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Permit CITY OF TIGARD PLUMBING PERMIT - COMMUNITY DEVELOPMENT Permit #: PLM2011 -00024 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/20/2011 Parcel: 2S111AD05700 Jurisdiction: Tigard Site address: 8710 SW PINEBROOK ST Project: BAUSTIAN Subdivision: PINEBROOK TERRACE Lot: 80 Project Description: Clothes washer installation. Contractor: RAYBORN'S PLUMBING INC Owner: BAUSTIAN, CAROL M 19990 SW CIPOLE RD 8710 SW PINEBROOK ST TUALATIN, OR 97062 TIGARD, OR 97224 PHONE: 503 - 692 -4139 PHONE: FAX: 503 - 691 -2328 FEES Quantity Description Date Amount 1 ea Clothes Washer 01/20/2011 $25.02 Specifics: 1 12% State Surcharge - 01/20/2011 $8.70 Plumbing 47 ea Minimum Fee Adjustment - 01/20/2011 $47.48 Type of Use SF 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: im or. 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. .503 691 2328 Rayborns Plumbing q 10:35:38 a.m. 01 -20 -2011 1 /2 R Plumbing Permit Application JAN 2 0 2011 Building Fixtures OF a FOR oiu i:: L NE: 0.1 \ , CITY OF TIGA9D R eceived r City of Tigard y �� Permit No J �� �, ,� • f 3125 SW Hall Blvd., Tigarci, oR t om ? ° LDING DI`lISIOP1 DBte/B r M Plan Review Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit No.: Inspection Line: 503.639.4175 Date ReadyBy: kris: B See Pa e 2 for Internet: www.ti Ii IYi A k l� and - or. ov y Y g g g Notified/Method: -ra760 Supplemental Information TYPE OF WORK FEE' SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description 1 Qty. I Ea. I Total _ Addition /alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (I) bath 312.70 2 t- 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 0 Master builder ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION / AND LOCATION Site utilities: Joh site address: 7/0 ��/ YIN �(o Catch basin or area drain 18.76 Drywell, leach line, or trench drain 18.76 City/State /ZIP: O r y 7 - r GL �' Footing drain (no. linear ft.: ) Page 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 ft.: _) Page 2 Storm sewer (no. linear ft.: _) Page 2 Water service (no. linear ft.: _) Page 2 Subdivision: Lot no.: Fixture or item: Tax map /parcel no.: Backtlow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 Clothes washer 1 25.02 t, (37- �4'S/e �� w 45 � �✓ %' ! / -V 1,1r _ Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump . 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Fixture/sewer cap 25.02 Name: - - Floor drain/floor sink/hub 25.02 Address: Garbage disposal 25.02 City /State /ZIP: Hose bib . 25.02 • Phone: ( ) Fax: ( ) Ice maker 12.51 ❑ APP ICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Medical gas (value: S ) Page 2 Business name: ar, ✓ / 4 ryt 5 1 ( ,) t O vl,t \Ol ,,,4_, `A C..� ✓ 'Primer 12.51 Contact name: K,a P Roof drain (commercial) 12.51 Address: / 9' 94/6/0 Z...14./ 41p1 (.e._ ICGC, Sink/basin/lavatory 25.02 City /State /ZIP: 1 f A 1ta )r i t�� Q r eel. o 6 Z Solar units (potable water) 62.54 Phone: (r � y f 3€ ( l Fax: : :('1) 6q� Tubishower /shower pan 12 51 - Urinal 25.02 E -mail: lif CONTRACTOR Water closet 25.02 t Water heater 37.52 Business name: IL j r t5 Pt V ✓ i L iv _ Water piping/DWV 56.29 Address: lei4.et sfi) L' pc i e... - L^ [ Other 25.02 City/State /ZIP: t'k_ t- tiL.- © ( d G j______ Subtotal i a.5.,0).„ Phone: (spa ) /f� e V 3 9 Fax: j 3 697 �� . Minimum permit fee: $72.50 -- 1,), , 50 [v Plan review (25 %ofpennit fee) CCB Lic.: /) 17lpL.? �_ Plumbing Lic. n• • 3/. � 160 z5 State surcharge (12% of permit fee) 7 q Authorized signature: /� / - TOTAL PERMIT FEE L This permit application expires if a permit is not obtained within ISO days Print name: , t ��.� ��� /� t � �. Date: \ �0� after it has been accepted as complete. �-t 1 *Fee methodology set by Tri- County Building Industry Service Board. I - Buildn5Perntt PLMti- PennitApp doc 10'0109 440- 4615Tt10.02;CONUWEB)