Permit CITY OF TIGARD PLUMBING PERMIT
:
COMMUNITY DEVELOPMENT Permit #: PLM2012 -00165
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2012
TIGARD ' 9 Parcel: 2S109AB02800
Jurisdiction: Tigard
Site address: 13525 SW MOUNTAIN RIDGE CT
Project: Richardsons Living Trust Subdivision: THREE MOUNTAINS ESTATES Lot: 21
Project Description: Install (1) shower pan
Contractor: RAYBORN'S PLUMBING INC Owner: RICHARDSON LIVING TRUST
19990 SW CIPOLE RD 13525 SW MOUNTAIN RIDGE CT
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 06/07/2012 $12.51
Specifics: 1 12% State Surcharge - 06/07/2012 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment - 06/07/2012 $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 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.
I
Issued By: � � / / Permittee Signature: 4PPLi t 4 % 7 19
�`•/ 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 09:19:37 a.m. 06 -07 -2012 1 /2. Si or
Plumbing Permit AnplicatrfpCp QED dfr
Buildin g Fixtures
City of Tigard JUN 0 7 2012 Rec-eived (1 (( Perm (N a ,,, 0
Date/By: Re
ip
view
SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.S Qb1Il OF TIGABD y: Other Permit No.:
Inspection Line: 503.639.4175
11/; A it i) e Rea B 2 for
Internet: www.tigard BUILDING DIVISION Not : 'I , Su ® pplemeen See p e ta 1 ormation
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use check list.
Description ( Qty. I Ea. I Total
"Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 ft. for each utility connection)
. CATEGORY OF CONSTRUCTION SFR (I) bath 312.70
I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
/ building ^ SFR(3)bath 500.32
❑ Accessory g ❑ 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: 1 3 c ..6. s (� C Catch basin or area drain 18.76
t �` e_ leach line, or trench drain 18.76
City/State/ZIP: 9 I _ 0 r a7o� -y
" 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.: Backflow prtrventer 31.27
DESCRIPTION OF WORK • Backwater valve 12.51
l l n Clothes washer 25.02
/I Sid,/1 <1401.*) C r. �" CIA,-- Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ' ❑ TENANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone: ( ) I Fax: ( ) Ice maker 12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor /grease trap 25.02
Business name: t P 1 r 1 n e_. Medical gas (value: $ _ ) Page 2
ervl S L Primer 12.51
Contact name: /y
t--y g Roof drain (commercial) 12.51
/
Address: / LIQQ' � 14.) 1 1 p to a _ Sink/basin/lavatory 25.02
City / State/ZIP _ �� r r 06 1 Solar units (potable water) 62.54
Phone: (6 ) 612_ ({ /3 [ f Fax: : 030 6 c ? I - .23.4 Tub /shower /shower pan / 12.51
E -mail: / t/ /� r r
(� y 4) K G e Go v,_
,_ Urinal 25.02
CONTRACTOR Water closet • 25.02
v L duty / S 1 L Water heater 37.52
Business name: gA P t U let,k i I. y 1� 1 k L L. W ater P t �P �
i DWV 56.29
` pl
Address: 14. 4 C ; ?elk , Other. 25.02
city/state/Z1Pl uft D e eV1061 Subtotal
Phone: (' o3) 6 C ( 2 CiI3 CI Fax: ( 503) Cc( _ 2 Minimum pemtit fee: $72.50
Plan review (25% of permit fee)
CB
C Lie.: g 7 Plumbin: ic. no.: I
�'- / � `I _ State surcharge (12% of permit fee)
Authorized signature: /
�- , • irJV / TOTAL PERMIT FEE
Print name: / f°. // � Tbb permit application expires if a permit Is not obtained wit o 180 days
d Q K r /I Date: after St has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board. SC
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