Permit CITY F TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2008 - 00184
Tic . R.D 13125 SW Hall Blvd Tigard, OR 97223 503.639.4171 DATE ISSUED: 5/1/2008
= PARCEL: 1S133DD-13700
SITE ADDRESS: 11948 SW 127TH PL ZONING: R -4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 LOT: 174 JURISDICTION: TIG
PROJECT: TYLER
Project Description: Installing new shower valve.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MICHAEL & TYLER
11948 SW 127TH PL Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 5/1/2008 $72.50
[TAX] 12% State Surch 5/1/2008 $8.70
Phone : Total $81.20
Contractor:
RAYBORN'S PLUMBING INC
19990 SW CIPOLE RD
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -4139
FAX 503 - 691 -2328
Reg #: LIC 87852
PLM 34 -166PB
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 suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: /'�f� Permittee Signature:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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.
Apr, 30. 2008 10:42AM Rayborns Plumbing No. 2643 P. 2
•
r
• • mbin r ]Permit Al t lication 'o . O1 a I c t. t s 1, UM.)
Cl Of Tigard
I d g Received
7� 1 ! , Permit No.: P /tom �/ '
Plan Review
13125 SW Ball Blvd., Tigard, OR 97223 Dm/By: L roc
Phone: 503.639.4171 Fax: 503.A98.'1960 Date/By: Other permit No.:
T I i; n k D Inspection Line: 503.639 Date Reads/By: him m Ste page 2 for
Internet; www.tigard - or.gov . Notified/Method: Supplemental Information
TYPE WdRK FFxe `fib '
i3LE .
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. J Total
n Addition/alteration/replacement a Other New 1- 2- family dwellings (includes 100 ft. for each utility connection)
. CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
i4 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi -family SFR (3) bath 399.00
[] Master builder - Each additional bath/kitchen 45.00
❑ O ther: Fire sprinkler L_ sq ft.) page 2
-, • JOE SITE INFORMATION ANI)� LOCATION.:' Ste utilities •
Job site address: L�/ / _ Catch basin or area drain 16.60
City / State/ZIP: r ,„ 9 7 2-D3 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: Project name: Footing drain (no. linear ft.: Page 2
-/-7/,,,r- Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft -: - _) Page 2
Storm seWet (no. linear ft.: ) Page 2
Subdivision: I Lot no.: Water Service (no. linear ft.: ___) Page 2
Tax map /parcel do.: Fiafure or item
77 Absorption valve 16.60
DISC*TION OE''W41$K Bacldlow preventer Page 2
W O he1.! s.40, ,,.e r • Ve.eiv Backwater valve 16.60
/` / :-/-1.- 7 r1 /S 40,....) • -A 7 ( 5 t at . e Y Clothes washer 16.60
O /2/ ~ Dishwasher 16.60 • • y Drinking fountain 16.60
it
a POPERTY OWNER • I , � • ❑ T
� - --
Ejectots/sump _ 16.60
Name: 01 % G ��_" i ' V 44/ _11/ le c Expansion tank 16.60
Address: Fixture /sewer cap 16.60 _
City/State/ZIP: at 7 - J ? Floor drain/floor sink/hub 16.60
Phone: ( ) ' ax: ( ) Garbage disposal 16,60
CANT I ❑ , C a I' B. O Hose bib 16 -60
U ; PSI .
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City/ State/ZIP: Roof drain (commercial 16.60 •
Phone: ( ) Fax: : ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan / 16.60
-marl' Urinal 16.60
-
iCONTR�I OR Water closet 16.60
Business name: / / P� f aj Water heater 16.60
de... / IV q 0 45 , CJ,J . R 01 Other Subtotal
City/ State/ZIP: j i"gc det,IF; to Or, . 17 /96 D - mini p e rm it fee: $72.
.
50
Phone: 6;°.1 ) 41, 7 4 I 3 Fax: ) 441.: x1 Residential backflow minimum permit fee: 536.25 4...5
s •
P lumbi ng Lic no.: 3 _ 66 Plan review (25 % of permit foe)
CCB Lic.: 9 q g P �'7
Authorized signature: _ State surcharge (12% of permit feo) g 70
,� TOTAL PERMIT FEE V ,2r0
Print nam AlA t �� Oaje; L` - 30 - U' This permit appticatiop expires if a p rmit is not obfaiued within
180 days after tt has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1: 113uildingetmiislPLM .PeyritAOD.doc 06/26/06 440.4616T(10/02/COM(WEB)
CITY OF TIGARD i -
BUILDING DIVISION PERMIT #: PI-M2008 -001B4
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2008
Phone: (503) 639 -4171 lete gyI
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/13/2008 TIME: 7:02AM PAGE: 33
SITE ADDRESS: 11948 SW 127TH PL CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 LOT #: 174 TYPE OF USE:
PROJECT NAME: 1YI..ER
DESCRIPTION: Installing new shower valve.
OWNER: TYLER, MICHAEL & JANE PHONE #:
CONTRACTOR: RAYBORN' S PLUMBING INC PHONE #: 503.692-4139
Inspection Request Scheduled For: Date: 5/13/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
322 Shower pan 069777 -01 503.692-4139
Corrections /Coomments /Instructions: -( i v . f
1 -ei is aroc.! �.J S�"✓� S � ✓
114 rte,;, / l I — 0%¢ 1 + 0 W Mb�. w, 2'' vxdt
i.... "TO r I) r To L 3 (-it/ I L.4
Tyl PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 01 Date: _CS111) Phone #: (503) 718-
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: PI.M2008- 001(84
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/20013
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 . °'I I..
INSPECTION WORKSHEET FOR DATE: 5/9 /2008 TIME: 7:OOAM PAGE: 32
SITE ADDRESS: 11948 SW 127TH PL CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 LOT #: 174 TYPE OF USE:
PROJECT NAME: TYLER
DESCRIPTION: Installing new shower valve.
OWNER: TYLER, MICHAEL & JANE PHONE #:
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 - 6924139
Inspection Request Scheduled For: Date: 5/9/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
322 Shower pan 069643 -01 503 - 692.4139 N
Corrections /Comments / Instructions:
•
❑ PASS ❑ PARTIAL APPROVAL [ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: \ u '\ Date: Al 9 //l Phone #: (503) 718 -
CITY OF TIGARD =:• >~ . .
A BUILDING DIVISION PERMIT #: PLM2008-00184 •
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2008
Phone: (503) 639 -4171 " tl '
Inspection Requests (24 Hrs.): (503) 639 -4175 .„' °TI1.
INSPECTION WORKSHEET FOR DATE: 515/2008 TIME: 7:01AM PAGE: 42
SITE ADDRESS: 11948 SW 127TH PL CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 LOT #: 174 TYPE OF USE:
PROJECT NAME: TYLER
DESCRIPTION: Insi new shower valve.
OWNER: TYLER, MICHAEL. & JANE PHONE #:
CONTRACTOR: RAYE3ORN'S PLUMBING INC PHONE #: 603 -692 -4139
Inspection Request Scheduled For: Date: 5/6 /2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 069330 -01 503.692 -4139 N
Corrections /Comments/ Instructions:
C ot,.- ti olJ#e, <St►o Ue.t tit, ,1_ , ,....A -db--
❑ PASS rg PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Crl " "- .✓ Date: GOAD 7 Phone #: (503) 718-