Permit CITY TI GARD PLUMBING PERMIT
� DEVELOPMENT SERVICES PERMIT #: P 9/2002 -00356
AT 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/9/2002
SITE ADDRESS: 14111 SW WAGONER PL PARCEL: 2S109BA -04800
SUBDIVISION: HILLSHIRE SUMMIT NO. 2 ZONING: R -7
BLOCK: LOT: 030 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: R3 FLOOR DRAINS; 2 TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: 1 OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 1 WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: THIS PERMIT IS REINSTATED FOR PURPOSE OF FINAL INSPECTION FOR A PERIOD OF 30 DAYS.
Installation of 30' of sewer line, 100' of water service, (1) lay, (1) shower, (1) water closet, (1) water heater, (1)
2" & (1) 4" floor drains, and (1) backflow preventer.
FEES
Owner:
Description Date Amount
HANSEN, LEIF C +
CAROL M [PLUMB] Permit Fee 9/9/2002 $237.15
14111 SW WAGONER PL [TAX] 8% State Tax 9/9/2002 $18.98
TIGARD, OR 97224 [PLUMB] Misc Fee 10/27/2004 $125.00
Phone : 503 740 - 3047 Total $381.13
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 692 - 4139 Sewer Inspection
Water Service Insp
Reg #: LIC 87852 Rough -in lnsp
PLM 34 - 166PB PLM /Underfloor
Top -out Insp
Final Inspection
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 s pended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by e 'regon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 throw. OAR
952 - 0001 -0100. You may obtain copies of these rules or direct questions to 0 AC by m; Ili , i (503)
246 -6699.
Issued By: Permittee Signature:
all (503) 639 -4175 by 7:00 P.M. for an inspection needed th - next b - s day
,LMa4029a -o'35Go
Plumbing Permit Application Date received Permit no.:
`) C'f Tigard Sewer Permit No. Building Permit No.
13125 SW Hall Blvd. Tigard, OR 97223 Proiect/Appl. No Expire Date
Phone. 503 639 -4171, Fax 503 598 -1960 Date issued By Receipt No.
Land Use A, ,royal Case File No. Payment Ty pe
....:. • .. .....:..
❑ 1 & 2 Family dwelling or accessory LI CommerciaUindustrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service ❑ Other:
< . 1<# 3. 1. f1•.. 1' �1;< 121I :1 >L:Y(1�: >:<» > » » >: »: »: »> »>� :;:: >:;: >:s: >: FE °: : `:: < ': : > ::: " > ' `3 r u�:�c � 1 > : . » . ::: » : : > >: : >::: >
.. ..........
Job address: 14111 SW Wagoner Place Description Qty Fee Total
No.: Suite no.: New 1 & 2 family dwelling only: 1+ 100 ft
Bldg. I SFR (1) Bath $249.20 0
Tax map /tax lot / account no.: SFR (2) Bath $350 0
SFR (3) Bath $399 0
Lot: I Block: I Subdivision : Each additional bath / kitchen $ 0
Project name: Hansen Site Utilities: Catch basin / area drain $16.60 0
City / county : Tigard I Zip : 97224 Dry wells/ leach line / trench dram $ 0
Footing drain (no. Lin. ft) $ 0
Description and Location of work: Pool House Plumbing Manufactured Home utilities- each $46.40 0
Date of Completion/ inspection: Manholes $ 0
0
R dram connector $
. ... ........................... . .... .....................;:: sanitary Sewer (no. of linear feet 100 ` 1 $55 00 55
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' 1 $55.00 55
Fixture or item
City : TUALATIN State: OR I Zip: 97062
Absorption valve $16.60 0
Phone : 503 692 -4139 Fax : 503 691 -2328 Back flow preventer 1 $27.55 27.55
E Mail Address : Wayne@Rayborns.com Backwater valve $16.60 0
Basins / Lavatory 1 $16.60 16.6
CCB no. : 87852 I Plumb. Bus. No. : 34 -166PB Clothes Washer $16.60 0
City / Metro Lic. No.: 001806 Dishwasher $16 60 0
- Drinking Fountain (s) $16 60 0
(N
Contractor s signature : LV.0 Ejector / sump $16 60 0
Print name: Wayne Siebold Date :9/9/02 Expansion Tank $16.60 0
w e ca
.:;;:.;:. ;:;.;:.:. :.
:.:.:.;:.: <.:..;:.;:
;. .;;:.;:. Fi xtur / sewer P $16.60 0
Floor drains/ floor sinks/ Hu • i i 2 $16.60 33.2
Name: Garbage Disposal $16.60 0
Address: Hose Bibb $16.60 0
City : State : OR I Zip: Ice maker $16.60 0
Interceptor / Grease trap $16.60 0
Phone . Fax : Primer $16.60 0
Roo dra (commercial) $16.60 0
C:ON r C 14 ENCJ N `I. .J C: fi< .
..... . : . ... (s), Bas Lay (s) $16.60 0
Notice : This permit application expires if a permit is not obtained Sump $16.60 0
within 180 days after it has been accepted as complete. Tubs/shower /shower pan 1 $16 60 16 6
Urinal $16.60 0
Water Closet 1 $16 60 16.6
Water heater 1 $16.60 16.6
Other $16.60 0
Visa charge on credit card authorization sheet. TOTAL $237.1
5
Residential Backflow Minimum Fee $72.50 237.15
minimum $36.25. Plan review @ 25%
Commercial requires 2 sets of o
Iso / riser. State charge .08 /0 18.98
Total 256.13