Permit CITY OF TIGARD PLUMBING PERMIT
'! COMMUNITY DEVELOPMENT Permit #: PLM2011 -00051
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/15/2011
Parcel: 1 S134CA07000
Jurisdiction: Tigard
Site address: 11720 SW BURLCREST DR
Project: WOLF Subdivision: BURLWOOD NO. 2 Lot: 10
Project Description: Replacing water piping and 30 ft. of water service. Electrical permit may be required if replacement piping affects
house grounding.
Contractor: RAYBORN'S PLUMBING INC Owner: WOLF, RAMEY LEE &
19990 SW CIPOLE RD WOLF, CHARLES E
TUALATIN, OR 97062 11720 SW BURLCREST DR
TIGARD, OR 97223
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
1 ea Water Piping /DWV 02/15/2011 $56.29
Specifics: 1 12% State Surcharge - 02/15/2011 $14.26
Plumbing
Type of Use: SF
30 If Water Service 02/15/2011 $62.54
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $133.09
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 503.232.1987 or 1.800.332
Issued By: 00 00 .1...'--
•ermittee 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 02:22:33 p.m. 02 -14 -2011 1 /2_
Plumbing Permit Application E N
Building Fixtures nL j' 1-011 01:1:1 CI:: I sr: ()NIA
City of Tigard FEB 15 2011 Received n
7'T �l'
2 f ll Date/By: /r� �� Permit No: �. '�rsj I a p,�
NI • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ill/// rr ��/ 1 �(J WV
Y . Phone: 503. 639.4171 Fax: 503.598..1960 T Gr�D p Date /By: Other Permit No.:
Inspection Line: 503.639.4175 t I I • l
T I G A a i� �►1 1LDIN� D(if IS! ® Date Ready /By: Juris: See Page 2 for
Internet: www.tigard or.gov NotifiedrMethod: ')'•L Supplemental information
• TYPE OF WORK FEE" SCHEDULE
❑ New construction ❑ Demolition For special information use checklist _
Description ! Qty. 1 Ea. j Total
Addition /alteration/replacement ❑ Other:
New 1 - 2- (amity dwellings (includes 100 fl. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
1 I- and 2- family dwelling El Commercial /industrial SFR (2) bath 437.78
❑ 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: _
r Catch basin or area drain 18.76
Job site address: / / 7.1D c514.) ia44.4f '01.--. ,N _ -
'. 1 ‘ ._ 1' Qi, D oting leach line, lior near trench drain 18.76
City/State /ZIP:
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: V Project name: (J G Manufactured home utilities 50,03
Cross street/directions to job site: / .S /� Manholes 18.76
4 5 C.., 3 Rain drain connector 18.76
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.:J) ) Page2 J. 3`Y
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backtlow preventer 31.27
• DESCRIPTION OF WORK Backwater valve 12,5
t'1 L.7- / Clothes washer 25.02
25.02
(& Pt 4.e / 11).643 W �I�,1If Dishwasher
V Drinking fountain 25.02
Ejectors /sump 25.02
R PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: j.)o Fixture'sewer 25
Floor
J r: // t n Garbage drain/floor isp sink /hub 25.02
Address: I 1 7 .1. V Lon ! �} -
Garbage disposal 25.02
City/State /ZIP: j /,,kl 97LZ ' Hose bib
25.02
Phone: (�3) 5 ii _ oe 7,9- Fax: ( ) Ice maker 1 2.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ �) Page 2
Contact name: Primer 12.51
Roof drain (commercial) 12.51
Address:
SinkJbasin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail Urinal 25.02
CONTRACTOR Water closet 25.02
J ,� / Water heater 37.52
Business name: A
6 �` (�`�[")l � Water piping/DWV 1 56.29 56 21
Address: . D 7 g k ' M v ��-
Other: 25.02
City/State /ZIP: 1 /4.-ALst_i• A) D t U
9' `a Subtotal // f5 fri
Phone: (m) 6/a- yr_f r � F ! _
Fax: ( 70 /� y j Minimum permit fee. $72.50
Plan review 25% or ennit fee)
CCB Lie.: $ ?R S lum bin g c. no.: Tit % ` p
State surcharge (12% of permit fee) I -/ 3 7
Authorized signature:
(J TOTAL PERMIT FEE J cirf
Print name: n /� f � , /, / L Date: !([/ /// This permit application expires if a permit is not obtained within 180 days
!� al"�_ ` // f after it has been accepted as complete.
*Fee methodology set by Tn -County Building Industry Service Board.
I. Building ?emits''Pt.Mf;- Permit App doc 10.01 so - t10 -Jb IbT11002COM'1VL'Bl