Permit ,..4 CITY OF TIGARD PLUMBING PERMIT
- 1 •• COMMUNITY DEVELOPMENT Permit #: PLM2011 -00308
Date Issued: 10/19/2011
TIGAR. D 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Parcel: 2S102BB01202
Jurisdiction: Tigard
Site address: 10010 SW JOHNSON ST
Project: FORD Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 16
Project Description: Master bathroom remodel
Contractor: RAYBORN'S PLUMBING INC Owner: FORD, ROBIN L /KELLY J
19990 SW CIPOLE RD 10010 SW JOHNSON ST
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE' 503 - 692 -4139 PHONE:
FAX• 503 - 691 -2328
FEES
Quantity Description Date Amount
2 ea Sink 10/19/2011 $50 04
Specifics: 2 ea Tub /Shower /Shower Pan 10/19/2011 $25 02
1 12% State Surcharge - 10/19/2011 $9 01
Type of Use: SF Plumbing
Class of Work: ALT
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
Issued By: / _ Permittee Signature:
Call y`..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 09.33 11 a m 10 -17 -2011 1 /2
M r ttya V k
Plumbing Permit Application
Building Fixtures OCT 17 201 Foil O I R is I St ON1.1
'
C
A #W7 11 1 , Il l anai ity of
W Ha B d., Tigard, OR 97223 {� ®F MAR 1P a v iew Permit No. al_", .. _ — -
4 8 13125 ■ Phone: 503.639.4171 Fax. 503.598.196�I�,�JlNG ®I i�'1 D Other Permit No.:
FLU ,� h t} Inspection line 503.639.4175 Date Ready /By im•ss FA See Page 2 for
• Internet: www tigard- or.gov Notified/Method 1.:r6 Supplemental Information
TYPE OF WORK FEE* SCHEDULE
ID New construction ❑ Demolition For special information use checklist
Descri rtion It . Ea Total
Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
4 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: /00/D S'L() /D �NS f) sl • Catch basin or area drain 18.76
t 4_,,,..4 � R n 02 4 3 D leach line, trench drain age 76
2
City /State /ZIP: 0 ll��
/ Footing oting drain (no. linear ft.: ar ft.: ) Page 2
Suite/bldg. /apt. no : I Project name: Fit+[. Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
6 5-5— Rain drain connector 18 76
� Sanitary sewer (no. linear ft ) Page 2
Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
M4 5T !` .L i /} Dishwasher washer 25.02
'����/ Dishwashher 25 02
Drinking fountain 25.02
Ejectors /sump 25.02
4 PROPERTY OWNER I 12 TENANT Expansion tank 12 51
Name: 'rci Fixture/sewer cap 25.02
1 0 ^ ' d p ke $ I S � Floor drain /floor sink /hub 25.02
V
Address /� !i) vG
V Garbage disposal 25 02
City /State /ZIP: 77 L Oti g71v Hose bib 2 5.02
Phone: ( ) Fax: ( ) Ice maker 51
❑ APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25 02
Business name: Medical gas (value $ ) Page 2
Pniner 12,51
Contact name:
Roof drain (commercial) 12.5 I
Address: Sink/basin/lavatory 25.02 Gy
City'State /ZIP: Solar units (potable water) 62.54
i
Phone: ( ) Fax:: ( ) Tub/shower/shower pan 12 51 a,S
E-mail: Unnal 25 02
Water closet 25 02
CONTRACTOR
Water heater 37.52
Business name:
if 0 ( i - .. .. , C • Water piping/DWV NM 56 29
Address:
• Q � a• � 6 Other: 25.02 IMI
City /State /ZIP: i G4 Dt_t - iA..) E 3 71)6.4 Subtotal
i ,w L p/ 23. Fg Minimum permit fee $72 50
Phone: i ) • _ Fax: 4 ��'� �
CCB Lie.: ■ A iumbui Lie o r r Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature: g Ira • ___ ' TOTAL PERMIT FEE $y t7
MEW Date: fills permit application expires if a permit is not obtained within 180 days
:1 , .rL . �� � �� ��� after it has been accepted as complete.
*Fee methodology set by In-County Building Industry Service Board.
I Budding PermitsPLMU- PaimiAppdo 10'0I09 .140- 4h161(1002.COMiWEB)