Permit CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2009 -00141
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/10/2009
Parcel: 1 S133DC10000
Jurisdiction: Tigard
Site address: 13135 SW SHORE DR
Subdivision: Lot: 0
Project: Vincent
Project Description: Add (1) lay, (1) w /c, and (1) tub /shower.
Owner: FEES
VINCENT, MADELINE C E Quantity Description Date Amount
13135 SW SHORE DRIVE 1 ea Lavatories 06/10/2009 $16.60
TIGARD, OR 97223 1 ea Tub /Shower /Shower Pan 06/10/2009 $16.60
PHONE: 1 ea Water Closet 06/10/2009 $16.60
1 12% State Surcharge - 06/10/2009 $8.70
Contractor: Plumbing
RAYBORNS PLUMBING INC 23 ea Minimum Fee Adjustment - 06/10/2009 $22.70
PO BOX 69 Plumbing
TUALATIN, OR 97062
PHONE: 503 - 692 -4139
FAX: 503 - 691 -2328
Type of Use: SF
Class of Work: ALT 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ` ,, C • I ,, I I - 1 , 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.
, .5',691 2328 Rayborns Plumbing 12:09:56 p.m. 06 -08 -2009 1 /2......
PlumbinE Permit Applicatio> E l \f ED
., , ., .
Building Fixtures JUN 0 8 2009 ",. i;OR Oi'iI(•I. LSE O\I.i
' City of Tigard eceived
i • • y g _ Permit No.: • t - • "` `� 4 • 13125 SW Hall Blvd., Tigard, OR 97223 ,ITY OF TIGARD P a Review
; .. II Phone: 503.639.4171 Fax: 503.5988.19OeDII�1 I Other Permit No.:
l�� ^' Da ta:
Ins Line: 503.639.4175 DIVISION
ltl'C w� k "[i Dale Ready. By: Jar : ® See Page 2 for
Internet: www.tigard or.gov Notified:Method: 't i 6 Supplemental Information
TYPE OF WORK FEE' SCIiEDULE
❑ New construction ❑ Demolition For special information use checklist
Description Qty. I Ea. I Total
lk Addition /alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family
SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
El O ther:
Fire sprinkler( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: / ?, 3 S i S ' /"� 6 h n ^O ik lid Catch basin or area drain 16.60
City/State/ZIP: , L G� K �� q ?z z 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: V I Project name: Footing drain (no. linear ft.: _ ) Page 2
Manufactured home utilities 110.00
Cross street /directions to job site: "
/
� Manholes 16.60
6 5 5 743 Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _) Page 2
Subdivision: I Lot no.: Water service (no. linear ft.: _) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
Backflow preventer Paget
New 24-1 -Agf AI 414.Sfr.ic 045S et Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
V PROPERTY OWNER I ❑TENANT
Drinking fountain
I Ejectors; sump 16.60
16.60
r � J
Name: Lai Ape Oil& ���(,� Expansion tank 16.60
Address: / 3 !2 SJ" Fixturcrsewer cap 16.60
City /State /ZIP: / ( lrl4 /i/j 9 72.2.■ 3 Floor drain/floor sink/hub 16.60
Phone: (03 7d v -, '7,rg z Fax: ( ) Garbage disposal 16.60
• ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
lee maker 16.60
Business name:
Interceptor /grouse trap 16.60
Contact name: Medical gas (value: S _) Page 2
Address: Primer 16.60
City /State /ZIP: Roof dr.tin (commercial) 16.60 `O
$ink/basin/lavalot 16 'b
Phone: ( ) Fax: : ( ) I t 6
Tub.'shower /shower pan 16.60 10
E -mail: •
Urinal 16.60
CONTRA TOR Water closet ' 16.60 I bb°
Business name: �f e'
/
/144 ` J Water heater 16.60
Address: / / Other: i cy
,- _ / jit) Oit 7766,1 Subtotal y q
City /State /ZIP: /
`�^a'" "' ° Minimum permit fee: S72.50 --) 2: 51 ,
(553) kg a„ `1/3 I Fax: (qbi) ,61 ,-z sag Residential backtlow minimum pennit fee: S36.25 I •
3‘1414‘104 Plan review (25% of v
CCB Lie.: �Sj' Plumbi .: pennit fee) Zd an d ok. 4 nici
AG E State surcharge (12% of permit fee) D
Authorized signature: I7�v TOTAL PERMIT FEE e 1 L
Print name:///e44.0% A Date: 6 -6 _0-' 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 Penults PLMF.PermitApp dot 1'_']706 44(1- 1616TI1hI:.C'OM WEB)
CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2009 -00141
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/10/2009
Parcel: 1 S133DC10000
Jurisdiction: Tigard
Site address: 13135 SW SHORE DR
Subdivision: Lot: 0
Project: Vincent
Project Description: Add (1) lay, (1) w /c, and (1) tub /shower.
Owner: FEES
VINCENT, MADELINE C E Quantity Description Date Amount
13135 SW SHORE DRIVE 1 ea Lavatories 06/10/2009 $16.60
TIGARD, OR 97223 1 ea Tub /Shower /Shower Pan 06/10/2009 $16.60
PHONE: 1 ea Water Closet 06/10/2009 $16.60
1 12% State Surcharge - 06/10/2009 $8.70
Contractor: Plumbing
RAYBORNS PLUMBING INC 23 ea Minimum Fee Adjustment - 06/10/2009 $22.70
PO BOX 69 Plumbing
TUALATIN, OR 97062
PHONE: 503 - 692 -4139
FAX: 503 - 691 -2328
Type of Use: SF
Class of Work: ALT 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ` ,, C • I ,, I I - 1 , 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.