Permit PCS -P( i --lv c C ( I czv ( <) w / c.,
q CITY OF TIGARD PLUMBING PERMIT •
`' I N • COMMUNITY DEVELOPMENT Permit #: PLM2009-00032
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/18/2009
Parcel: 2S 103DA05491
Jurisdiction: TIG
Site address: 13425 SW 107TH AVE
Subdivision: Lot:
Project: MERRITT
Project Description: Install (1) shower, and (1) washer. 3/18/09 ADDED (1) lay, and (1) w /c.
Owner: FEES
KAREN MERRITT Quantity Description Date Amount
13425 SW 107TH AVE 1 [PLUMB] Permit Fee 02/18/2009 $72.50
TIGARD, OR 97223 1 [TAX] 12% State 02/18/2009 $8.70
PHONE:
Surcharge
Contractor:
RAYBORN'S PLUMBING INC
19990 SW CIPOLE RD
TUALATIN, OR 97062
PHONE: 503 - 692 -4139
FAX: 503 - 691 -2328
Type of Use: SF
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 -0100. You may obtain a copy of the rules
Issued By: .
-,-.01-t. 1\ , -- Q'u > Permittee Si ec ' p _ ( k cn,1 `^/' '
u CJI� r ( r
', �
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.
" CITY OF TIGARD, PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2009 -00032
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/18/2009
PARCEL: 2S 103DA -05491
SITE ADDRESS: 13425 SW 107TH AVE ZONING: R -3.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: MERRITT
Project Description: Install (1) shower, and (1) washer.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: 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
KAREN MERRITT
13425 SW 107TH AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 2/18/2009 $72.50
[TAX] 12% State Surch 2/18/2009 $8.70
Phone : Total $81.20
Contractor:
RAYBORN'S PLUMBING INC
97 REQUIRED ITEMS AND REPORTS
TUALATIN, OR OR 970662 2
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: 4aat RA ta/S Permittee Signature: Vi
Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 1
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 6912328 Rayborns Plumbing 03:53:55 p.m. 02 -18 -2009 1 /2
Plumbing Permit Application 1,,R t)l I It r I •i t,�l
Ci of Ti and FEB i 8 20 Received
h g eBy: a • IA . oci ( Permit No.: e rf
• 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGA `', Review
Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
i` \1,i) Inspection Line: 503.639.4175 BUILDING DIVI', e rwu: W See P.ge2 for
Internet: www.tigard -or.gov Notified/Method: 1 ( C Supplemental leformation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. ! Total
' Addition/alteration/replacement ❑ Other. New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (t) bath 249.20
%1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: Fire sprinkler ( sq. ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: /. 3 ydS J id /0 7 fh Catch basin or area drain _ 16.60
City/State/ZIP: ,���4 �� g7,2a3 Dtywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: _) Page 2
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 sewer (no. linear ft.: _) Page 2
Subdivision: 1 Lot no.: Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map /parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
/ y.Gili �'A /fir 42 f`je-p. Backwater valve 16.60
Clothes washer / 16.60 /4. zp
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT
Drinking fountain 16.60 v �
Ejectors/sump 16.60
Name: 7G/'/Vi Expansion tank t 16.60
Address: Ai y1s 6W l474 ! Fixture/sewer cap 16.60
City/State/ZIP: 7 % ,iitrl/ �9-,�0 ' 3 7.2 3 Floor drain/floor sink/hub 16.60
Phone: ( ) �/� Fax: ( ) Garbage disposal 16.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: Medical gas (value: S ) 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 / G 6a
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: ,Q�� f �� r `" /_ • Water heater 16.60
Address: / 6'eLy ,6 9 p ✓ Other:
tal
City/State/ZIP: Tuts pie. y7oba- Sabto
/ Minimum permit fee: S72.50 0
Phone: ,R)( .. ,ci /,g 9 Fax: f,G314 3 2
Residential backflow minimum permit fee: $36.25 1 Sd
(f
CCB Lie.: e 7 $ Sa , Plumbing Lic. no.: 3! / "el Plan review (25% of permit fee)
` r State surcharge (12% of permit fee) 6
Authorized signature. / 4.40 4.40 TOTAL PE FEE g"1;.1
^
Print name: I ��./ ie� Date: a /j / This permit application expires if a permit is not obtained within
�� f 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
1:1 Buildineermits\PLM- Perm+tApp.doc 06/26/06 4404616T(10/02/COM/wEB)
4 tG'3 691 1328 Rayborns Plumbing 10:23:35 a.m. 03 -18 -2009 3 /3_
•
•
Plumbing Permit Application I N.., Ol 11(I 1 so O\ I 1
City of Tigard iS r • Received 1 II 13125 SW Hall Blvd., Tigard, OR 9720 Nit Y' V • 1 8 • Permit No. j Q -.040 ,3 2-
Phone: 503.639.4171 Fax: x: 503.595 1960 !� Pty Review
Inspection Line: 503.639. a 5 �k�r Date /By: Other Pe No.:
Cr '� ®``''�S\� Date Ready/By: h¢i. 1 0 See Page 2 for
Internet: www.tigardor.gov ( \V Notified/Method: T I • 1 i ,-.1 Supplemental lnformadoa
TYPE OF WORK FEE' SCI EDIR.E
❑ New construction 1 ❑ Demolition For spedel Information use checklist
' gAddition/alteration/replacement ❑ Other: Description I Qty. Ea. I Total
New 1- 2- tamlly dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
~ j' I- and 2- family dwelling 0 Commercial/industrial SFR (2) bath 350.00
❑ Accessory building CI Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
JOH SITE INFORMATION AND LOCATION Fire sprinkler ( sq. ft.) Page 2
Site utilities
Job site address: /3y07,5- JQl / Q 7 e-h Catch basin or area drain
r 16.60
City /State/ZIP: ,A4./. 9 7, 2 3 Drywell, leach line, or trench drain I 16.60
Suite/bldg. /apt. no.: Project name: Footing drain (no. linear ft.: Page 2
Cross street/directions to job site: Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: 1 Lot no.; Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Fixture or item
DESCRIPTION OF WORK Absorption valve 16.60
�,
! Backflow preventer Page 2
A/4�J SA diAlior / IJdJ%te - D Ja,v ?olle +i r Backwater valve 16.60
Clothes washer / 16.60 !6. Z0
P. L - t at) o ?- cc Q 3 a Dishwasher 16.60
❑ PROPERTY OWNER l ❑ TENANT Drinking fountain 16.60
Name: / Ejectors/sump 16.60
Address: �� Ll�s _ Expansion tank 16.60
7 ) /D76 j Fixture/sewer cap 16.60
City /State/ZIP: 7 ? , ,,,,,,,,, ,�ggi�pp ` � 3 Floor drain/floor sink/hub 16.60 -
Phone: ( ) v
Fax: ( ) Garbage disposal 1 6.60
❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Business name: Ice maker 16.60
Contact name:
Interceptor /grease trap 16.60
Medical gas (value: S ) Page 2
Address:
Primer 16.60
City /State/ZIP: Roof drain (commercial) 4e . 16.60
Phone: ( ) I Fax: : ( ) • Sink/basin/lavatory 16.60 /6r` -
E -mail: Tub /shower /shower pan / 16.60 /`. Ad
Urinal 16.60
CONTRACTOR
r Water closet V 16.60 /4 J
� -
Business name: sI 1 � 4, 3 /04 iitr . Water h eater 16.60
(/
/
Address: _
�O 8. 4 `� //k.- Other:
City/State/ZIP: Tl G 97o ea- Subtotal
Pfione: Minimum permit fee: $72.50
�Sb3 ) ,7a - y/3 9 l Fax: L4sa 17/ Residential backflow minimum permit fee: $36.25 7 2-so
CCB Lie.: S 7 g 3.2_, Plumbing Lic. no.:3 Plan review (25% of permit fec)
Authorized si � f n /`� P � State surcharge (12% of permit fec) 8 . 7 6
`
TOTAL PERMIT FEE g 1,',,, Q
b
Print name: l Ay� w , I Date $r I This permit application expires if a
.f_5,3 /O�f permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
1 : 1 Building‘Permits1PLM- PeroitApp.doc 0612606 440.4616T(10102/COMJWEa)
CITY OF TIGARD - , , e
BUILDING DIVISION P MIT #: Pt..M2009.00031
13125 SW Hall Blvd., Tigard, OR 97223 / DAT ISSUED: 2.1 1812009
Phone: (503) 639 -4171 haf i;� Ak
Inspection Requests (24 Hrs.): (503) 6394175 ^'I I!% � / I 1
INSPECTION WORKSHEET FOR DATE: 2/20/2009 TIME: 7:0 PAGE: 19
SITE ADDRESS: 13425 SW 10TTH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MERRITT
DESCRIPTION: Install (1) shower, and (1) washer.
OWNER: MERRITT, KAREN PHONE #:
CONTRACTOR: RAYt3ORN'S PLUMBING INC • PHONE #: 503 - 6924139
Inspection Request Scheduled For: Date: 2120/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 080654 -01 503 - 692.41.39 N
Corrections /Comments /Instructions: /, / l
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❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
4) .7/0 Phone #: `'
4
Inspector: Date: / (503) 718-
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a L.1 LM 200? - 13425 107TH AVE Install (1) shower, an... Inspections 02/18/2009 0 N ,
CAP ID: PLM2009 -00032 -
e i Cancel Reports �I Help ��
Inspection Detail Conditions (0) Documents (0) _ I
Inspection Type Address Case # , - j
" 399 Plumbing final 13425 SW 107TH AVE PLM2009 -00032 = : 1
�i
Request Date Request Time Requestor's Phone Number
03/26/2009 12 :38 503 629 - 139 _ - '
f Request Comment — T
F;
j o00874oi 503- 629 -4139
= i 1, ii
• i Scheduled Date Scheduled Time Ii
03/27.2009 12:00 AM " ,
_; Inspection Date Inspection Time Result Department Inspector �'
03/27/2009 11:25 FAIL Building Gary Noble ---
Result Comment
OPSC, 419.0 - Temperature exceeds 120 deg. at tub /showers.
i
1
,
CAP Type Internal Use Only
Building /Res/Plumbing /NA HST09 00000 - 00566
` . Reports ,
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