Permit CITY TIGARD PLUMBING PERMIT
I ` DEVELOPMENT SERVICES PERMIT #: PLM2005 -00175
t;�1I , DATE ISSUED: 4/28/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 25101 DC -04602
SITE ADDRESS: 07337 SW TECH CENTER DR ZONING: I -P
SUBDIVISION: LOT: JURISDICTION: TIG
Project Description: Installation of pressure reducing valve & backflow device.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MCCORMACK, WILLIAM L + DARLENE T
7190 SW SANDBURG ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 4/28/2005 $72.50
[TAX] 8% State Surcha 4/28/2005 $5.80
Phone : 503 624 - 2090 Total $78.30
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Phone : 503- 692 -4139
Reg #: LTC 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:- ,1-27 Z Permittee Signature: ?� .e ® \��n
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day. V
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.
Apr. 28. 2005 8: 31AV1 Rayborns Plumbing No. 1506 P. 2/3
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Plumbitnff Permit A a�4® , . _ :. ..,, 4. . ,„
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City of Tigard al Bl ,, EB �: / 2 ? , 13125 SW H 65 �"J , Parmit :?' ` D0.? l� Q / 7 5 TiOR 97223 A p(� F. $ ZQ� P
Phone: 503.639.4171 Fax: 503.598-1 %O H1 I\ , ,F .1,�', Date/By: Other Permit Na,-.
24- Hour Inspection Line; 503.639.4175 • ry ti r
Internet: www.ci.tigatd.or.us CITY O f 1 1'- 1` S S� Pogo 2for
Date Re B
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�' Notifi Supplemental Information
❑ New construction ❑ Demolition For special (UJ017 canon use cheekliss
Descri . ; on by . Es- Total
' Addition/alteration/replacement ❑ Other: New 1- 2 - favdly dwellings (includes 100 R for each utility connection)
i ' 0 1 ,b *§",$,5`JC4 k . . , {' SFR (1) bath 249.20
❑ 1- and 2- family dwelling IXI Commercial /industrial SFR (2) bath 350.00
El Accessory building 111 Multi-family SFR (3) bath _ 399.00
111 Master builder Each additional bath /kitchen 45.00
❑ O ther:
y7 � , ���� t Fire sprinkler t_ s4. ft-) Page 2
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..,,; ,.., .. ;,. , .:. .,:.,,::,. �..> :'`. Site at0itle -
Job site address: '7 3 1 S t .) 1 QC.. C 1 , r 1) r Catch basin or area drain 16 -60
City / State/ZIP: 1 ` fly 1 N` 17 a 3 Drywell, leach line, or trench drain 16.60
Suite/bldg /apt. no.: 1 Project name: Footing drain (no. linear ft: ) Page 2
Manufactu home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft: ) Page 2
Storm sewer (no. linear ft: 1 Page 2
Water service (no linear ft: ) Page 2 -
Subdivision: l Lot no.:
Fixture or item
Tax map /parcel no.:
sorpti valve 16.60
... .:...:... . . ....`.:f „,• ::- " „':....., ... , _....:ve , ..c -, `,i W
.r„ ,,, kllowprevcpRer Page 2
-E-,, a f i p r 'p 5 s W, tpee q_G r' my ("Cr /Ve Backwater valve 16.60
Ji / ell e D . J ot! o t' e _ J Clothes washer 16 -60
a
Al �/ �v Dishwasher 16.60
A n
; ; {:: .�<.> : Dr iktngfowttai 16.60
?; E ctorsi
16.60
ii� J0 suRlp
Name: Rct Te 1G Li .5 A coke Expansion tank 16.60
Address: --- 37 S (/■ -- re C 1'l C e ri-J /"- 7 Fixture /sewer cap 16.60
City /State/ZIP; - 179 e t rc.t TN Ci - 1 22_, 3 Floor drain /floor sink/hub 16.60
1 Garbage disposal 16.60
Phone= (Stab) 7 Faa: ( )
, I;' Y�, IG'''` t �' ,'Y ;;.. t� "�P�'�1!I':`i <''i' -
" .:..... ;: � � rf: '.:'.:' t
...... lee make[ 16.60
Business name: ,. ! 4�t , interceptor /grease trap 16.60
Contact name: F r / �, L Medical gas (value: $ ) Page 2
Address: t� 1 7 oc- 6 7 - primer v 16.60
City / State/ZIP: � t,( ^� /4, L3 / �//4, C'') �y �� Roof drain commercial 16.60
� q �(/ � ( ?
Sink/basin/lavatory 16.60
Phone: (SO i 4v _ 54/ I Fax: : (,5 ) 67 / - 23 ,a„ Tub/shower/shower pan 16 -60
E-maiL Q.ef'/. ba/t/)S . CG/M Urinal 16.60
' .`NA. * 7
Water closet 16.60
Business name: R 0. kl 0 f r1 S? ttq(y b i 1 J Water heater 16.60
Address: P> b 1- (� `I Other: 1 I _
City /State/ZIP: �� l k,. (-) g - 4_0 - c, ik_ Minimum 0
•
nimum permit fee: $ $72 72 -50
Phone: ( x .06) 1., el - W 1 .3 1 Fax' (SD5 C, 91 • ?.3 air Residential backflow minimum 7.
permit fee: $36.25
CCB Lie.: i 1 g " --, Plumbing Lic. um: .24-(44 p A Plan review (25% of permit fee)
State surcharge (S of permit fee) g! gD
Authorized signature: _L
. J '� r °/u TOTAL PERMIT FEE -7 • d
Print name: ef f �.i oL f- 4_ Date: 1,4 we . This permit application expires if n permit is not obtained within
180 days alter It has been accepted as complete.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2005 -00175
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/28/2005
Phone: (503) 639 -4171 Ami invi!l'iI?I
Inspection Requests (24 Hrs.): (503) 639 -4175 ...'
INSPECTION WORKSHEET FOR DATE: 515/2005 TIME: 7 :16AM PAGE: 58
SITE ADDRESS: 07337 SW TECH CENTER DR CLASS OF WORK: .
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: RAYTEX USA
DESCRIPTION: Installation of pressure reducing valve & backflow device.
OWNER: MCCORMACK, WILLIAM L + DARLENE T, PHONE #: 503 -624 -2090
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 - 692-4139
Inspection Request Scheduled For: Date: 6/5/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
325 RP /backflow preventer 006171 -01 503 -692 -4139 N
Corrections /Comments /Instructions:
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1
PASS ❑ PARTIAL APPROVAL ❑ CANCEL El NO ACCESS
El FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: /t Date: J \J l- Phone #: (503) 718 -