Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2013 00287
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/20/2013
Parcel: 2S115AA09100
Jurisdiction: Tigard
Site address: 10761 SW TITAN LN
Project: BRICKLEY Subdivision: BERKLEY ESTATES Lot: 23
Project Description: Shower replacement.
Contractor: RAYBORN'S PLUMBING INC Owner: BRICKLEY,JAMES M&KATHRYN A TR
19990 SW CIPOLE RD 10761 SW TITAN LN
TUALATIN,OR 97062 TIGARD,OR 97224
PHONE: 503-692-4139 PHONE:
FAX: 503-691-2328
FEES
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 08/20/2013 $12.51
Specifics: 1 12%State Surcharge- 08/20/2013 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment- 08/20/2013 $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: — Permittee Signature: I
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.
08-15-13;09:57 ;Rayborn's Plumbing ;5036912328 # 2/ 2
Plumbing Permit ApplicatiaCn�a I D
Site Utilities AUG 1 5 2013 1.(1k UI I it l t si '' ',1
City of Tigard Received
Date/B : "WA Permit No.: '7
■ 13125 SW Hall Blvd.,Tigard,OR 97 OF TIGARD
II _ Phone: 503.639.4171 Fax: 503.5 Pin Review
. Ocher Permit No.:
Inspection Lino: 503.639.4175 ING DIVISION Dte'
1 r t, %J+n
Date Ready/By: !aril. III See Page 2 for
Internet: www.tigard-or.gov Notified/Method: _ , So•.lem oral Information
TYPE OF WORK FEE* SCHEDULE ,;..
❑New construction ❑Demolition For special yarinatIon use checklist.
® Addition/a[teration/replacement 0 Other - Description f Qty. Total
New 1-2-family dwelllugs(includes 100 R.Ibr each uu connection)
CATEGORY OF CONSTRUCTION SFR(t)bath 312.70
® I-and 2-family dwelling ❑Commercial/industrial 5FR(2)both 437.78
Accesso building
SFR(3)bath 500.32
❑ rY g ❑Multi-family
Each additional bath/kitchen 25.02
❑ Master builder ❑Other: _ Fire sprinkler
n 408 r. B INFORMATIO D utilities:
sq.IL} pogo 2
��t:au,i;D':r�;i'«�.,::n�✓',�,�,.,,�...... ..N.. _ ..,..... .,.�;fW LOCATION• �,.. Site utilities:
t
Job site address:Jj' ( s --77-4(.4..„...„._ Catch basin or area drain 18.76
City/Sta_tc/ZIP:I/ e ewe)...., o g. q i72 "� y Footing 1.leach line,or trench drain Page 2
3 Footin drain(no.linear ft.: Page 2
Suite/bldg./apt.no.: Project name: (3r7't(.l Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sower(no.linear ft.: Page 2
Storm sewer(no,linear ft.:_) Page 2
Water service(no.linear R.:, ) Page 2
Subdivision: Lot no.:
Fixture or Item:
Tax map/parcel no.: Backflow prcvcntcr 31.27
DESCRIPTION OF WORK Backwater valve 12.51
�/a/aC� _ Clothes washer 25,02
U tc�G!r Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER - I ❑ TENANT Expansion tank 12.51
Name; Fixtur/sewercap 25,02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
PPLICAN 1
❑ CONTACT PERSON Interceptor/grease trap 25.02
r le Medical gas(value;$ ) Page Business name: - ,15 K I 4_-
Primer 12.51
Contact name: Akipt / �tic__ J
'mil r� A Roof drain(commercial) 12.51
Address: ily.QD L i) e.,pb j� CtJ� -
I { Sink/basin/lavatory 25.02
City/Statc/Z1P:.„! '� 7� �� _ Solar units(potable water) 62.54 -
Phone: y,, ) -+-�+" I y Fax::( f• , _Tub/shower/shower pan !' 12.51
E-mail: Urinal 25.02
� „ 6 toy1,Bl ct ecat Water closet .
CONTRACTOR 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 J Plu• bing Li , o.:34-166PB Plan review (25%ofpermit fee)
�,�'� State surcharge(t2°/aofpermitfco) 0
Authorized signature: }r-„
1'�� _ .��' /_A"' TOTAL PERMIT FE
[lint name:.►/ , - 0 _ Date:e_,'���„, Tbts permit appllcadon expires if a permit Is not obtutned n ISO days
"� dd after It has been accepted as complete.
'Fee methodology set by Tri.County Building Industry Service Board