Permit CITY OF TIGARD PLUMBING PERMIT
11111 4: '- COMMUNITY DEVELOPMENT Permit#: PLM2013 00313
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/10/2013
Parcel: 2S 104CA 11900
Jurisdiction: Tigard
Site address: 13696 SW WESTRIDGE TER
Project: SWINHOE Subdivision: HILLSHIRE Lot: 119
Project Description: Replace shower pan
Contractor: RAYBORN'S PLUMBING INC Owner: SWINHOE, MICHAEL A&JENNIFER L
19990 SW CIPOLE RD 13696 SW WESTRIDGE TERR
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 09/10/2013 $12.51
Specifics: 1 12%State Surcharge- 09/10/2013 $8.70
Plumbing
Type of Use SF 60 ea Minimum Fee Adjustment- 09/10/2013 $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 ByED Ceeam4A Permittee Signature: c
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.
Resend09-06-13;08: 57 ;Rayborn's PIumbing ;5036912328 # 1/ 2
Plumbing Permit Application
Building Fixtures ��\J
RED , Received
City of Tigard Date/ay; 7 /O /3 Permit No,: 7dO/D-CO 3 j"
III 14 13125 SW Hall Blvd.,Tigard,OR 97eX.n p 9 2013 Plan Review
Phone: 503.639.4171 Fax: 503.39 . 0 Other Permit No.:
Inspection line: 503.639.4175 Date Re
T'14;A N[� OF TIGAR® Date Ready/By farts: See Page a for
Internet: www.tigard-or.gov cI� f� p' • Notified/Method: Supplemental Information
. •.. `TYPE:_OF Ii DINg,O.VIP-! .r!' :I ::: FEE";SCHEDULE, =.
0
New construction ❑Demolition For special Information use checklist
Description I Qty. ( Ea. J Total
Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 R.for each utility connection)
CATEGORY:OF�CONSTRXJ,CTION.t`'..• , SFR(I)bath 312.70
'a r
l-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
Fite sprinkler L___sq.ft.) Page 2
''JOB°SITE,INFORMATION'AND,LOCATION.:_; • Site utilities:
t?ii Job site address: / 3 b y( [4, we, ,Pt�` �y race! Catch basin or area drain 1 8.76
� O 6 7=3` (/ Drywel�lwch tine or trench drain 18.76
City/Statd2lP: � -
�1 C}�L Footing drain(no,linear R.: ) Page 2
Suite/bldg./apt.no.: v 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 ft.: Page 2
Storm sewer(no.linear ft.:_) Page 2
Water service(no.linear R: ) Page 2
Subdivision: I Lot no.: Fixture or Item: •
Tax map/parcel no.: Bacldlow preventer 31.27
Backwater vale
• DESCRIPTION OF WORK c
12 51
, Clothes washer 25.02
4\d'e?�(.G 6//h Owen r04-" - Dishwasher 25.02
Drinking fotmtain 25.02
Ejectors/sump 25.02
- 0,PROPERTY OWNER`' .. ` ❑ TENANT :• ' : H : Expansion tank 12.51
Name:
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/Statc/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
. , , ❑ APPLICANT . ❑ CONTACT PERSON Interteptor/grease trap 25.02
tt r (� ` !Medical gas(value:$ ) Page 2
Business name:
Rav Io0 Nee 1 I.u vt,,t_ L4 \1C.. Primer 12.51
Contact name: ,, 9 ..N .. t
VQ, -° l ;-� Roof drain(commercial) 12.51
Address: / dc tc(0 $LA-) G o l e. ` ei Sink/basin/lavatory 25.02
City/State/ZIP 0 41.70Q Solar units(potable water) 62.54
Phone p Fax:: /�f Tub/shower/sh_ower pan 12.51
�io3) (���- ���( (b�3} 6'1.1 `s�. � Urinal 25.02
E-mail: �fQr,e (� 6r S. C.a4-"-'6.� -
NTRACTOR Water closet 25.02
• ,�� / / Water heater 37.52
Business name:7al 40rrt S / /!/ysyfjJ, Of / ,. - Waterpiping/DWV 56.29
0
Address: /ff7/ '� G��O/G J 4 / Other 25.02
City/State/`Z17P:3! !...77.74t� , fii 0 t /d76�'' Subtotal
) 67��
Minimum permit fcc: $72.50
Phone:(� ) `� � Fax:( � .-_,
/� Plan review (25%of permit fee)
CCB Lie.: s 7 g'6 Plu.bing Lic.no.:2y-/ State surohnrge(12%of permit fee)
Authorized signature: /�?:.1
�.����i� � TOTAL PERMIT FEE fp Print name: /I/r��L� /./ I I Date: a��r� This permit application expires If a permit Is not obtained wit da
ti- / ,- after It has been accepted as complete.
`fee methodology eat by Tri-County Building Industry Service Board.
10/01f09 440-4616T(10/02/COM/WEB) /kV
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13696 SW WESTRIDGE TER, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
2013-12-11 00:00:00
PLM2013-00313
PASS - No C of O
Violation Summary:
Inspector Contractor