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Permit CITY OF TIGARD PLUMBING PERMIT ""1 2 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00075 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/11/2011 Parcel: 2S110DD02500 Jurisdiction: Tigard Site address: 10585 SW CENTURY OAK DR Project: COFFIELD Subdivision: SUMMERFIELD NO. 1 Lot: 32 Project Description: Tub /shower installation. Contractor: RAYBORN'S PLUMBING INC Owner: HOHN, GLORIA M TR & 19990 SW CIPOLE RD HOHN, JAMES G TR TUALATIN, OR 97062 10585 SW CENTURY OAK DR TIGARD, OR 97224 PHONE: 503 - 692 -4139 PHONE: FAX: 503 - 691 -2328 FEES Quantity Description Date Amount 1 ea Tub /Shower /Shower Pan 03/11/2011 $12.51 Specifics: 1 12% State Surcharge - 03/11/2011 $8.70 Plumbing Type of Use: SF 60 ea Minimum Fee Adjustment - 03/11/2011 $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 Notific... - • -r. 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 • . estions to OUN • • ' g 503.232.1987 or 1.800.332.2344. Issue. By: k_ OA. LI 4 Permittee Signatu r: - l j AV 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 03:13:46 p.m. 03 -11 -2011 1 / Plumbing Permit Application Site Utilities FOR OFFICE USE ONI,1 City of Tigard Received ,.., • 13125 SW Hall Blvd., Tigard OR 97223 DateiB : "MIA No. / 7 -1 Pl Review ��- S • Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.: Inspection Line: 503 Date/By: T 1 C A R L� Date Ready/By: Jg H See Page 2 for Internet: Www.tigard or.gov Notified /Method: • r Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New construction ❑ Demolition For special information use checklist. Description ® Addition/alteration/replacement ❑ Other: Qty. Ea. y Total New 1- 2- family dwellings ( includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath J 312.70 ® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78 ❑ Accessory building ❑ Multi- family SFR (3) bath 500.32 Each additional bath/kitchen 25.02 ❑ Master builder ❑ Other Fire sprinkler ( sq. ft.) I Page 2 ; 4 ;, .19 _Pi1« Tmti A ND_ LOCATION Site utilities: Job site address: f �} 1 t y Qu.�s Catch basin or area drain 18.76 J City/State/ZIP: ', q p-Y a ©f Z� Drywell, leach line, or trench drain 18.76 Suite/bldgJapt. no.: Project name: Footing drain (no. linear fl.: Page 2 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: I Lot no.: Fixture or item: Tax map /parcel no.: Backflow preventer 1 31.27 DESCRIPTION OF WORK Backwater valve 12.51 �� ' Clothes washer 25.02 OtcrCv- _ Dishwasher 25.02 Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank Name: /1 yt - 7 Fixture/sewer 25.02 �ttO / d V- 10 4 �/� /W 25.02 Address: Floor drain/floor sink/hub 25.02 City/State/ZIP: Garbage disposal 25.02 Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker 12.51 0 APPLICANT -- -- 61-e9I91'A'CT PERSON Interceptor/grease trap 25.02 Business name: �n C S � ` `A Medical gas (value: S ) Page 2 f Contact name: Q . Primer 12.51 �G �� i., ✓x� Roof drain (commercial) 12.31 Address:. . , 0 a W /� x �--+1 Sink/basin/lavatory 25.02 City /State/ZIP: 1 1 d , cji.A. 0 ( 4. j . Solar units (potable water) - 62.54 - Phona 4 ; 9 3 ) C 4D. _ q ► 3 9 Fax: : (3) e ({ I A i' Tub /shower /shower pan 1 2.51 i E -mail: {e > Urinal 25.02 4 , V t4 S ONTRACTOR Waterclosct 25.02 Business name: RAYBORN'S PLUMBING INC Water heater 37 5 Water piping/DWY 56.29 Address: P.O. Box 69 Other. 25.02 City /State/ZIP: Tualatin, OR 97062 Subtotal .-,1 Phone: (503) 692 -4139 Fax: (503) 691 -2328 Minimum permit fee: $72.50 /1 . J v CCB Lic.: _mow_ Lie. n. �. '166PB Plan review (25 %ofpetmit fee) Authorized signature ...41/ �� State surcharge (12 %ofpermitfee) �' TOTAL PERMIT FEE Print name: ,// This application Il .�(//`jfp ���� 1 Date: Pe rmit Pn cation expires if a permit is not obtained with a 180 days after it has been accepted as complete. "Fee methodology set by Tri- County Building Industry Service Board. MBuildiol ;iPamits PmnuApp.doe 10;01:09 440 -46161(10'02KOM /WEa)