Permit q CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00050
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/15/2011
Parcel: 2S103BCO3300
Jurisdiction: TIGARD
Site address: 12300 SW ALBERTA ST
Project: OLIVER Subdivision: CANOGA PARK Lot: 7
Project Description: Replacing 60 ft. of water service. Electrical permit may be required if replacement piping affects house grounding.
Contractor: RAYBORN'S PLUMBING INC Owner: OLIVER, CHARLES A
19990 SW CIPOLE RD 12300 SW ALBERTA ST
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
60 If Water Service 02/15/2011 $62.54
Specifics: 1 12% State Surcharge - 02/15/2011 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 02/15/2011 $9.96
Plumbing
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 -0090. You may obtain a copy of the rules
or direct questions to O C by calling 503.232.1987 or 1.80 - .
Issued By: • Permittee Signature: i t
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 01:28:33 p.in. 02 -14 -2011 1 /2-
Plumbing Permit AppltRa ' 0 El
t 111. k,J � ``
Building Fixtures FOR oi'iici I si: (>r.I,1
FEB 1 5 2011 Received
IIII City of Tigard Date/By' ,�� �/ - -,K,-
a 13125 SW Hall Blvd., Tigard, OR 9 22l- t y �/ i1` L/
C � 8 Review
Phone: 503.639.4171 Fax: 5�3 S S h960 Pl Other Permit No.:
Inspection Line: 503.639.41- S I S O Date /By
I I G A It D t�� J��p��J� D l� P Iv Date Ready /By: .turfs: ®See Page 2 for
Internet: www.tigard or.gov Notified/Method: 1 L( Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition Fors. eclat' in ormation use checklist.
Description Qty. Ea. Total _
Q Addition/alteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
'� 1- and 2- family dwelling C7 Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Ot her: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: _
Job site address: /j3 (:)c.7 ,CW A LBpn c--/ Catch basin or area drain 18.76
/, � T�l Drywell, leach line, or trench drain 18.76
City/State /ZIP: AAA-. 15k-- 4117 ...U__? Footing drain (no. linear R.: _) Page 2
Suite/bldg. /apt. no.: Project name: 42/ /d. .iJ Manufactured home utilities 50.03
Cross street/directions to job site: 4 Manholes 18.76
SS ) , j Rain drain connector 18.76
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Water service (no. linear ft. :612 / Page 2 64.5*
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
V /�
,Q� �) Clothes washer 25.02
e.eik - .1 2 Z , Le - Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: fl�� /1 Fixture 25.02
/ / ^ Floor drain/floor sink /hub 25.02
/t -
Address. _3D riu) 6,(L - [ _O(t,/.
Garbage
City /State /ZIP: '7` }� � u L +` Hose disposal 25.02
!/ . ��� 3 e bib 25.02
Phone: (5' _'7 ! Fax: ( ) Ice maker 12.51
❑ APPLICANT ! ❑ CONTACT PERSON Interceptor /grease trap 25.02
1 Business (tame: Medical gas (value: $ �) Page 2
Contact name: Primer 12.51
Roof drain (commercial) 12.51
Address:
Sink/basin/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
//
Water heater 37.52
Business name:
AQh V S P/ar � '1 � N . Water piping/DWV 56.29
Address: p t 4 n _ Other: 25.02
City /State /ZIP: �
kA J .. c/ L 97�� Subtotal a
tal 64Pf
Phone: i5153 ) ‘f ..1 Fax: i'jj3) 69/-.J.2 8 Minimum permit fee: $72.50 _3'„t�°
Plu i c . no.: 3 - ddpa (25% permit Fee)
CCB Lic.: (, /
Plan review 2 5% of D
State surcharge (12% of permit fee) $ 7
Authorized signature. All�� ,
I' /, TOTAL PERMIT FEE / JD
Print name: / , 1 1 M Date: This permit application expires if a permit is not obtained within 184 days
-- f - - after It has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board
I: Building Purmits•I'I.MU•PermitApp doc 10 01.09 440- 4016T( IPmYCOvt WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12300 SW ALBERTA ST, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2011 -00050
Inspection Type: Inspector:
399 Plumbing final Chip Barnett
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor