Permit C ITY OF TIGARD PLUMBING PERMIT
l DEVELOPMENT SERVICES PERMIT #: PLM2006 -00393
* � 11 � 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 8/23/2006
PARCEL: 2S 111 CC -16700
SITE ADDRESS: 10130 SW HIGHLAND DR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.4 LOT: 218 JURISDICTION: TIG
Project Description: Replace water heater.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
BOB NOTTINGHAM
10130 SW HIGHLAND DR Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 8/23/2006 $72.50
[TAX] 8% State Surcha 8/23/2006 $5.80
Phone : 503- 694 -5412 Total $78.30
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -4139 •
FAX 503 -691 -2328
Reg #: LIC 87852
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 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503 - 246 -6699 or 1- 800 - 332 -2344.
Issued By: '' ��, �?�� Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
Aug. 23. 2006 2:43PM Rayborns Plumbing No. 5679 P. 1
Plumbing Permit A -0p he tionn W • FOR OFFICE USE ONLY
i YO 0- -- . - _
City of Tigard Receive ,.-� _�/� Q
pans �3 0 l) I`L%)`' Permit ',�� 49g g
Phone: 503.639.4171 Fax: 503.598,1960
13125 5W H311 Blvd -, Tigard, OR 97223 2 , plan Review � Z`x
^11 2 ,_ „t y Plan
24- Hour Inspection Line: 503.639.4(75 AUG �oo dt, : Other PennitNo.:
Internet www cl.tigard or us - Date Ready /By rvr s� 1171 See Page Z for
b ‘,/ 4 bt f 1 ■ 0 na -4.L' Notified/Method:
/ 100DADADADADADA
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❑ New construction ❑ Demolition For Veda! infprmalion use checklist
Description . 1 Qty. 1 Ea. I Total
gr; Addition /alteration/replacement ❑ Other:
New 1- 2- family dwellings (includes 100 ft, for each utility connection)
4m ' ; I i ,,�r�ap •n r a tlg. � o t9t e 5 ^m tie , r� rrR"r
l , r, n; 1 - 7 tr
Satga: a tr r t4 , rlAft, 1 0 �I n or1 ti3!t 4hIcL 7t t15 Tr y a r L l t t, r
ct i s:t,, � ? ! =t= ?� r ,'` u,. 1 �>...,, 1 „? . , : ; :.. . -. trT) t , :,1 #4r , ,`I SI SFR (1) bath 249.20
1- and 2 fainily dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory uilding SFR (3) bath 399.00
rY ❑M ulti - family
ID Master builder CI Other: Each additional bath/kitchen 45.00
� '', ' r 1. (fin Fire sprinkler (_ sq. tt.) Page 2
, 1 � .71 ,, t )1i Ew i f ;7 y Yl tali t }q$ i
1t1 'S . J 11 t ft ) L J 1)
`tIs- 'f.i..._rrF, 4=Er ,. r l 9 ,if?14.:4� >? :,?] ""ti�'t'F".��r'.E�A /gi�1 ut , taA '��tf�.IMMi_( },I.,1.4.E.� ;°r?',. Site utilities
Job site address: D • / , w/ j , j _Catch basin or area drain 16,60
City /State/ZIP: jaf � 9',A�),/ Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: T I Project name: Footing drain (no. linear ft,: ) Page 2
Cross street/directions to job site:
Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: -) Page 2
Storm sewer (no. linear ft.: ____•) Page 2
•
Subdivision: Lot no.: Water service (no. linear ft ) Page 2
Tax map /parcel no
Fixture or item
... nvn y , , .m -,. c Absorption valve 16.60
V R ArW,, ' a ,.. nil P 51;11' y al 0 A { fl , i-S# r,i., 7 r'F t; .. 1 -; ' .: P
1 U 1 '7:4!%! r , ) r2!`} `) , L�, K � 1 t .. C l +1 f Y i4 S >: �) it ::
' flit �a ' ltd. , . „rr,, r• :,.- 7 r 1,,,,,. 1 r -r.: r , -6 >r)� � . � r..MN mot.,,,,,.{ Backflow preventer Page 2
' .1IIjIjrI e r r ll` Y r.I. 1 P Drinking fountain 16.60
r a7. t'iki . ib., A ils .7 "# t h F�:� , i..,f... 1 -I.i..d I z�.,1 \,'.1 <j!r ' I �;;1 i,I . 4 47 - � aI.3 `w.
Ejectors /sump 16.60
Name: A/ // 7 ' 9 ��
Expansion tank 16.60
Address;
430 S AU 1 r L . Mil1 - Fixture /sewer cap 16.60
City /State /ZIP; ' ; r, i _ Floor drain /floor sink/hub 16.60
Fax: ( ) Garbage disposal 16.60
4,-. 047 s i +F oi. = ca r+ I Ittt r a i i ° i7 -, 1 t 1 Hose bib 16.60
Tatldt3, �∎ P 1 itt t � �t� "r' i:a. p r i Ail: :1` 71f ut' Mr., rl 0411 1 "�tG ftt i maker 16.60
B name: ' /� /G/ r i..4f • interceptor /grease trap 16.60
Contact name: A/ i�LL14t Medical gas (value; $ ) Page 2
Address: ptX 49 Primer 16.60
City / State/ZiP: / .t/ CiM (9 R 9 7764 Roof drain (commercial) 16.60
Phone: (� - 3) . -. '1137 I Fax : : :: (j3) 49/ x-3.4 Sink/basin/lavatory I6.60 •
/ Tub /shower /shower pan 16.60
E -mail 4 i-' • „ / , /ZS
c tCS p� fa T ro r a'�y a g" 3 n a iYP"'7 ti! t " ,yr L Urinal 16.60
} I t �+t}: t]f r 1.. .7iI ire } ,yr i " 4 r I� N t 5 F F� rT 1 ,1 ii : 1 i f'-� P tt tKII T:i t x PI
kil':ISI.tea1Uai ikI Gti ll;.ib ittg�r :t n?;L:2t rrIisl'ky)4Lt'I Ii 1l i i ksY�"' Fi,r Water closet 16.60
IZESEIr iWater heater r, 16.60
Address: do i c _ ' Other
City / State/ZIP: r4 j A. A 4d _ Subtotal.
Minimum permit fee: $72.50 7y �t.
Phone; 6793 ),C9„;.). - y�,3 y Fax: $' 3 ) 6, `,� .) 3 1 Residential backflow minimum permit fee: $36.25
CCB Lic.: c r 7 8 Plumbing Lic. no.: - 4 G pig Plan review (25% of permit fee)
State surcharge (8% of perm t fee) • J t`3
Authorized signature: ,/, f, TOTAL PERMIT FEE -1 g, 9, /I
� .. i Date; This permit application expires if a permit is not obtaine within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\ building \PermitS\PLM- PermiIApp.doc 00/05 440-4616T(I0/02/COM/WE.9)
11wY OF_TIGARD
BUILDING DIVISION PERMIT #: PLM2006.00393
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8123/2005
Phone: (503) 639 -4171 41,0 �iV"
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
INSPECTION WORKSHEET FOR DATE: 9/f2QQ6 TIME: 7:05AM PAGE: 75
SITE ADDRESS: 10130 SW HIGHLAND DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NC` .4 LOT #: 218 TYPE OF USE:
PROJECT NAME: NOTTINGHAM
DESCRIPTION: Replace water heater.
OWNER: NOTTINGHAM, BOB PHONE #: 503 - 694.5412
CONTRACTOR: RAYBORNS PLUMBING INC PHONE #: 503-692-4139
Inspection Request Scheduled For: Date: c9/ ?005 Pour Time:
Code # Inspection Description Confirm # Contact # Message l
399 Plumbing final 03 049-01 503 -692 -4139 V /�
-
Corrections /Comments /Instructions: (S5 U
C i t� �t c
•
- r J isi" \.
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITI • AL ES ASSESSED
c
Inspector: ;�j�[� Date: C 7 4' Phone #: (503) 718_242