Loading...
Permit CITY OF TIGARD PLUMBING PERMIT '1 COMMUNITY DEVELOPMENT Permit #: PLM2011 -00189 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/14/2011 Parcel: 1 S135CD02500 Jurisdiction: Tigard Site address: 11835 SW 95TH AVE Project: CORYELL Subdivision: BOETCHERS ADDITION Lot: 7 Project Description: Replace 100 ft. of water service. Contractor: RAYBORN'S PLUMBING INC Owner: CORYELL, JACK M SR & ALICE 0 REV 19990 SW CIPOLE RD LIVING TRUST TUALATIN, OR 97062 12675 SW 111TH PL TIGARD, OR 97223 PHONE: 503 - 692 -4139 PHONE: FAX: 503 - 691 -2328 FEES Quantity Description Date Amount 100 If Water Service 06/14/2011 $62.54 Specifics: 1 12% State Surcharge - 06/14/2011 $8.70 Plumbing Type of Use: SF 10 ea Minimum Fee Adjustment - 06/14/2011 $9.96 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 1.800.33 . Issued By: Permittee Signature: Ca 9.4175 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 09:49:58 a.m. 06 -13 -2011 1 12_ 03 691 2328 Rayborns Plumbing Plumbing Permit Application FiEC� vn Building Fixtures FOR' OFFICE 1 sr, f)NLv City of Tigard JUN 1 4 2011 Received , I Permit LOrs I l w • 13125 SW Hall Blvd., Tigard, OR 97223 Date.B i No U PI_ Phone: 503.639.4171 Fax: 503.598.1960 CITY ,.I Plan Review OF TlGr''1 Dale /By: Other Permit No.: 'I ht A R n Inspection 503.639 • Line: .4175 BUILDING v Date Read !e Internet: Line: gard- or.gov BUIL DING DI VISI(,•.r y y Jura. PI See Page 2 for Noti6ed'Method: I i a Supplemental Information TYPE OF WORK FEE* SCHEDULE ❑ New • struction ❑ Demolition For special information use checklist. % Addition /alteration /replacement ❑Other: Description I Qty. I Ea. I Total New I- 2- family dwellings (includes 100 ft for each utility connection) CATEGORY OF CONSTRUCTION SFR (1) bath 312.70 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78 building SFR (3) bath 500.32 ❑ Accessory g ❑ Multi - family ❑ Master builder Each additional bath kitchen 25.02 ❑ Other: Fire sprinkler ( sq. ft.) Page 2 JOB SITE INFORMATION AND LOCATION Site utilities: Job site address: , 3 / Catch basin or area drain 18.76 City/State/ZIP: •, Drywell, leach line, or trench drain 18.76 4' r q Footing drain (no. linear ft.: �) Page 2 Suite/bldg. /apt. no Project name: J �l Manufactured home utilities 50.03 Cross street/directions to job site: Q 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.; /a) Page 2 Fixture Subdivision: Lot no.: /- xture or item: Tax snap /parcel no.: Backtlow preventer 31.27 DESCRIPTION OF WORK Backwater valve 12.51 ��� Clothes washer 25 02 ��4z 1 /.e,- . �y rviCs //AO 4.1 Dishwasher 25.02 Drinking fountain 25.02 Ejectors /sump 25.02 - ❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51 Name: Fixture/sewer cap 25.02 Address: Floor drain/floor sink/hub 25.02 Garbage disposal 25.02 City /State /ZIP: Hose bib 25.02 Phone: ( ) Fax: ( ) Ice maker o I� 51 ❑ APPLICANT R CONTACT PERSON Interceptor /grease trap 25.02 Business name: � / /v 6r - Medical gas (value: $ ) Page 2 �. .1 4 Contact name: Na Kett ; LA, 12.51 / Roof drain (commercial) 12.51 Address: /7 �QO SW r Sink/basin/lavatory 25.02 City/State! "LIP: . ,. /e e2 7 3 Solar units (potable water) 62.54 Phone: (, ) 3) , 72- q Fax:: (3) 6Cfl .....Pg Tub /shower /shower pan 12.51 E -mail: ' '/ �> ii / arm S . e..,,,,,_-... Urinal 25.02 (� CONTRACTOR Water closet 25.02 � 1 v , - Water heater 37.52 Business name: I ,� ✓ ` Water piping/DWV 56.29 Address: s c. ef3(P Re...t. Other: 25.02 City /State /ZIP: obi \a a•r . Q. 47062 Subtotal Phone: (5 J _ q ( 3 ' Fax: ( 6 Cll _ �3Dg Minimum permit fee: $72.50 CCB Lic.: � Q�� ^ 16g J� permit review (25% of permit fee) Plumbin_ Lic. no.: � � State surcharge (12% of pmit fee) Authorized signature: �� i ... '' �' � ���' y TOTAL PERMIT FEE Print name: . 4/ 4 / r , / ,e. 'ice, v - cs f& o,, Date: 6 -13 1 I This permit application expires if a permit is not obtained wl n 180 days I after It has been accepted as complete. *Fee methodology set by Tri -County Building Industry Service Board. I Budding to ts.,PLMU -Penn it App.doe 10.01,09 440- 4016T( 10 WEB)