Permit n CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 -00170
Date Issued: 06/05/2013
T EGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Parcel: 1S125CD07800
•
Jurisdiction: Tigard
Site address: 9959 SW LANDAU PL
Project: BOLER Subdivision: TIGARD WOODS Lot: 4
Project Description: Tub replacement.
Contractor: RAYBORN'S PLUMBING INC Owner: BOLER, RICKY & PATRICIA
19990 SW CIPOLE RD 9959 SW LANDAU PL
• TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 06/05/2013 $12 51
Specifics: 1 12% State Surcharge - 06/05/2013 $8 70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment - 06/05/2013 $59 99
Plumbing
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 -0090 You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232 1987 or 1.800 332 2344.
Issued By: - - mittee Signature:
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.
06 -04- 13;14:35 ;Rayborn's Plumbing ;5036912328 # 1/ 2
Plumbing Permit Application RECEIVED
Site Utilities JUN 04 2313 ink t►FI 1(t t 4,1 . t1\1.
City of Tigard Received
14 13125 SW Hall Blvd., Tigatd.OR 97223 + Tin , ' 1 � Dato/B , �o 4p3 6'77; Permit No,: Arl at-A -.� I7o
■ Phone: 503.639.4171 Fax: 503.598.1 �
- INCi DMSI �� I�tJBY: Other Permit No.:
t t t , ` t , t inspection Line: 503.639.4175 Date Ready/By Jiub ®S ee Page for
Internet: www.tigard -or.gov Notitiied/Metbod: 5 temente! information
TYPE OF WORK >, . • . •- - -. FEE* SCHEDULE'',:. <q::..
New consiruetion ❑ Demolition For spedal Information use checklist.
Description 1 Qty i En. I Total
el Addition/alteration/replacement ❑ Other: New 1- 2-famlly dwellings (includes 100 R. for each utility connection)
ea • • • • • NSTRUCTION SFR (I) bath 312.70
® 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
❑ Accessory building ❑ Multi- tbmily SFR (3) bath 500.32
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other Fire sprinkler ( sq. ft) Page 2
1; 4 „ , j A � i , , , , J O & , 5 g i e - 1 1 R W I , 1 0 N ;
AN LOCATION. , , . . , : : , . . . . i . , . , : Site utilities:
Job site address: I is-a? S(.`1 r . a dt7l.V 7 , Catch basin or area drain 18.76
Drywall, leach line, or trench drain 18.76
City /State/ZIP: -r- L..,„,. D 2 �*z�� Page Footing drain (no. linear R.: _) Pa e 2
Suite/bldg./apt. no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18,76
Rain drain connector 18.76
Sanitary sewer (no. linear 11.: _ ) Page 2
Storm sewer (no. linear R.: _) Page 2
Water service (no. linear R.: ) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Back(low preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25,02
� IQ t -r9 o Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 2.5.02
CI PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: Fixture/:res./el. cap 25.02
Address:
Floor drain/floor sink/hub 25.02
City/State/ZIP: Garbage disposal 25.02
Hose bib 25.02
Phone, ( ) Fax: ( ) Ice maker 12.51
1 ' ' ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical
Business name: 11 1 yprs (value S ) Page 2
}I � utA.tt%AC I. A L
Contact name: Aj Primer 12.51
� t6 � Roof drain (commercial) 12.51
Address: ) q of ere) w t O n
1 Sink/basin/lavatory 25.02
City /State/ZIP' •
0 , o . a Solar units (potable water) 62.54
Phone: Q3 ) $.2 - - 13 C( Fax: : (SOb) gee 1 - p Tub/shower /shower par " 12.51
E- mail: 44, i4 , �� rt/L C . �•.,....- Urinal 25.02
CONTRACTOR Walter closes 25.02
Water heater 37.52
Business name: RAYBORN'S PLUMBING INC
Water piping/DWV 56.29
Address: P.O. Box 69 Other 25.02
City/State/ZIP: Tualatin, OR 97062 Subtotal
Phone (503) 692 -4139 Fax: (503) 691 -2328 Minimum permit fee: 572,50
CCB Lie.: 87852 ' I11,mbing ' no.: 34 -166PB Plan review (25% of permit fee)
State surcharge (12% of permit fee)
Authorized signature /
r.✓i��" �7/ i' TOTAL PERMIT FEE FD
Print name: �� �/ /�� i�� Date: 6 - N - 1 This permit application expires If a permit b not obtained withitllSO d
" after It has been accepted as complete.
'Fee methodology act by T6.County Building Industry Service Board.