Permit 11 11] CITY OF TIGARD • PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00151
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/17/2011
Parcel: 2S111DD14400
Jurisdiction: Tigard
Site address: 15779 SW 87TH AVE
Project: LAMBERT Subdivision: MILLMONT PARK Lot: 21
Project Description: Shower pan installation.
Contractor: RAYBORN'S PLUMBING INC Owner: LAMBERT, KATHRYN L
19990 SW DIPOLE RD 15779 SW 87TH AVE
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 05/17/2011 $12.51
Specifics: 1 12% State Surcharge - 05/17/2011 $8.70
Plumbing
Type of Use: COM 60 ea Minimum Fee Adjustment - 05/17/2011 $59.99
Class of Work: ALT Plumbing
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
�_ 111110 t
Issued By: f �� i � Permittee Signature:
r i
all 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.
x.503 691 2328 Rayborns Plumbing 09:07:02 a.m. 05 -17 -2011 1 /2
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Plumbing Permit Annlicatiot \\A
Building Fixtures ei '10 \\ FOR 01:1;1(..1 1 SE () NIA
City of Tigard 1� �� w` Received 17 / Permit No:
• 13125 SW Hall Blvd., Tigard, OR 9722 � 1G S 1NJ Plan Date / 'B y :
Review
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■ ' Phone: 5 Fax: 503.598.196 O N. � l� Dale /By: Other Permit No.:
• l "I t ; : •1 t. . f) Inspection Line: 503.639.4175 C1 l �(5 Date Ready'By: Jmv: ® See Page 2 for
Internet: www.tigard- or.gov � Notified Method: Supplemental Information
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T YPE OF WOR SCHEDULE
& b FEE* ^
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
x Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection) _
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
g 1- 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: Catch basin or area drain 18.76
1 S ' 7°
�,� ! � D / � Drywall, leach line, lior near trench drain Page 2
City/State/ZIP:
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt.no.: Project name: LA M. 6 Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
_;� ( e,-21 Rain drain connector 18.76
L��i�a J . e,
Sanitary sewer (no. linear ft.: ^) Page 2
Stonn sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backtlow preventer 31.27
Backwater valve 12.51
DESCRIPTION OF WORK
']�/ Clothes washer 25.02
is . u • ..// it, / l `•.€ Dishwasher 25.02
g` Drinking fountain 25.02
Ejectors /sump 25.02
PROPERTY OWNER `- ❑ TENANT Expansion tank 12.51
Name: L 14114.4,8-e-#1-1
Floor d drain/
Fixture/sewer cap 25.02
rain/ r
/.. y floor sink/hub 25.02
Address: 1 r ` / ) S 7' Garbage disposal 25.02
City /State /ZIP: L OA_ (7 771 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ _ ) Page 2
Business name:
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 ( 12.51 a '.71
Urinal 25.02
E -mail:
Water closet 25.02
CO ' iiikTOR Water heater 37.52
W,M Water piping/DWV 56.29
Address: MA C . 9 Other: 25.02
City /State/ZIP: ke / � i p C! �, - Minimum permit fee: $72.50 (ZT1 i
Phone: - ) 69,2. 4! Fax: ( ) _ 3,
f mbin g Lic. 0.: _
CCB Lic.: ° � 4 9
/ '� State surcharge (12 %of permit f'ee) 7
Authorized signature: , � ,'``, / TOTAL PERMIT FEE ( Z°
♦, Jr W L ( This permit a pplication expires if a permit is not obtained within 180 days
Print name: r''. tl i (L! A ��1 �L after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
I. Building Permits PLM11- PernmtApp doc 1001 09 40- 451sT(Io 022 COM'WEB)