Permit CITY OF TIGARD PLUMBING PERMIT
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11/ '- COMMUNITY DEVELOPMENT Permit #: PLM2011 -00095
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/29/2011
Parcel: 25111 CC10000
Jurisdiction: Tigard
Site address: 15780 SW GREENS WAY
Project: Torheim Subdivision: SUMMERFIELD NO. 2 Lot: 127
Project Description: Replace tub /shower and valve.
Contractor: RAYBORN'S PLUMBING INC Owner: TORHEIM, MARGARET
19990 SW CIPOLE RD 15780 SW GREENS WAY
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 03/29/2011 $12.51
Specifics: 1 12% State Surcharge - 03/29/2011 $8.70
Plumbing
Type of Use SF 60 ea Minimum Fee Adjustment - 03/29/2011 $59.99
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 que • to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued : k / / Permittee Signature: / ad
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 09:52:54 a.m. 03 -29 -2011 1 /2
Plumbing Permit Application
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Building Fixtures FOR OFFICE USE ()NIA
Ci of Tigard 3 '` _ Rec •'�
g ® Pcnnit No.: •�Q
1111 - Date/8
• 13125 SW Hall Blvd., Tigard, OR 9722 r`k, r O Plan Review
tQ Phone: 503.718.2439 Fax: 503.598.l 0 oil %CS , te/ • Other Permit No.:
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Inspection Line: 503.639.4175 \ \1t
T I G A R L) ,�, ( t , iLs' to Ready /By: kris: t3 See Page 2 for
Internet www.tigard or.gov - s r • Notified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction El Demolition For special information use checklist
Description I Qty, I Ea. I Total
® Addition/alteration/replacement ❑ Other: _ New I - 2-family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
® I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
building SFR(3)bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other: Fire sprinkler ( , sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15780 SW Greens Way Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/ZIP: Tigard OR 97224 Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: Project name: Margaret Torheim Manufactured home utilities 50.03
Cross street/directions to job site: 655 137 Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear ft.: 1 Page 2
Storm sewer (no. linear ft.: _,,,_„) Page 2
Water service (no. linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or Item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Replace Tub/Shw and Valve Dishwasher 25.02
Drinking fountain 25,02
Ejectors /sump 25.02
Ei PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Margaret Torheim Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 15780 SW Greens Way Garbage disposal 25.02
City /State /ZIP: Tigard OR 97224 _ Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
- - - ---G - ARFUICANT - - ❑- CONTACT - PERSON lnterceptor/grrase trap 25.02 _
Business name: Medical gas (value: $ _ ) Page 2
Primer 12.51
Contact name:
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 I 12.51 12.51
E -mail:
Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: Rayborn's Plumbing Inc. _ Water piping/DWV 56.29
Address: P.O. Box 69 Other: 25,02
City/State/ZIP: Tualatin OR 97062 Subtotal 12.51
Phone: (503) 692 - 4139 Fax: (503) 691 - 2328 Minimum permit fee: 572.50 72.50
Plan review (25% of permit fee)
CCB Lie.: 87852 PI bing Lie. no. : - 166PB
�, State surcharge (12% of permit fee) 8.70
Authorized signature: • I . TOTAL PERMIT FEE 81.20
This permit application expires if a permit is not obtained within 180 days
Print name: Kenneth A. Provancher Date: 3/29111 J after it has been accepted as complete.
*Fee methodology set by Tri County Building Industry Service Board.
L Building 'Pnrmits' 1001'09 440 - 5T(10'UT'COMMWEn)
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