Permit a, CITY OF TIGARD PLUMBING PERMIT
u�`I°� DEVELOPMENT SERVICES PERMIT #: PLM2001 -00048
Ail DATE ISSUED: 02/15/2001
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 09860 SW RIVERWOOD LN PARCEL: 2S114BD-01200
SUBDIVISION: PICKS LANDING ZONING: R -4.5
BLOCK: LOT: 073 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: REMODEL AND RELOCATE VARIOUS FIXTURES IN LAUNDRY /BATH NOTE: ELECTRICAL PERMIT
REQUIRED
FEES
Owner:
Type By Date Amount Receipt
TORRENCE, EVELYN P K + PRMT CTR 02/15/2001 $72.50 27200100000
STANLEY E TRUSTEES 5PCT CTR 02/15/2001 $5.80 27200100000
9860 SW RIVERWOOD LANE
TIGARD, OR 97224 Total $78.30
Phone 1:
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
lnsp
Phone 1: 503 - 692 -4139 Rough -in
Reg #: LIC 00087852 Final Inspection
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 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
Issued By: ( Permittee Signature: / !L/
3) 639 -4175 by 7:00 P.M. for an inspection needed the next business da
• Feb - 14 - 01 03 :31P Rayborn's Plumbing, Inc.. 15036912328 P_O1
yl Permit Application Date r eceived:
`✓ �� Permit no.:�- '"� .i ►
Sewer Permit No. Building Permit No.
City of Tigard Proiect/APpl, No. Expire Date
13125 SW Hall 131vd. Tigard, OR 97223 Date issued By Receipt No.
Phone: 503 639 -4171, Fax 503 598 -1960 Case File No. Payment Type
Land Use A. •royal
TS.14O *P ` ...... .......
L. I & 2 Family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family 0 Tenant improvement
'] New construction Addition/alteration /replacement 0 Food service ❑ Other:
trlt{ :SI11 i *.1i>t1211tiI1tt ....
1N @E *il;;E1E'111 tf4it :ittttti�l�it uu �#ta'111i�i
. . .
Fee Total
` Description Qty Job address: 9860 SW Riverwood Lane New 1 & 2 family dwelling only: /+ 100 ft
Bldg. No.: I Suite no.. SFR (l)Bath $249.20 0
SFR (2) Bath $350 0
Tax map /tax lot / account no.: SFR (3) Bath $399 0
Lot I Block: I Subdivision : Each additional bath / kitchen $ 0
Project name: Stan Torrence Site Utilities: Catch basin / area drain $16.60 0
Draywells/ leach line / trench drian $ 0
City / county : I Zi p ' Footing drain (no. Lin. ft ) $ 0
Description and Location of work: Remodel Manufactured Home utilities- each $46.40 0
Date of Completion/ inspection: Manholes $ 0
0
1'1lti11 . C(�' 1 txC w o ne
Rain drain connect r $ 0
;:; ..... , . Sanitary 5e er (n . o 1i ar f ee t ) 100 ` $55.00 0
Business name : RAYBORN'S PLUMBING
Storm Sewer (no. of linear feet) 100' $55.00 0
Address : P.O. BOX 69 Water Service (no. of linear feet)100' $55.00 0
Fixture or item :
City : TUALATIN State: OR 1 Zip: 97062 Absorption valve $16.60 0
Phone : 503 692 -4139 Fax : 503 691 -2328 Back flow preventer $27.55 0
Backwater valve $16.60 0
E Mail Address : Wayne(pDRayborns.com Basins / Lavatory $16.6() 0
CCB no. : 87852 1 Plumb. Bus. No. : 34 -166PB Clothes Washer 1 $16.60 16.6
Dishwasher $16.60 0 hwa
City / Metro Lic. No.: 001806 Dis $16.60 0
S_ ^ J 4 Drinking Fountain (s)
Contractor's signature :. (.cJ�'r - t GD Ejector / sump $16.60 0
Print name: Wayne Siebold { Date :2/14/01 Expansion Tank $16.60 0
Fixture / sewer cap $16,60 0
(;r'�T• 3f '1 P...12y(3" $16.60 0
.. Floor drains/ floor sinks/ Hub , . loor drain
Name: , Garbage Disposal $16.60 0
Hose Bibb _ $16.60 0
Address:
Ice maker $16.60 0
City : Stale : OR `Zip: , Interceptor / Grease trap $16.60 0
Phone : Fax : Primer $16.60 0
Roof drain (commerical) $16.60 0
-7 - Nit .. cM, 1�GI 1F ERt'..... { . ..P14 %.131. L ..
; . .. (s), Basin(s), Lay (s) 1
Sinks(s,R ns,Lv s $16.60 16.6
..... ;:. . ,_ $16.60 0
Notice : This permit application expires if a permit is not obtained Sump 1 $16.60 1
within 180 days alter it has been accepted as complete. Tubs/shower /shower pan $16.60 0
Urinal
Notes: Supply STUPID Second Fixture Form 1111111 Water Closet • l $16.60 16.6
1 Water heater $16.60 0
Other : ' i . $16.60 0
TOTAL / 66.4
1 . Minimun Fee $50 .6.40 /
Visa Card # 4833 4900 0291 0642 Expire Date - 09/ 01 Plan review (0,30 %°
Cardholder name - r '•ward L. . w IV
A\
charge .08% \
/ � Total 0 4x71.71
SIGNA ' ° "'/ , 1,,,,i 1I' 4--fi Tstount$ �l • q( r -
179' o
S go
--Jr,Fi7§5--- ,
.
•
Feb -14 -01 03:31P Rayborn's Plumbing, Inc. 15036912328 P_02
•.t.Io / /C0 FRI 10:48 FAX 503 598 1980 CITY OF TICARD 2003
•
PLUMBING PERMIT FEES:
PRICE TOTAL . N ew 1 and 2- fatiilly dwellings only: •
FIXTURES. (individual) ' • ..OTY (ei AMOUNT , (includes all plumbing fixtures in PRICE TOTAL
' Sink 16.60 the dWelling and the first100 ft. • QTY (ea) AMOUNT
Lavatory 16.60 for each utility connection)
One (1) bath - _ $249.20
Tub or 1 ub /Shower Comb. 16.60 Two (2) bath $350.00 _
Shower Only f 16.60 Three_(3) bath 33
^ _ 99.00 _
Water Closet T 16.60 __._ - __ _
SUBTOTAL •
Urinal 16.60 8% STATE SURCHARGE , '
Dishwasher 16.60 PLAN REVIEW 25_ % OF SUBTOTAL
• Garbage Disposal 18.60 TOTAL
Laundry Tray l 16.60
Washing Machine ' 16.60
Floor Drain /Floor Sink 2" 16.60
3" 16.60 PLEASE COMPLETE:
4" 16.60
- Water Heater 0 conversion 0 like kind 16.60 Quantity b e Work Performed
Gas piping requires a separate mechanical Fixture Type: New Moved Replaced Removedf
permit. _ Capped!
MFG Home New Water Service 46.40 Sink
MFG Home New San /Storm Sewer 46.40 Lavatory
Hose Bibs 16.60 Tub or Tub /Shower
Combination i
Roof Drains 16.60 , Shower Only ✓
Drinking Fountain 111.60 Water Closet ✓
Oilier Fixtures (Specify) 16.60 ' Urinal
Dishwasher
Garbage Disposal
Laundry Room Tray ✓ _
Washing Machine 1:/'
- -. Floor Drain /Sink: 2" - -
Sewer - 1st 100' 55.00 -
3 "
Sewer - each additional 100' 46.40 4" -
Water Service - 1st 100' 55.00 Water Heater
Water Service - each additional 200' 46.40 Other Fixtures
_ (Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40 '
Residential Backflow Prevention Device" 27.55 - ----
Catch Basin 16.60 T -
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE:
Rain Drain, single family dwelling 65.25
Grease Traps 16.60 -
QUANTITY TOTAL -
Isometric or riser diagram Is required It
m
Quantity Total is > 9
'SUBTOTAL ' • 8% STATE SURCHARGE '
•
"PLAN REVIEW 25% OF SUBTOTAL .
Required only if fixture qty. total Is > 9
TOTAL $
•
* Minimum permit fee is $72.50 + 8% stale surcharge, except Residential Backflow
Prevention Device, which Is $38.25 + 8% state surcharge
"All New Commercial Buildings require plans with isometric or riser diagram arid
plan review.
(3 '
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Insp Line: 639 -4175 Business Line: 63 171
BOP
Date Requested 3— Z-f AM PM BLD
Location 98' G Sw / ?,b eA Suite ?J /— d o< re
Contact Person Ph G 9 Z-'1 elet jt , / O o c/"
Contractor Ph SWR
BUILDING Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final �"`
PASS PART FAIL ` Q s Zc1
unt3J14,,,'
'Post&
Under Slab
Top Out
Water Service
Sanitary Sewer
.'• rains
~-y FAIL
Rough In
Gas Line
Sm■ke Dampers
PART FAIL
;RICA >' .., ..
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
Backfill /Grading
Sanitary Sewer •
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk 3/2
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.
yv y ,�
CITY OF TIGARD BUILDING INSPECTION DIVISION
MST ,
24-How-Inspection Line:. 639 -4175 Business Line: 639 -4171
r. BUP
Date Requested 3-2 G AM PM BLD
Location 9 t' d S w v --• t.-" cl t Suite
r% MEC ()
Contact Person Ph ee f y/) y PLM 'ti/
Contractor Ph SWR
e Tenant/Owner ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes:
Slab SIT
Post & Beam
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing •
Firewall
Fire Sprinkler
Fire Alarm /
. Susp'd Ceiling C,) /'
Roof
Misc:
Final •
PASS PART FAIL (7110}V1—%.Q.,_
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
Rain Drains
F�ASS PART
MECHANICAL.° : r t
Post & Beam
Rough In
- Gas Line
Smoke Dampers
• Final -
PASS PART FAIL
ELECTRICAL, , e °„ TM
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm .
Final
PASS PART FAIL
SITE;
Backfill /Grading
Sanitary Sewer
' Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA a
I
Approach /Sidewalk A
Other Date / V Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site .
CITY OF TIGARD• BUILDING INSPECTION DIVISION
MST
24 -Hour AispeCtion Line: 639 175 Business Line: 639 -4171
BUP
Date Requested /4 AM PM BLD
Location 9 ?4 AA Suite MtC
Contact Person ') Ph PLM klia
Contractor Ph 96 9 ^ 3 ?0 9 SWR
BUILDING Tenant/Owner
Retaining Wall ELR c - ® 5
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Notes / O G
Slab SIT
Post & Beam -
Ext Sheath /Shear A-4 c 91-4 r frfruy) ,
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Misc:
Final
PASS PART FAIL
PLUMBING
Post & Beam
�l b t )
'Q op Ou
Water Service
Sanitary Sewer
Rain Drains
re*, PART FAIL
{? "ANICAL
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
- T FAIL
EIMCTRICA
a.
Low Voltage
Fire Alarm
F'I -
PART FAIL
Backfill /Grading
Sanitary Sewer
Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: Td. [ ] Unable to inspect - no access
ADA //6 v / Ins
Approach /Sidewalk 2 lJ
Other Date Inspector Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site