Permit CITY TIGARD PLUMBING PERMIT
T . 1 4 . DEVELOPMENT SERVICES PERMIT #: PLM2004 -00093
Ail V 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/3/04
SITE ADDRESS: 17005 SW 92ND AVENUE PARCEL: 2S114A0 -01500
SUBDIVISION: ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: NEW GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: M FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 2 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES: 1
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Remarks: Set fixtures on existing rough -ins for (1) ice maker & (2) sinks. Installing (1) new dishwasher.
FEES
Owner:
Description Date Amount
TIGARD, CITY OF
13125 SW HALL [PLUMB] Permit Fee 3/3/04 $72.50
TIGARD, OR 97223 [TAX] 8% State Surchan 3/3/04 $5.80
Total $78.30
Phone :
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 692 4139 Top -out lnsp
Final Inspection
Reg #: MET 00001806
L1C 87852
PLM 34 -166PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
I sued B / / Permittee Si nature: . s/Nar& , reir"
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Mar -02 -04 09:20A Rayborn's Plumbing, Inc. 15036912328 P.01
Building Fixtures i
Plumbing Permit Application Received Plumbing /
Date /By: 0o` el Permit No.: NA9O AOa r 3
Planning Approval Sewer /✓ �y� n
City of Tigard
RECEIVE ill Received
Permit Nu.: of 000 7?
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503 Fax: 503 20i , � t � _. Post - Review Land Use
Date/By: Case No.:
Internet: www.ci.tigard.or.us CI IG _ =r ' I h ,, Contact J ® See Page 2 for
24 - hour Inspection Request: �6 ; x}7 5 Name /Method: / 16 . Supplemental Information.
'V DIVISION
TYPE OF WORK FEE* SCHEDULE (for special information use checklist)
New construction ❑ Demolition Description Qty. j Fee(ea.) J Total
Addition/alteration/replacement ❑Other: • . New 1 - & 2 - family dwellings
CATEGORY OF CONSTRUCTION (includei 100 ft for each utility connection) •
1 & 2-Family dwelling Commercial/Industrial SFR (1) bath 249.20
❑ y g il /Id il SFR (2) bath 350.00
❑Accessory Building Multi- Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler - sq. ft.: Page 2
Job site address: 1700S SW ?Z.hi) Ave Site Utilities
Suite #: Bldg. /Apt. #: Catch basin/area drain 16.60
Project Name: CooicS e.' . CaA1 SSz0N Dr line /trench drain 16.60
Pro
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
C-OC>KS PAiti , Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: Lot #: Storm sewer no, linear ft.) Page 2
Tax map /parcel #: c5/ 1 i O/ SDO
Water service (no. linear ft.) Page 2 _
Fixture or Item
DESCRIPTION OF WORK Absorption valve 16.60
E-T FzVc'eu /LIES D 4 E ISTi Backflow preventer Page 2
ke t 4 H - (N S Backwater valve 16.60
Clothes washer 16.60
Dishwasher j 16.60 /6.42o
Drinking fountain 16.60
'1 PROPERTY OWNER • TENANT Ejectors/sump 16.60
ame: C. cr Q p Expansion tank 1 6.60 .
Address: )q-)1g..5 t I.,Z I4.6 L.L. 0`1" Fixture /sewer cap 16.60
Ci ae /Zi : -1 Pc .. QQ q'1 'S Floor drain /floor sink /hub 16.60
/Stt
y p ` Gar disposal 16.60
Phone: (p -X11 7 ( Fax: Hose bib 16.60
0 APPLICANT CONTACT PERSON Ice maker I 16.60 /6. Coo
Name: Interceptor /grease trap 16.60
Medical g as - value: $ Page 2
Primer
Address: 16.60
City /State /Zip: Roof drain (commercial) 16.60
Phone: Fax: Sink/basin/lavatory , 4 16.60 = . d•o
E -mail: Tub /shower /shower pan 16.60
CONTRACTOR Urinal 16.60
Business Name: RA Y 86108 FL.LLMs DIG' 1,41M, Water closet 16.60
Water heater 16.60
Address: Pp eo)( 49 Other:
City /State /Zip: i( € AVgrkei OIL g7t9 Other:
Phone:. 6Q2�ef134 i ax:s03. 91•232 g Plumbing Permit Fees *_
Subtotal $
CCB Lic. #: BTBS"Z Plumb. Lic. #: 3q../6 Minimum Permit Fee $72.50 $ n
Authorized /� / t Residential Backflow Minimum Fee $36.25 - 2g. 57)
Signature: e.0 Date:3 /R`Dr, . Plan Review (25% of Permit Fee) $ -in
3A M A L fib 7-- 1- -rAsciA! State Surcharge (8% of Permit Fee) $ 5. SO
(Please print name) TOTAL PERMIT FEE $ -7 O . ?)n
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri- County Building Industry Service Board.
1.`Dsts'.Permit FormsTimPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested ( AM PM BUP
Location /7006 ViLef Suite p� MI5
Contact Person Ph ( - 600
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Fi reveal l
Fire Sprinkler No' -
Fire Alarm
Susp'd Ceiling /
Roof
Other:
Final
P RT FAIL
Posteam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Onh
PART FAIL
E NICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG /Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE ❑ Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA Inspector Ext
Approach /Sidewalk Date
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL