Permit CITY OF TIGARD PLUMBING PERMIT
2 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00336
Date Issued: 11/08/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S110DB92091
Jurisdiction: Tigard
Site address: 15431 SW FOUNTAINWOOD PL
Project: HILDEBRAND Subdivision:VTAINWOOD AT SUMMERFIELD A CO Lot: 9
Project Description: Clothes washer.
Contractor: RAYBORN'S PLUMBING INC Owner: HILDEBRAND, CARVER & MILDRED BER
19990 SW CIPOLE RD HILDEBRAND TRUST
TUALATIN, OR 97062 15431 SW FOUNTAINWOOD PL
TIGARD, OR 97224
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
1 ea Clothes Washer 11/08/2011 $25.02
Specifics: 1 12% State Surcharge - 11/08/2011 $8.70
Plumbing
Type of Use SF 47 ea Minimum Fee Adjustment - 11/08/2011 $47.48
Class of Work: ALT Plumbing
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: _- - rmittee 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.
12:05:21 p.m. 11 -07 -2011 1 /2
503 691 2328 Rayborns Plumbing
Plumbing Permit Application
Site Utilities R ECEIV row orrlc); t l: t),.,
City of Tigard q eceived
• 13125 SW Hall Blvd., Tigard, OR 97223 V 7 n 2 1 >atelBy: f may Permit No.: „� l •
I
• ' Phone: 503.639.4171 Fax: 503.598.1960 a Other Permit No.:
Inspection lane: 503.639.4175 CITY OF TIG t° ' lc "L
T I G ,1 R t7 ady/By: f 0 See Page 2 for
Internet: www.tigard- or.gov
6 ''� Method: S iplemental Information
TYPE "OP WORK FEE* SCHEDULE • . •
❑ New construction ❑ Demolition For special information use checklist
Description
® Addition/alteration/replacement ❑ Other: QCY• Ea. Total
New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
CI Accessory building ❑ Multi - family SFR (3) bath 500.32
CI Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler ( sq. ft.) _ Page 2
.108 SITE, I AND LOCATION - g
=ra�tlf kY� ... . - ;..ms - Site utilities:
Job site address: 1 5-9 ci SW G� 1 "� J itCa Catch basin or area drain 18.76
City /State/ZIP: Tie I 1 - ( 97-7.2 y tf/ /� Drywall, leach line, or trench drain 18.76
� ►tC // / Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: Project name: �`l�/UL6 Manufactured home utilities
50.03
Cross street/directions to job site: Manholes `
1 8.76
Rain drain connector 18.76
d S,- C of Sanitary sewer (no. linear ft.: -_) Page 2
/ Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear ft.: �) Page 2
Subdivision: 1 Lot no.:
_ Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
QS/ / /1I(6 - Clothes washer 1 25.02 2.c OZ--
jta&_ tI'l, i /A' k E2Q• Dishwasher 25.02
J Drinking fountain 25.02
Ejectors/sump 25.02
R. PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Name: 1 .4 i
Fixture/sewer cap 25.02
Address: 15 / .54, Aun facodWAf7 t Ate Garbage drain/floor disposal sink/hub _ 25.02
cL f i Qarbage disposal 25.02
- City /State /ZIP: Ti , .ol f f' ? ZZ?
` Nose bib 25.02
Phone:) ) eg - yi /7 Fax: ( ) Ice L� ce ma 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $_) Page 2
'Contact name: Primer 12.51
Address: Roof drain (commercial) 12.51
Sink/basin/lavatory 25.02
City/State/ZIP: Solar units (potable water) 62.54
Phone: ( ) 1 Fax: : ( ) Tub /shower /shower pan 12.51 • -
E -mail: Urinal 25.02
CONTRACTOR Water closet 25.02
Business name: RAYBORN'S PLUMBING INC Water heater 37.52
Water piping/DWV 56.29
Address: P.O. Box 69
Other 25.02
City /State /ZIP: Tualatin, OR 97062 Subtotal 2,5 6.1-
Phone: (503) 692 -4139 Fax: (503) 691 -2328 Minimum permit fee: $72.50
CCB Lic.: 87852 Plumbing • c. no.: 34 -I66PB Plan review (25% of permit fee)
Authorized signature: -� 44 -�
State surcharge (12% of permit fee) 8 - -
�; 1 TOTAL PERMIT FEE D lV
Print name: )
[' This permit application expires if a permit is not obtained within t80 days
` i Dater / /7///
r after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.