Permit CITY OF TIGARD PLUMBING PERMIT
1111 '
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00128
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/21/2012
Parcel: 2S 104AA02400
Jurisdiction: Tigard
Site address: 12265 SW 127TH AVE
Project: Wyffels Subdivision: BELLWOOD Lot: 73
Project Description: Master Bath remodel. (1) lavatory, (1) shower pan, (1) water closet
Contractor: RAYBORN'S PLUMBING INC Owner: WYFFELS, HENRY R
19990 SW CIPOLE RD 12265 SW 127TH AVE
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -4139 PHONE: 503-680-6776
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
1 ea Lavatories 05/21/2012 $25.02
Specifics: 1 ea Tub /Shower /Shower Pan 05/21/2012 $12.51
1 ea Water Closet 05/21/2012 $25.02
Type of Use: SF 1 12% State Surcharge - 05/21/2012 $8.70
Class of Work: ALT Plumbing
Type of Const:
10 ea Minimum Fee Adjustment - 05/21/2012 $9.95
Occupancy Grp: Plumbing
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: Q AU P I' n PZ-/ C ,I _41) DN I
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 Rayborns Plumbing 01:39:37 p.m. 05 -18 -2012 1 awe. dee....-
Pl
R ECEIVED
umbine Permit Application
Building Fixtures MAY 1 8 2012 / l tilt l >fl it 1. t `l tl.l l
III City of Tigard CITY OF TIGARD $ l Q./4 dQa ...0C
i 13125 SW Hall Blvd, Tigard, OR 972 . ll I I 1 OI I I S G / AiID p��gV a , I � L Permit No.:
■ Phone: 503.639.4171 Fax: 503.598.�b0ILDI1�lu DI Y ISIOI�I %en Review
Date/By: Other Permit No.: ' 13 See Page 2 for
r I t ; ,\ I: I, Inspection Line: 503.639.4175 Data Ready/By: Grp,/
Internet: www.tigard ar.gov
Notified/Method: LI p Supplemental Information
. TYPE OR WORK - " FEE* SCHEDULE
❑ New construction ❑ Demolition Forspeci!allflformtflfon use checklist.
�1 Description I Qty. I_ Ea. I_ Total
e� Addition/alteration/replacement ❑ Other: New I- 2 - family dwellings (includes 100 ft. for each utilityconnection)
• • CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
RI I - and 2- fancily dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
❑ Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler ( sq. It) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: / 4 r j A
Dry
l 6 Catch besot or area drain 18.76
City/State/ZIP: 4 v' O wel l , leach tine, or trench drain 18.76
?l D (� ' z � .23
Footing drain (no. linear ft.: _) Page 2
Suite/bldgiapt. no.: Project name: r
I W� p1 m Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector , 18.76
6s - s - 1y Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: _,) Page 2
Water service (no. linear ft.: ____) Page 2
Subdivision: I Lot no.: Fixture or Item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION 0 WORK Backwater valve 12.51
11 1.lo """ �� Clothes washer 25.02
A +
_. ... i / Dishwasher 25.02
_ Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER 1 ❑ TENANT Expansion tank
12.51
Name: D f la Fixture/sewercap 25.02
Address: �f / 1570 �insoorsink/hub 25.02
mo �16.r ,4 CI y Garbage disposal 25.02
City /StateiZlP: •
4 "l � �` _ f7��73 Hose bib 25.02
Phone:J 5 !� Fax: ( ) Ice maker
12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptorigrease trap 25.02
Business name: Medical gas (value: S 1 Page 2
Contact name:
Primer 12.51
Roof drain (commercial) 12.51
Address:
Sinbhasim'lavatory I 25.02 $ 5
City.'State;ZlP: Solar units (potable water) 62.54 ,
Phone ( ) Fax:: ( ) Tub/shower/shower pan i 12.51 is S''1 1
E -mail: Urinal 25.02
nti � i CONTRA OR Water closet I 25.02. 401
LAI- Water heater 37.52
Business name: y6/LN S (Mi&, Water piping,DWV 56.29 Address: 6 OOther 25.02
y ( � D „ 9 w Subtotal 4 ?,� Cit ; State/ZIP: �`� �� � {�A -
i nS I P ,.
Phone: ( , . 0 - 1 F ax; r J • :. Minimum permit fee: 572.50
r r ��mbing Lic. o.: � ` t 01 ( i Plan review x25 %ot permit fee)
State surch F
Authorized signature u SO days
/
s A �' TOTAL PERMIT FEE EE
i/
�� �, `���M N Date: Ni This permit application expires If a permit is not obtained within SO days
after It has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Board.
I:-BuihLrg Permila'PLMIJ- PmnitApp dn.: I0.0I tM 330.4416T( IWAICOMLWFBI