Permit " CITY OF TIGARD
PLUMBING PERMIT
A" I DEVELOPMENT SERVICES PERMIT #: PLM2004 -00465
- _ "� 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/6/2004
SITE ADDRESS: 09100 SW EDGEWOOD ST PARCEL: 2S102DC -01601
SUBDIVISION: EDGEWOOD ZONING: R -4.5
BLOCK: LOT: 014 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: • WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 1
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Repipe water service and run hosebib to garage.
FEES
Owner:
Description Date Amount
GILCHRIST, EARL J NONA [PLUMB] Permit Fee 10/6/2004 $116.20
9100 SW EDGEWOOD [TAX] 8% State Surchar� 10/6/2004 $9.29
TIGARD, OR R 97223 D 97223 ST
Total $125.49
Phone:
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Top -out Insp
Reg #: LIC 87852 Final Inspection
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
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR
952 =01os. You may obtain copies of these rules or direct questions to OUNC by calling (503)
246-6699.
Iss ed B y: , , ../-ii 4 1 � 1 � / / , / � Permittee Signatures i 1,i
Call (50 639 -4175 by 7:00 P.M. for an inspection needed the next a usiness day
__Oct-06-04 10:48A Rayborn's Plumbing, Inc_ 15036912328 _ - P_02
Bujjding Fixtures RECEIVED
Plumbing
Tigard bing Permit Application 2004 FOR OFFICE LSE ONLY
City of
Cit Received
g CITY OF TICARD Datee /° 04/ Perrvt N 66
13125 SW Hall Blvd., Ti ard, OR 97223 y '`��� it
g Plan Review
Phone: 503.639.4171 Fax: 503 598 . DIVIMI l ''" +� I ' � Date/By: Other Permit No .
24 Flour Inspection Line: 503 639.4175 • .. III Date Ready/By: I° See Page 2 for
Internet. www.ci.tigard.or us Notified/Method. /6. Supplemental Information
; i . ?c3rikSC)D it- ? ; ff k, ' „n : - 1A fi... ;-r.: n _ , i .- ' 3 ;' 17''' Y;Y . '''' ' , . ''i ' - FEE" SCHEDTJLE
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❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Fa. i Total
VLAddition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
-.: , ` Sf; I'„ �1S' t - • , gym: �- a ' i .',N. , J .i , P. 9, -
Yt', ;'- I•i ,• i:;i ^ .i ' li , :' . ' ,iR �• . 1 SFR (i) bath 249.20
I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family
SFR (3) bath 399.00
— Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
�+.�. ` x,ii s��� f >iJGA -� .• ,llr, t Fire sprinkler ( sq ft) Page 2
-w'i# r3 ;i<;�;r,Y;l,, Y: w t 4`;; ,`, . 4r• :ir -
' �N•�t a4:. }���' r ������•w •r�. �:?i:ttl•�� ;, •ry A° Site utilities
Job site address" c ' / O U S L) EGi Q e 44100 d Catch basin or area drain 16.60
City/State /ZIP: - a rd 0 re J C, 7 3 Drywell, leach line, or trench dram 16 60
Suite bldg. /apt. no.: Project name. o Footing drain (no. linear ft ) Page 2
G � C�ir. S r P�( Manufactured home utilities 110 00
Cross street/directions to job site:
Manholes 16 60
Rain drain connector 16 60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no linear ft.: ) Page 2
Water service (no. linear ft.: ) Page 2 i
Subdivision: Lot no.:
Fixture or item
Tax map /parcel no.: 16 60
Absorption valve
ri, "' ' "' 4'«
N�, vn i '# -' ,li Si 1 i "" `k' " i;>;. • v enter Page 2
', . 7Ii ?: . _ „. . - - -NI /- ~ .: • , . . : i o -I. n 1 i ' , - - Backflow pre g
Rt P ' , u . t Gl r'� r r 6, 4 a c Backwater valve 16 60
P 1 Clothes washer 1 16.60 ic . p
Dishwasher 16.60
t ,- ; :,A • I , Drinking fountain 16.60
`-'1'.- 7 7 t l 0 � ril i( ?�y ` c • y �'• f l .I 'I` , r;
r;
ar' "' • . /1.41, Ejectors /sump 16.60
Name Abpn G, /Gh"VS 1 Expansion tank _ 16.60
Address 9 / 0 51-, E:491 w0 Q d Fixture/sewer cap 16.60
City/State/ZIP. — 77,9 4 ,-,1 ' ,O 9 7 ..z-z- ..z-z- 3 Floor drain/floor sink/hub 16.60
Phone: (R (, 39 5 $' / l Fax: ( ) ^/ Garbage disposal 16.60
1, a� z . ry 1 ,; , -' ., tr . s �rti_�1 • � � -,: r : Hose bib ( 16.60 � . • k•f tom. i ^ •, i� _ /_ >� `Tflf -Ir t a .•.: Ice maker 16 60
Business name. Ray horn's p IGt�'r'47i ct I' c interceptor /grease trap 16 "60
Contact name: E r • •'■ _" e f / Medical gas (value $ ) Page 2
Address: p e of `I• C5 1 Primer 16.60
City/State/ZIP. ,4 { j 4 -f, '^ i 1 l ? Q to _ Roof drain (commercial) 16.60
sink/basin/lavatory 3 16.60 9 • , a
Phone: ( (,'1 Ci sr
) ui( 37 � C Fax: (, ) 25 2 Tub /shower /shower pan I6 -60 , G •
E -mail: Q,- / ,. ( orn. c O i"4 Urinal 16 60
1 "'•i ` - ' ' ..-, . Ar,ik r . ' . tom' '
'1...e;,`,. ..;:';.,. ;•.4(11 `•R ,,,; i4 ''FS:tQ[ . . 1, Y, : ;,i :i- t i'. - Water closet 16 60 4, • , 0
Business name: Q n I rr ► 61•� -r -- Water heater 16.60
Address. 0 Other: -
P 0 B / k � p //6,2,6 Subtota 7"7.7"7.1 City/State/ZiP: — 4 / R '7' n l e . 7 3-0 G 2- Minimum permit fee: 572.50
Phone: ( -03) 4p y 0 - . (� z 3 7 Fax. (5 C 9 / - Z 3 2 $' Residential backflow minimum permit fee" $36.25
g 7 ' 5 a / Plumbing Lie no.: ,4 _ Plan review (25% of permit fee)
CCB Lic.: g .3 / t i G /0
c8 AA„,„ e e � I State surcharge (8% of permit fee) 9 -21 Authonzed signature: • L �, -a-� TOTAL PERMIT FEE
Print name: 6,.. i ,- - 1 - 4 -{--- Date: (p - , -Q ill This permit application expires if a permit is not obtained wit to
180 days after it has been accepted as complete.
"Fee methodology set by Tri -County Building Industry Service Board
.\Buiidmg\Petmits\PLMF- PemutApp doc 12103 440.4616T( 10/CJCOM/WEB)