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Permit CITY OF TIGARD PLUMBING PERMIT ` ° 7 '" COMMUNITY DEVELOPMENT Permit #: PLM2011 -00326 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 11/01/2011 Parcel: 2S110DD12300 Jurisdiction: Tigard Site address: 10720 SW HIGHLAND DR Project: WILSON Subdivision: SUMMERFIELD NO.13 Lot: 693 Project Description: Replacing bathroom tub Contractor: RAYBORN'S PLUMBING INC Owner: WILSON, CHARLENE 19990 SW CIPOLE RD 10720 SW HIGHLAND DR 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 11/01/2011 $12 51 Specifics: 1 12% State Surcharge - 11/01/2011 $8 70 Plumbing Type of Use SF 60 ea Minimum Fee Adjustment - 11/01/2011 $59.99 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 foll w th- rules adopted :y the Oregon Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952. -009() You . obt.'r a .y of the rules or direct questions to OUNC by calking 503 232 1987 or 1 8 "•; 2 234- Issued By: /J - ermittee Signature: / Call 503.63'.4 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 completi i. ' of the project. Approved plans are required on the job site at the time of each inspection. -503 691 2328 Rayborns Plumbing 1121 10 a m 11 -01 -2011 1 /2... PiumbinE Permit ApnlicM Building Fixtures I•;(•)I1 OF FR' I' t SF: 0 \1.. 74 City of Tigard �y 01 2011 Date/By, / J »1 ^ T Permit No : /J/ , ex \ I i� (�1].� • 13125 SW Hall Blvd., Tigard, OR 3 Date Re v 1 / ,7 ► ` p((f t / r�10 Plan Review Phone. 503 639.4171 Fax g T IGARD Date%By Other Permit No • Inspection ection Line 503 639 417 I l l Date Ready By: Acts. ® See Page 2 for Internet www T I (.. A,R t n and - o y y B g g BUI DING DIVISION NotifiedNelhod ; -*L� Supplemental Information - TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description I Qty. 1 Ea 1 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 0 and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 SFR (3) bath 500 32 ❑ Accessory building ❑ Multifamily 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: I O ri ; s (...- ) 1„1 A f��n D Catch basin or area dram 18.76 r. Drywell, leach line, or trench drain 18 76 City /State /ZIP:,„,0-011..5 (A f c.i. Of 417 7 t,4 Footing dram (no. linear ft.. ) Page 2 Suite/bldg./apt no.: 1 Project name: ✓v 1 Id 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 . ) Page 2 Subdivision: Lot no.: Fixture or item: Tax map /parcel no. Backflow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12 51 jj�� --1----,,,‘„, Clothes washer 25 02 Il P-��t �e / ,c kO t-..) e r Dishwasher 25.02 Drinking fountain 25.02 Electors/sump 25.02 ❑ PROPERTV OWNER I ❑ TENANT Expansion tank 12.51 Fixtuieisewer cap 25.02 Name: Floor drain/floor sinklhub 25.02 Address: Garbage disposal 25.02 City /State /ZIP: __ _ Hose bib 25.02 Phone: ( ) Fax: ( ) ice maker 12.51 _LICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 1 i Medical gas (value: $ ) Page 2 Business name: Y1n0V'IA 5 PIUtM Wbto tA. L-- Primer 1251 Contact name: L 4 - if. l Roof drain (commercial) 12 51 Address: 0 i • S w 1 pQ 1-e Sink/basin/lavatory 25 02 City /State /ZIP• V i v._ 0 {- a( 06 , Solar units (potable 62.54 Phone: (col ) 6 q - Lt\ 3 q Fax: : ( 3) 6 et 1 Tub /shower /shower pan / 12.51 Urinal 25.02 E -mail: r e- (Yl\`100 r to c o _ �/ Water closet 25.02 CONTRACTOR V - `- © f• 1 Water heater 37.52 Business name: YJ r n S Pit) V�b� l k G. - Water pipmg/DWV 56 29 Address: s 11�� (,� C. • • 0 , -- 8 ) Other 25 02 City /State /ZIP: i1� -A. l ,,,_, l t 0 6a- , Subtotal Phone: (6'31 6 ` 7;2 i ..1// ;,. C C Fax: (4::0) �‘en _ Minimum permit fee; $72 50 �� .. S 0 CCB Lic.: 7 a L J _ / ' lumbin • ic. no.: L - 1 Plan review (25% of permit fee -7 U �� State surcharge (12% of permit fee) -r- ` Authorized signature. ` �1� � TOTAL PERMIT FEE , i, �'�} Print name: 4 ) e / `' Date: 1 J - ' - J / This permit application expires if a permit is not obtained wit ' I O days v vY+ 1 1 after it has been accepted as complete. *Fee methodology set by Trt-County Building Industry Service Board I'Buddm5PertmtsPi.Mt PernetApp do,: 10'0100 440- 4016T(t0•02TOM WEB)