Permit ,� CITY OF TIGARD PLUMBING PERMIT
I N It ' COMMUNITY DEVELOPMENT Permit #: PLM2011 -00132
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/26/2011
Parcel: 2S103BB07901
Jurisdiction: Tigard
Site address: 12350 SW 124TH AVE
Project: Hinds Subdivision: LAKE TERRACE Lot: 8
Project Description: Installation of bathroom in shop.
Contractor: RAYBORN'S PLUMBING INC Owner: HINDS, TOM M & JUDY G
19990 SW CIPOLE RD 12350 SW 124TH AVE
TUALATIN, OR 97062 TIGARD, OR 97223
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PHONE: 503 - 590 -5295
HONE: 503 - 692 -4139
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
2 ea Lavatories 04/26/2011 $50.04
Specifics: 1 ea Tub /Shower /Shower Pan 04/26/2011 $12.51
1 ea Water Closet 04/26/2011 $25.02
Type of Use: SF 1 ea Water Heater 04/26/2011 $37.52
Class of Work: ALT 1 12% State Surcharge - 04/26/2011 $15.01
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $140.10
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
issu , or it : . is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
ity Notification Cen -r, Th. ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
r direct questions to OU s b calling A 0 .232.1987 or 1.800.332.2344.
ssued By: i , Permittee 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 Rayboms Plumbing 01:11:19 p.m. 04-25-2011 1 /2.,..
Plumbing, Permit Applica nCEl V ED
Site Utilities APR 26 2011
City Tigard Received
Ci
I N
• 131 S W o f H . a l l B l.v d., Tig: . + F TIGARD D p � j 1 / / P e r m i t No.://_ 40/33 �1
ll Phone: 5036394171 F � I A Pl Review /+
DIVISI Other Permit No.:
Inspection Line: 503.639.4175 �N Date By;
1 1 (, i It t Date Ready/By:
Internet: www.tigard- or.gov Noti£red Metluid: Stow 1 See Page 2 for
J Supplemental Information
TYPE OF WORK FEE' SCHEDULE
❑ New construction ❑ Demolition For special injorrnalon use checklist
Description I Qty. I Total
® Addition /alteration/replacement ❑ Other: New 1-2- family dwellings (includes 100 ft. for each Ea.
connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
® I- 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. ft.) Page 2
4,,,;,,,,, , .., ,., O ,S1TIi INFORMATION AND LOCATION Site utilities:
Job site address: JJ' 35) , ) /_rl U 4 � dY Catch basin or area drain 18.76
City/State/ZIP: ? J OIL ! R� ! H �3 Drywell, leach line, or trench drain 18.76
'� d� Footing drain (no. linear ft.: __) Page 2
Suite/bldg./apt. no.: I Project name: ) I'�.
Manufactured home utilities 50.03
Cross street /directions to job site: Manholes 18.76
44 -.c -- ! 1 y Rain drain connector 18.76 ^
Sanitary sewer (no. linear ft.: __) Page 2
Storm sewer (no. linear ft.: ,) Page 2
Water service (no. linear ft.: __) i Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
5 J, 13.t4- Dis washer 25.02
rw Ip• k • Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
V4 PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: t14 t. • f Fixture'sewer cap 25.02
Floor Address: , . � fl) G, 'v1 L� Q - • _ Garbage disposal 25.02
25.02
V' G� l. � O x 7 IR'Y Garbage disposal 25 02
City'State'ZIP: �� G �
J Hose bib 25.02
- Phone: 03) q j' - Fax: ( ) Ice maker
❑ APPLICANT 12.51
❑ CONTACT PERSON I nten:cptor'grease trap ' 25.02
Business name: Medical gas (value: $ � Page 2
Contact name: Primer 12.51
1 � � Address: Roof drain (commercial) 12.51
1' Sinkrbasin lavatory 25.02
M City /State /ZIP; Solar units (potable water) Z 6' �� Oy
.54
IA Phone: ( ) Fax: : ( ) Tub /shower: shower pan 1 12.51 I 27/
E -mail: Urinal 25.02
CONTRACTOR Water closet 1 25.02 Z3 -61.2
Business name: RAYBORN'S PLUMBING INC Water heater 37.52 37 s
Water piping DWV 56.29
Address: P.O. Box 69 Other. 25.02
City, State /ZIP: Tualatin, OR 97062 Subtotal tg" O '(
I Phone: (503) 692 -4139 I Fax: (503) 691 -2328 Minimum permit fee: 572.50
CCB Lic,: 87852 i i lambing Lic. 7 •.: 34 -166PB
Plan review (25% of pennit fee)
bugs ,� State urcha O T L � iii
Authorized signature: V
TOTAL PERMIT FEE 'l.�(7 l
Date: This permit application expires if a permit is not obtained within Igo days
a I / /� r ,_,,. after it has been accepted as complete.
'Fee methodology set by Tri- Ccunty Building Industry Service Board.