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Permit
, CITY OF TIGARD PLUMBING PERMIT O t 11 ' h COMMUNITY DEVELOPMENT Permit #: PLM2011 -00334 Date Issued: 11/04/2011 - L I.GA ;D 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 1 S133DC15900 Jurisdiction: Tigard Site address: 12974 SW LAURMONT DR Project: MORAN Subdivision: VILLAGE AT SUMMER LAKE PARK Lot: 14 Project Description: Replacing 60 ft of water service. Electrical permit may be required if house grounding is affected. Contractor: RAYBORN'S PLUMBING INC Owner: MORAN, JOY L REVOCABLE TRUST 19990 SW CIPOLE RD SNEDECOR, DIANE C TUALATIN, OR 97062 9941 NW BRIE CT PORTLAND, OR 97229 PHONE: 503 - 692 -4139 PHONE FAX• 503 - 691 -2328 FEES Quantity Description Date Amount 60 If Water Service 11/04/2011 $62.54 Specifics: 1 12% State Surcharge - 11/04/2011 $8.70 Plumbing 10 ea Minimum Fee Adjustment - 11/04/2011 $9 96 Type of Use SF Plumbing Class of Work: ALT 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. Issued By: Permittee Signature: ,� Call 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. -503 691 2328 Rayboms Plumbing 03 p m 11 -03 -2011 1 /2....., Plumbing Permit Application RECEIVED Building Fixtures NOV 0 3 2011 FOIZ OI•:FIf! 1 ;I: . 0.1.N City of Tigard Received Date 'By. at. Penmt No. • 13125 SW Hall Blvd.. Tigard. OR 9727 OF TIGARD ' � /__ 0.4, - 9tt��3311��JJ�� P lan Review Phone. 503.639 4171 Fax: 503 5 Other Permit No . DING bate /By: _ `l1 O A R D Inspection Line 503 DI1V U DIV ISIO Date ReadytBy. Lt4__ Ea See Page 2 for Internet. www tigard - gov Notified /Method: l • Supplemental Information TYPE OF WORK FEE* SCHEDULE D construction ❑ Demolition For s. eclat in ormation use checklist. Descri.tion WON Ea, 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 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 0 Accessory building ❑ Multi- family SFR (3) bath 540 32 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: / j Catch base crane drat 18 76 �r �� + r' Drywell, leach line, or trench ench drain 18 76 City /State/ZIP: /Jr ae. ©r eno62 Footing dram (no. linear ft _) Page 2 Suttelbldg.lapt. no.. Project name: Manufactured home utilities 50 03 Cross street/directions to job site. Manholes 18 76 Rain drain connector 18 76 Sanitary sewer (no linear ft : ) Page 2 Storm sewer (no. linear ft.. •-__) Page 2 Water service (no. linear ft if 1.) ) j.i , j Page 2 , _ Z Subdivision: Lot no.: Fixture or item: Tax map/parcel no.: Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12 51 k �J Clothes washer 25.02 -AL'e. k.J. .5 e Y UtCf-,. Dishwasher 2502 Dnnkmg fountain 25 02 Ejectors/sump 25.02 ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture /sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City/State/ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 --B ❑ CONTACT PERSON Interceptor /grease trap 25 02 Business name: I Medical gas (value S ) Page 2 Contact name: /b Primer 12,51 �4' /e /7�i� h pot drain (commercial) 12.51 Address: / '7 ' ..5e..,,, � �,,p,„./e, Sink/basin/lavatory 25 02 City /State /ZIP: -- - " ----.1 � i r , r - C! d6 Solar units (potable water) 62.54 Phone: ( ) 6T2 -Y /3 Fax: : (Q3) C'b .3,;_,g Tub /shower /shower pan 12.51 E -mail: �Llre re . t. O VA-^-- Urinal 25 02 `�' Water closet 37.52 CONTRACTOR r � Water heater 37 52 Business name: Ka,, , OV 4 . s Ft0 ViAl A `kr-_--. Waterpiping/DWV 5629 Address. Iaqcr0 S L gl Other. 25.02 MN Guy /State /ZIP • tJU \ . w... a - ci7D - Subtotal Phone: (spa ) G'; _ (//3r Fax: („03 ) 6W _a 3�1 Minimum permit fee: 572.50 -7), y/ / Plan review (25% of permit CCB Ltc. i. 9 35 Pium.in; Lic no: 1.1 _ bd r t fee) EN i .,. Authorized signature' surcharge (12% of permit tee) nature' �� g .... i ,,,/ :..ra�.,��.T „ TOTAL PERMIT FEE �y�� ir(• .)-0 Print name: ) - Date - 1 ( ( This permit application expires if a permit Is not obtained within 180 days itkj f e N .. .' i� t ( after it has been accepted as complete. •fee methodology set by Tn- County Building Industry Service Board. i , Building Perms PLMU- PermrtApp doc 1001 09 440- 4616T(10'02,COM. WEB)