Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2011 -00056
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/17/2011
Parcel: 2S114BA05300
Jurisdiction: Tigard
Site address: 9900 SW KENT CT
Project: Masters Subdivision: PICKS LANDING NO. 2 Lot: 87
Project Description: Change -out tub and valve.
Contractor: RAYBORN'S PLUMBING INC Owner: MASTERS, ROBERT & MARILYN
19990 SW CIPOLE RD 9900 SW KENT CT
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
ea Tub /Shower /Shower Pan 02/17/2011 $12.51
Specifics: 1 12% State Surcharge - 02/17/2011 $8.70
Plumbing
60 ea Minimum Fee Adjustment - 02/17/2011 $59.99
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 Notific. •• enter. 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 s estions to •UNC by calling 503.232.1987 or 1.800.332.2344. ,y
Issued =y: / � e Permittee Signatu
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 01:13:35 p.m. 02 -16 -2011 1 /2
Plumbing Permit Application rte a 1a ° p
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Building Fixtures ` `� '" . l Ol OFl•l( lr. USE ()NI .1
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City of Tigard 0S5,3 t a 1 1 1 Received t
Date/By: v /& /1 Penn" No.: a to*/ /- �b5
• 13125 SW Hall Blvd., Tigard, OR 97223,(19 Plan Review
■ Phone: 503.639.4171 Fax: 503.598.1960 •fit Other Permit No.:
Inspection Line: 503.639.4175 {{���P l ° "t " Date/By: Date Read !B Page 2 for
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Supplement:0 Information
. TYPE OF WORD i1 \�" ".J v FEE* SCHEDULE •
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CI New construction 17) Demolition For special information use checklist
Description I Qty. I Ea. I Total
IR Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
DLl- and 2- family dwelling El 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: Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: r t Catch basin or area drain 18.76 ,. . .. i imiam
• Drywell, leach line, or trench drain 18.76
City /State/ZIP: , -� �, Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt. no.: 1 Project name: III
!a Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
/e 5- * 1 Sanitary sewer (no. linear ft.: _) Page 2
( U Storm sewer (no. linear ft.: _) Page 2
Water service (no. linear ft:: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
....• .%. , I . a Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Ai PROPERTY OWNER 1 ❑ TENANT Expansion tank 12.51
Fixturelsewer cap 25.02
Name: e,� T Floor drain/floor sink/hub 25.02
Address: �9DD J` to KoY4,I acria ati Garbage disposal 25.02
City/State /ZIP: T on 47211,4 y Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ _) Page 2
Primer 12.51
Contact name:
Roof drain (commercial) 12.51
Address: Sinlebasin/lavatory 25.02
City /State /ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub/shower /shower pan 1 12.51 j
E -mail: Urinal 25.02
Water closet 25.02
CONTRCC 4R -
Water heater 37.52 PP Business name: , 0. .o .1Lu:A 1 Waterpiping/DWV 56.29
Address: , 1 PA V Other: 25.02
City/State /ZIP: Re ik ` �_ Subtotal Z i
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. Minimum permit fee: 572.50 r r Fax:
Phone: • 3 6 1-
I ✓ /`^� Plan review (25% of permit fee) 70
CCB Lie.: Plumbin: _ic no.: b6P State surcharge (12% of permit fee) g
Authorized signature:!' TOTAL PERMIT FEE et Z0
e - This permit application expires if a permit is not obtained within 180 days
Print name: D
vt t - _ after it has been accepted as complete.
"Fee methodology set by Tri -County Building Industry Service Board.
I -Building Permits PLMC -Per nitApp dn.: 10'01.09 440.461 bT(10:02,COM WEB)