Permit M1
CI TY OF TIGARD PLUMBING PERMIT
- 74 A ' , 16 DEVELOPMENT SERVICES PERMIT #: PLM2006 -00026
--y 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 1/23/2006
PARCEL: 2S 111 AB -05100
SITE ADDRESS: 09100 SW INEZ ST ZONING: R -4.5
SUBDIVISION: PENMAR TERRACE LOT: 003 JURISDICTION: TIG
Project Description: Replace water service.
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: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 40 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
ROBIN CONDER
9100 SW INEZ ST Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 1/23/2006 $72.50
[TAX] 8% State Surcha 1/23/2006 $5.80
Phone : 503- 816 -8154 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 B "� Permittee Signature: y g Se A \c:N
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.
Jan, 23. 2006 9 :12AM Rayborns Plumbing No. 9416 P. 2
PlumbiII Per mit Ap`` ` ``ioh -'�
� rt>'lt orr <icE 1)st'. r >N11X
City W Tigard Date/Hy: Permit Nom 1 "∎� doaa6
W Hall Blvd,, Tigard, OR 97223 JAN 2 3 200
Flan Rceived ' ' _ p / ' /�
13125 S , l D �� r
Phone: 503.639.4171 Fax: 503.598.1960 D la++ Review 0 �� /�
P \ , i ''' `t`'� 1 I'``� Dat6lBy; • Other Permit No.:
24 Hour Inspection Line 503 639 4175 g i 1,J
Internet www c+ tigard or us t,A O I •• Date Ready/By: '11'65;
See Page 2for
Not' le e
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❑ New construction ❑ Demolition For s .edal in ormation use checklist
n Addition/alteration/replacement ❑ Other: Ea. Total
\. r y TM u ,,, +tit.<.r' „.„ N a ily dry lliugs (includes 100 ft. for each utility connection)
Description
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New 1-2-family e '
t ...r; "i'-I„'. 'a,,..e.�`. , 1 :t a i . i g04at ` ?�.„�rx.} ?,113_ ffI a'11 `tr.? s SFR bath 24920
Al- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
w
❑ Accessory building SFR (3) bath 399.00
r5 g ❑ Multi - family _
Each additional bath/kitchen 45.00
❑ Master builder El Other:
s"ti '' :rrt l � r ' r . {' , 9 , s, �' E�v .! ', $ 1. . . ,, S utilities
ties ( s � ft) I Page 2 •
Job site address' 1108 ` t, ■) _.n e z \5 L Catch basin or area drain 16.60
City /State/ZIP. 7 4 , - 4 , p 9 e) , 7 a ` Drywell, leach line, or trench drain I 16.60
Suitc/bldg. /apt. no.: t/ 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.:_3. )4. � Page 2 J t � , pi
' Tax map /parcel no.:
Fixture or item
, . ^, q.�:n1(r . rc �r^^•a ^r. w, . "mff+�-,_c,?.17..^tr..7,3r .T,. r ^�r.. ; ^. �. ?. 1 ; i1 , ..,u"r:S:R , „ : , : r s� ". .E;.: ;.,, :::te, Q Page 2
f Cgi_ e,r (.) q - Q r V/ 4 e. Backwater valve 16.60 '
Clothes washer 16.60
Dishwasher 16.60
. :._,s--r ,: :g: M:r.� a •.,,,. .,.Z, �, fountain 16.60
s-
-.+ y + v) � Drinking
ku t, \ ,: �ll�' �, . ei %��$� ...,:itmi.,:- �;�;„"�''�.,^ Y.i_ �..�",= ;� ng
7.IATv.3fS .0 CRA "I.':' .:.::d ^.,�nvr:� A�R�. � ".�. �...r..�Eyikcl.$ a' i,.. i .�>.•:.$ 'M ki
Wit-+ .MRS.::�::::r. . .,.. "�w_-�r.5�5��:.7:.x,.,. \.,. � �J.�'�',��d:..�G;,'t]:;a
Ejectors /sump 16,60
Name. I 0 Je, A - ■ or - Expansion tank 16.60 _
Address: 9 / 0 S (,...) 2hzz- S V Fixture/sewer cap 16.60
City /State /ZIP: 77, v rc>/ tie 9 7 a u Floor drain /floor sink/hub 16.60
Phone: 3) ei y - / pax: ( ) / Garbage disposal 16.60
F�" "" ^., "C I' n P`?''.t *, 7 : ^F"� r r-57 11l w7 r . Hose bib
'" �' � r r �= a x � +r .� x „� 1 16.60
. O l-3tr - :r .41, 4 :1 ?�i 3E " l`, k ai'-s .t t t it 1
>..,,�.,, ;r .�: ,:,. tit Ice maker 16,60
! • II Interceptor /grease trap . 16.60
Contact name;
Et T w - Medical gas (value: $ ) Page 2
Address! p o 6 G� Primer 16.60
City /State /ZIP: p 9 ! ` ' s u 976 / Roof drain (commercial) 16.60 • � a Sink/basin/lavatory 16.60
Phone: (.503) 6 �� y /.3 1 Fax : •Z ) 6 91-3�-IP -
Tub /shower /shower pan 16.60
Email Cr n r• • or , 6
^TI Ft;7nr urn a^a Mir :,•- -. wa r ,M psi t1,lo< -, a J^ Urinal 16.60
,. ?, ix � a � a . of a � E 1 � 3 1 :�,C� ay i� ir ; ,:;: Cr,� 7 ---
5101 .. . r�'Sx, µr d g � �„' � Gx : tit _x , Mitt kg., x 4=4 :ft ri �.l :it r Water closet 16.60
Business name: /Q q or ns 1 01 m 1)1 + G Water heater 16.60
Address: r ' PieZ � O i 6 Gy J Other:
/ < 9 7o � Subtotal
City /State /ZIP: @ L ? �7 5-5. Min imum permit fee: $72.50
Phone:(r) Z'Z• yy/..? 0.3
ay Fax: )41 /. � _3� g , Residentialbackflowminimumpermitfee: $36.25 7
� 2.50
'
CCB Lic.: Z_716 Plumbing Lic no a -I C. ( ps Plan review (25% of permit fee)
f
Authorized signature: State surcharge (8% of permit fee) S' $U
TOTAL PERMIT FEE 7 3
Print name, E T. A 4 -E 4- Date: 1_ pa ..O4 This permit application expires If a permit is not obtained within
180 days after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board.
i:\ Building \Permus\PLM -PermiLApp.doc 06/05 440.46t /02 /CONUWEB)