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Permit . CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT Permit #: PLM2011 -00131 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2011 Parcel: 2S115AD00600 Jurisdiction: Tigard Site address: 16740 SW 108TH AVE Project: Hackett Subdivision: WILLOW BROOK FARM Lot: 30 Project Description: New hot/cold hose bib Contractor: RAYBORN'S PLUMBING INC Owner: HACKETT, JULIE A & BRUCE E 19990 SW CIPOLE RD 16740 SW 108TH AVE TUALATIN, OR 97062 TIGARD, OR 97224 PHONE: 503 - 995 -9392 HONE: 503 - 692 -4139 FAX: 503 - 691 -2328 FEES Quantity Description Date Amount 1 ea Hose Bib 04/26/2011 $25.02 Specifics: 1 12% State Surcharge - 04/26/2011 $8.70 Plumbing Type of Use: SF 47 ea Minimum Fee Adjustment - 04/26/2011 $47.48 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 Noti icati n 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 ■irec uestions UNC by calling 503.232.1987 or 1.800.332.2344. Issued y: Co Permittee Signa • � 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 10:27:22 a.m. 04 -25 -2011 1 /2 RECEIVED Plumbing Permit Application APR 2 6 2011 Site Utilities CITY OF TIGARD 1 O (11.11( I 1 SII ON! 1 City of Tigard g erved imir lt!o�r w r to/ tY g BUILDING DIVISIO /," , , � Dat /B 11 1 13125 SW Hall Blvd., Ti a OR 97223 L Phone: 503.639.4171 Fax: 503.598.1960 Plan Review DatuBy: Other Permit No.: I I I:I Inspection Line: 503.639.4175 Date Ready /By: cars: lin See Page 2 for Internet: www.tigatd- or,gov Notified/Method: Supplemental Information TYPE OF WORK FEE* SCHEDULE • ❑ New construction ❑ 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 (1) bath I ! 312.70 ® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 ❑ Accessory building ❑ Multi- family SFR (3) bath 500.32 ❑ Master builder Each additional bath/kitchen 25.02 ❑ Other: Fire sprinkler ( sq. I)) Page 2 , ;;;, 0 jugliaYF( RaTiort AND LOCATION ... Site utilities: lob site address: /6 7w/ /7 �.t� /pet- Catch basin or area drain 18.76 City/State/ZIP: 7 ��d. © " /`j , J Footing l 1g l am / / •x (`,,1 5 ! `7 Footing drain (no. linear ft.: ` ) Page 2 Suite/bldg. /apt. no.: Project name: A e,t• Manufactured home utilities 50.03 Cross street/directions to job site: Manholes 18.76 Rain drain connector 18.76 ij e S - ] Sanitary sewer (no. linear ft.: _) Page 2 1 Storm sewer (no. linear ft.: _) Page 2 Water service (no. linear ft.: _) Page 2 Subdivision: 1 Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 31 DESCRIPTION OF WORK Backwater valve 12.51 nped4) J 9yet,/ / it _ / Z1 Clothes washer 25.02 �I"o� +L I��� Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51 Name:tp Fixturesewercap 25.02 Address: 1 h. L1 Q cbj fb Floor dmiNFloorsink/hub 25.02 < q y V Garbage disposal ®j City/State/ZIP: (� n�, G ,,/J'„ Hose bib ' 25.02 Dry - Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 - Business name: _ Medical gas (value: S __) Page 2 Contact name: Primer 12.51 Address: Roof drain (commercial) 12.51 S i nkbasi ry 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: RAYBORN'S PLUMBING INC Water piping/DWV 56.29 Address: P.O. Box 69 Other. 25.02 - City/State/ZIP: Tualatin, OR 97062 Subtotal �s Phone: (503) 692 -4139 1 Fax: (503) 691 -2328 Minimum permit fee: $72.50 74 CCB Lie.: 87852 I P bing Lie. no.. 4 -166P8 Plan review (25% of permit fee) • State _ surcharge(12 %ofpennitfee) $ ` A Authorized signature: - 'nr� Al g IsD �L Date: 1 TOTAL PERMIT FEE i / This permit apptkaN M on expires if a permit not obtained within 180 days NtF/ Print name: 4• ' �' E 31 after it has been accepted as complete. iii, *Fee methodology set by Tri- County Building Industry Service Board.