Permit CITY OF TIGARD
PLUMBING PERMIT
DEVELOPMENT SERVICES 00233
DATE ISSUED: 5/26/2004
---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
SITE ADDRESS: 07993 SW CHURCHILL WAY PARCEL: 2S112CD -06800
SUBDIVISION: BOND PARK NO. 2 ZONING: R -12
BLOCK: LOT: 048 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 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
Remarks: Replace tub with shower.
FEES
Owner:
Description Date Amount
MARKOVITZ, KIRK A AND AMY S
7993 SW CHURCHILL WAY [PLUMB] Permit Fee 5/26/2004 $72.50
TIGARD, OR 97223 [TAX] 8% State Surcharl 5/26/2004 $5.80
Total $78.30
Phone:
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 Rough -in Insp
Final Inspection
Reg #: MET 00001806
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 -66 • ! .
Issu- By: - ,I — I 4 1 PermitteeSignature:
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
May -25 -04 02:45P Ray. t. f' fr1, , Inc. 15036912328 P_01
I 17 P�Ulliib g Permit AppI1Ca ®M AY 2 4 5 Date received: ��J Permit no.:PLy V-06,9-33
City of Tigard
CITY OF TIGARb 20 �� Sewer Permit No. Building Permit No.
g
1`3125 SW Hall Blvd. Ti ard, OR 97223 Proiect/Aunpl. No. Expire Date
Date issued
Phone: 503 639 -4171, Fax 503 598- 19f� UILDING DIVISION By Receipt No.
Land Use A •.royal Case File No. Payment 1 vne
TYPE OF PERMIT
. _ . .. ., , .. . ..... .._..... _ ..
i
X I & 2 Family dwelling or accessory 1 0 Commercial /industrial I 0 Multi -famil ' 0 Tenant improvement
U New construction X Addition/alteration /replacement 0 Food serv'. e i O Other:
JOB SI I I. 1\1 ORV IIO\ FEE SCL hDULr (for informaion use checklist)
Job address: 7993 SW Church+ r/. Way Don , -- Qty Fee Total
New 1 & 2 family dwelling only: 1+ 100 ft
Bldg. No.: I Suite no.: SFR (1) Bath $249.20 0
Tax map /tax lot / account no.: SFR (2) Bath $350 0
Lot: I Block: I Subdivision : SFR (3) Bath $349 0
Each additional bath / kitchen $ 0
Project name: Kirk Markovitz Site Utilities: Catch basin / area drain $16.60 0 _
City / county : Tigard I Zip : OR Dry wells/ leach line / trench drain $ 0
Footing drain (no. Lin. ft) $ 0
Description and Location of work: Replace tub with shower Manufactured Floitte utilities- each $46.40 0
Date of Completion/ inspection: Manholes $ 0
Rain drain connector $ 0
Sanitary Sewer (no. of linear feet) 100 ' $55.00 0
Business name : RAYBORN'S PLUMBING Storm Sewer (no. of linear feet) 100' $55.00 0
Address : P.O. BOX 69 Water Service (no. of linear feet)l00' $55.00 0
Fixture or item
City : TUALATIN State: OR I Zip: 97062
Absorption valve $16.60 0
Phone : 503 692 -4139 Fax : 503 691 -2328 Back flow preventer $27.55 0
E Mail Address : Backwater valve $16.60 0
Basins / Lavatory $16.60 0
CCB no. : 87852 I Plumb. Bus. No. : 34 - I66PB Clothes Washer $16.60 0
City / Metro Lie. No.: 00180. Dishwasher $16.60 0
Contractor's signature : / Drinking Fountain (s) $16.60 0
/ /// `���� . Ejector / sump $16.60 0
Print name: �� a 1 , J �� Date :5/25/04 Expansion 'Tank $16.60 0
W Ni El? Fixture / sewer cap $16.60 0 1
Floor drains/ floor sinks/ Flub $16.60 0
Name: Kirk Markovitz Garbage Disposal $16.60 0
Address: 7993 SW Church; ii Way Hose Bibb $16.60 0
City : Tigard State : OR Zip: 97224 Ice maker $16.60 0
Interceptor / Grease trap $16.60 0
Phone : 503 684 -5164 Fax : Primer $16.60 0
('ON'r.. ('T & ENt ;T \I:FR NOT APPLICABLE
Roof drain (commercial) $16.60 0
Sinks (s), Basin(s), Lav (s) $16.60 0
Notice : This permit application expires if a permit is not obtained Sump $16.60 0
within 180 days after it has been accepted as complete. Tubs/shower /shower pan 1 $16.60 16.6
Urinal $16.60 0
Water Closet $16.60 0
i 2::‹ Water heater $16.60 0
_r Other : $16.60 0
TOTAL 16.6
Residential Backflow Minimum Fee $72.50 72.50
Visa charge on credit card authorization sheet. minimum $36.25. Plan review @ 25%
Commercial requires 2 sets of o
Iso / riser. State charge .08 /0 5.80
Total 78.30
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 ,
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
0/3 BUP
Received ` 7 Date Requested AM PM BUP
Location _ .� ... _ _ / uite MEC
•
Contact Person Ph ( ) J' PLM .� �f'' - - 33
Contractor Ph ( 57)3) b 4 L SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Crawl ELR
Drain
}r
Crl Drain ((ff
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
P.
• RT FAIL
1 LUMBIN
Po =earn
TT. b
- ough -In
- er Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
PART FAIL
ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA /221/7
Approach/Sidewalk Date 0 p Inspector Ext
Other:
Final DO OT REMOVE this inspection record from the Job site.
PASS PART FAIL