Permit , ,_
14 4 CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2009 -00058
TIG ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/18/2009
Parcel: 2S 111 BD00501
Jurisdiction: Tigard
Site address: 14860 SW 98TH AVE
Subdivision: DARMEL Lot: 3
Project: Benjamin
Project Description: Install (200) ft. new water service.
Owner: FEES
BENJAMIN, WARD A/KIMBERLY A Quantity Description Date Amount
14860 SW 98TH AVE
TIGARD, OR 97224 200 If Water Service 03/18/2009 $101.40
1 12% State Surcharge - 03/18/2009 $12.17
PHONE:
Plumbing
Contractor:
RAYBORNS PLUMBING INC
PO BOX 69
TUALATIN, OR 97062
PHONE: 503 - 692 -4139
FAX: 503- 691 -2328
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Stories:
Total $113.57
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 -0100. You may obtain a copy of the rules
Issued By: q cyl_ak'n 1 (, X L o I n ,� J Permittee Signature: � Qp I i ,S
Y Call 503.639.4175 by 7:00 a.m. for an inspection that business day. {rl ` Jl, , 1
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.
i t'- 5 0 3 - 6 9 1 113 2!" Rayborns Plumbing 11:28:12 a.m. 03 -17 -2009 1 /2,„„.
Plumbing Permit AppiicationR
Building Fixtures MAR 17 2009 FOR OFFICE l SI. ON IA
City of Tigard Received
`J [ Permit No.: •
IN 13175 SW Hall Blvd., Tigard, OR 9722 OF TIGA1tD Date'B :. �? • d Pi t
• Phone: 503,639.4171 Fax: 503.59g-1 r ' Ian Revew
Other Permit No.:
In spection Line: 503.639.4175 D � ING D NISIO Re rib . it n Internet: www.ti -0r. Ov Date Ready By: t lure: ® See Page 2 for
7
grid g Notified/Method: 1 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special Information use checklist
Descri ,tion a . Ea. Total
)gtAddition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
Al- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
El Master builder Each additional bath /kitchen 45.00
❑ O ther: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: /Jc 0 St,€J 9 . ,Vei Catch basin or area drain 16.60
City/State/ZIP: t 7 5,d .77.4.2y Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: / Footing drain (no. linear ft.: ` ) Page 2
Cross street/directions to job site:
� Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no, linear ft.: _ ) Page 2
' Storm sewer (no. linear ft.: _ ) ' Page 2 UMJ
Subdivision: Lot no.: i• / .' Page 2 ,
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
/44e/e, Ao use '. Clothes
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain
Ejectorsisump r
Name: / 014/10 t Expansion tank 16.60
Address: /V /I o Valle-m-•• 9[J %J Ave. t
City / State/ZIP: /' A l ' -
Phone: ( ) Fax: ( ) Garbage
bib 16.60
❑ APPLICANT 0 CONTACT PERSON Hose
Ice maker 16.60
Business name:
Interceptor/grease trap 16.60
Contact name: Medical gas (value: $ 1 Page 2
Address: Printer , 16.60
City/ State/ZIP: Roof - - - drain II I fcommercial) 16.60
Phone: ( ) Fax:: ( ) '
E -mail: r
Urinal ,.t
CONTRACTOR Water closet 16.60
Business name: / • I
Water heater 16.60 '
•/ ..0 / ./ . ._ /. _
Address: Ao .601 0? Other:
City/State/ZIP: ; t J ' 7D 60l-, Subtotal O
.00 tS03) Minimum permit fee: 572.50
Phone
69, 9 Far 3 ) 4 9 R es id en ti al backflow minimum permit fee: S36.25
CCB Lic.: 8 es-01_, Plumbing Lic. no3iJ! /4 61/ Plan review (25% of permit fee)
f�' State surcharge (12% of permit fee)
Authorized signature: /G!'I r / GY' ' e. _. TOTAL PERMIT FEE / 2 '� 7
Print name: /12 s, /27Z/062,04;4," Date: �// 3/D 9 This permit application expires if a permit is not obtained within
// I80 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
L Building Perms PLMF- Perm 12 .27 06 440. 4616'010 02.COM WEB)