Permit y CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM2013 -00059
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/19/2013
Parcel: 2S 111 DC06800
Jurisdiction: Tigard
Site address: 9450 SW BRENTWOOD PL
Project: Chandlee Subdivision: SUMMERFIELD NO.9 Lot: 496
Project Description: Bathroom remodel, demo corner shower, install new shower, move toilet.
Contractor: RAYBORN'S PLUMBING INC Owner: CHANDLEE, GENE S &
19990 SW CIPOLE RD MARILYN A
TUALATIN, OR 97062 9450 SW BRENTWOOD PL
TIGARD, OR 97224
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES •
Quantity Description Date Amount
1 ea Fixture /Sewer Cap 02/19/2013 $25.02
Specifics: 1 ea Tub /Shower /Shower Pan 02/19/2013 $12.51
1 ea Water Closet 02/19/2013 $25.02
Type of Use: SF 1 12% State Surcharge - 02/19/2013 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment - 02/19/2013 $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 stions to OU . by c. ' g 503.232.1987 or 1.800.332.2344.
Iss ed By: I Permittee Signa a e:
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 12:48:45 p.m. 02 -14 -2013 1 /2_.■
Plumbing Permit Applicatio
Building Fixtures
City and FEB 14 2013 Received ��// � /�
ty of Tigard Date/By: oZ ly l3 Permit No.: n�g...
1 850 Hall Blvd., Tigard, OR 9722 O TIGARD Plan Review
Phone: 503.639.4171 Fax: 503.598 + Date/By Other Permit No.:
:� 1; Internet: Inspection Line: 503.639.4175 ii ING D NISI ON Date Ready/By, lure: 0 See Pate 2 for
I :
Internet: www.tigatd or,gov BUILDING
Notified/Method: Supplemental Information •
. TY PE OF WORK FEE* SCHEDULE .
❑ New construction ❑ Demolition For special inforesadon use checklist.
Description I Qty. I Ea. I Total
,leAddition/alteration/replacement ❑ Other: New I - 2- family dwellings (includes 100 ft. for each utility connection)
.. CATEGORY. OF CONSTRUCTION • .. SFR (I) bath 312.70
and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other. Fire rinkler
sp (_ sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 9' yco s [3 rev, - WcaCCi p 1.
Catch basin orates drain 18.76
City/ State/ZIP: a ,C. O R. G/ h , D . L n oting leach line,ne ar ft.: trench drain 18.76
t k � (�' D Footing drain (no. linear _) Page 2
Suite/bldg./apt. no.: I Project name: C f{ -4.iv O LEA..., Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
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 OF WORK Backwater valve 12.51
1 Clothes washer 25.02
I ConAC.r Stnpwtr t AS FG&XI A)et..2 SIAnt.Cr Dishwasher 25.02
ylgv2 T , r
p ei F ! uyrgf Drinking fountain 25.02
^ Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Cje�£, Q M t`y N Cite-,E Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City /State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
i APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Medical gas (value: $ _) Page 2
Business name:
Kay \00. f v. S 1 U e W . � ; N.,..1 ` rLC- Primer 12.51
Contact name: u 4.e 1� 0.�..&). r ti
N Roof drain (commercial) 12.51
Address: 1 R4A 0 Li) C . L l DP Rd Sink/basin/lavatory 25.02
City/State/ZIP A I. o r 9,106- Solar units (potable water) 62.54
Phone: ( "(. ) 6 ..... q 1 3 Fax:: ( 3) 6 4 l - gag Tub/shower/shower pan / 12,51 -
1
Urinal 25.02
E -mail: 4a { e r(:01(0.- • t t '-
n „.,.
y Water closet 25.02
C O NTRACTOR /
O+ Water heater 37.52
Business name: I , 1 ( Vl r s l `o X11 0 I A. I. 4 r Water pipingiDWV 56.29
Address: ' ei e{ 0 Sw _ le. 1 Other: 25.02
City/State/ZIP - & \ i , C( 06.P,- Subtotal
Phone (663) 4 ) . . - L 13 l Fax: ( 6 C(i ..: ? Minimum permit fee: $72.50
Plan review (25% of permit fee)
CCB Lic.: 4 -.).__ Plumbing Lic. no.: 3y' 166? L
�'_� /• State surcharge (12% of permit fee)
Authorized signature: '`��% �.� - ; TOTAL PERMIT FEE
� / i ce -•, _
Print name: 44- y _ Dat 9_. This permit application expires if a permit Is not obtained within IRO days .
Q' �f .// 2 e after it has been accepted as complete. Olt/
*Fee methodology set by Tri- County Building Industry Service Board.
1:-Building Pcrmes 1001 09 440- 1616T(10 COM/WEB)