Permit CITY OF TIGARD PLUMBING PERMIT
II , - COMMUNITY DEVELOPMENT Permit #: PLM2011 -00145
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/10/2011
Parcel: 1 S135CD04700
Jurisdiction: Tigard
Site address: 11865 SW 95TH AVE
Project: Good Subdivision: BOETCHERS ADDITION Lot: 8
Project Description: Replacing plumbing fixtures.
Contractor: RAYBORN'S PLUMBING INC Owner: GOOD, JAMES JR & JULIA
19990 SW CIPOLE RD 11865 SW 95TH AVE
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -4139 PHONE.
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
1 ea Ejectors /Sump 05/10/2011 $25.02
Specifics: 1 ea Sink 05/10/2011 $25.02
1 ea Water Closet 05/10/2011 $25.02
Type of Use: SF 1 12% State Surcharge - 05/10/2011 $9.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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 OUNC by calling 503.232.1987 or 1.800.332.2344.
S
Issued By: Permittee Signature:
Call ` "i .•39.4175 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 08:59:37 a.m. 05 -09 -2011 1 /2
• CEIVED
Plumbing Permit AnnBead I ti •
Building Fixtures MAY 10 2011 FOR OI I R i .: I SE ON1.1
_
City of Tigard Deceived
• 13125 SW Hall Blvd., Tigard, O
, ❑ Date By: 5 4) f/ Permit No.: OL� ti (,Y11 K�
111. 1 TIGA� Plan Review
' 1 1 - •- Phone: 503.639.4171 Fax:
I. e 1 D ate / B y. -
OtliecPermitNo _
. .
Inspection Line: 503.639.417 G DIVISION Date Rea /B ® See P
1 I Li i\ R I) dY Y age 2 for
Internet: www.tigard or.gov Notified /Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. I Ea. 1 Total
Addition/alteration /replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
. CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
I- and 2- family dwelling ❑ Commercial /industrial SFR(2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ 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: ` gas- c• 14 , .{-�- A Catch basin or area drain 18.76
h Drywell, leach line, or trench drain 18.76
City/State/ZIP: i q Footing drain (rto. linear ft.: ) Page 2
.13 --
Suite/bldg. /apt. no.: 0 17 Project name: 6.ipeci Manufactured home utilities 50.03
- Cross street/directions to job site: Manholes 18.76
l Rain drain connector 18.76
� r
���.
Sanitary sewer(no. linear ft.: ) 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
1 r _�>i L-.! _. _. ' Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump I 25.02 2"
14 PROPERTY OWNER ❑ TENANT Expansion tank 12.51
��� / Fixture/sewer cap 25.02
Name: �(
ii jir c j f Floor drain/floor sink hub 25.02
Address: -7 Garbagge e disposal 25.02
____i
City /State /ZIP: nit__ 712 5 Hose bib 25.02
Phone: 57 c , -) T/6 Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ _ ) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sinlvbasin/lavatory l 25.02 R s01
City /State /ZIP: Solar units (potable water) 62.54 0�
Phone: ( ) Fax: : ( ) Tubishower /shower pan 12.51
E-mail: Urinal 25.02
Water closet ( 25.02 2f -
CONTRACTOR
/ /a�� ` Water Pe 37.52
��
Business name: Water i pin in DWV 56.29
r
Address: ' �� Other: 25.02
City /State /ZIP: ru . [.0 (' re Subtotal -
Phone:1„r. /�l 9.2. v` ) �4 [� j�� • x: �� /� Q Mtmmwnpennttfee: $72.50
cfFax: , LLB
CCB Lie.: E3 , 2 , ? „--- umbing Li . no.: -�O� A9 Plan review (25% of permit fee)
State surcharge (12% of permit fee) 0
Authonzed signature: TOTAL PERMIT FEE $ ` ( J c7
This permit application expires if a permit Is not obtained within 180 days
Print name: v � 6, , Date:S 9f �j
PP P P
�il/Li'L r r `r." / ! after It has been accepted as complete.
`Fee methodology set by Tri- County Building Industry Service Board.
I: Building '.Permits - PLMU- PermitApp.doc 10 0109 4 40 -0b IbT110.02,COt'WEBI