ! � ??S ■ , ,, r bri nking fountain 16.60
ru C. p ">+ l7.4e f 5 r q , <F i . ; , :, : { r? ^+ � }.�.L �' � n U. • r.M 63 RS ''v�Zt�� s, L� fr 1 'a' F
i?i .2_. f. :3 - 2 'fs.,� : y o� LINi4 tt�,i ..� : ::ien - :, ar?ti;,:.9l.._.. Ejectors /sump 16.60
Name: Q t So-) a /'07 Expansion tank
16.60
Address: / 7 9 >- / (*.0 eft / e--/c_ LA/ Fixture/sewer cap 16 -60
City/State/ZIP: A . .I^ 0 0 r : 9' 7/ 2, 6 Floor drain/floor sink/hub 16.60
Phone; (,e-63 " 80 3 ^ ,70 6 - Fax: ( )
Garbage disposal 16.60
, ««� : �:.: : ° ^is >:: s ?i Y : L ,a ::a:yPA4' , - :,:,: i $'vr V I 1' Hose bib 16 -60
+, y k 4r J �� e w r �, d F r - w n �
u. 3i n" . °^ , X i t2! n ,t M .e 1.�2 ! (r. °(i , t'ti ' `' : s 1 l t jt a :, ': '(± ice maker 16.60
Business name: fia R o el r/S - ' i 4Md7 1' Q htterceptor / trap 16.60 -
Contact name: Er rt - r n . _ J Medical gas (value: S ) Page 2
Address: /J) D .6 Q)C 6/ Primer 16.60
City/State/ZIP: 7: 4,4‘4 , / h' 0 i 1 70 6;i3- Roof drain (commercial) 16 -60 -
't' '
Fax: Sink/basin/lavatory 16.60
Phone:
�03) 9 � � 3 �3) 6 �� `� �� Tub /shower /shower pan _16,60
E-mail I 0 I rri boe4s. Goon _ Urinal 16,60
.. a. p's ,S g z.n w . � 't. rQt_ d, ale 1� 5 ` r."t+..r;a':' Sn �s ` + _ o ,�^ ^<w , i1 � , s , W ater closet 16.60
Business name: A Y b 0,,,_, p1 b i ,i r Water heater 16.60
Address: (j./ Q y, 4 q Other
�-- - 6,e 9 7d 6
Subtotal y� , yo
City/State/ZIP.. 4.. � � ,
� M ini mum permit fee: $72.50
Phoxle: 6-ks) 9 a, - l// `,3 7 FaX; (�t,2T3) G 7/ - Zs V- k Residential backflow minimum permit fee: $36.25 7 0 � •,
CCB Lic -: 8"7 rS D Plumbing Lic. no.; 34_ / eg, L p Plan review (25% of permit fee)
t State surcharge (8% of permit fee) 5.
Authorized siy
TOTAL PERMIT FEE 7 3,30
Print name; "J / bate: . e ! . , This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
'Pee methodology set by Tri- County Building Industry Service Board .
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I.
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: PLM2005.00128
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/29/2006
Phone: (503) 639 -4171 e
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/1/2005 TIME: 7 :10AM PAGE: 95
SITE ADDRESS: 15119 SW 91ST AVE CLASS OF WORK:
SUBDIVISION: MALLARD LAKES LOT #: 001 TYPE OF USE:
PROJECT NAME: CAMERON
DESCRIPTION: Replace water service.
OWNER: CAMERON, DUNCAN D + DEBORAH K, PHONE #: 503- 803 -2060
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 -692 -4139
Inspection Request Scheduled For: Date: 4/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 003442 -01 5503 -692 -4139 N
Corrections /Comments /Instructions:
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I CA / 1
d
1 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: /1 7) T Date: Z j 0 Phone #: (503) 718-