Permit CITY OF TIGARD PLUMBING PERMIT
a - COMMUNITY DEVELOPMENT Permit #: PLM2012 -00166
T [ G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012
Parcel: 1 S133DD16400
Jurisdiction: Tigard
Site address: 11989 SW 129TH PL
Project: Harbolt Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 200
Project Description: (1) shower pan
Contractor: RAYBORN'S PLUMBING INC Owner: HARBOLT, JAMES B & MONICA M
19990 SW CIPOLE RD 11989 SW 129TH PL
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
1 ea Tub /Shower /Shower Pan 06/11/2012 $12.51
Specifics: 1 12% State Surcharge - 06/11/2012 $8.70
Plumbing
Type of Use SF 60 ea Minimum Fee Adjustment - 06/11/2012 $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. D/y �e /� 1 1 v /�
Issued By: Permittee Signature: 0, I I f"'C.ICrK - 'kl.
iiiiitegli 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 09:37:27 a.m. 06 -07 -2012 1 /
Plumbing Permit Analicatio \ f E'' / °4CMt 0/� - /, V
Building Fixtures l OR 0111(1: ( SI O.1.\'
J UN 0 7 2012 '
City of Tigard Received (p ((1 (2 P�1 c ) O /a /!,4,
•J ll Per N o.
• III 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
I Phone: 503.639.4171 Fax: 503.598.I6pn/ OF TIGARD Date/By: Other Permit No.:
1 . 1 c j A R „ Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready /By: r (p ® See Page 2 for
Internet: www.tigatd- or.gov Notified/Method: (p Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ Ney.Cbnstruction ❑ Demolition For special Information use checkli
x^f Description I Qty. I Ea. 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 0 Commercial /industrial SFR (2) bath 437.78
•
12 Accessory building SFR (3) bath 500.32
q` g ❑ Multi - family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other. Fire sprinkler ( sq. tt.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: / / 7f9' sG/ ) r Pi Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State/ZIP: f ,MP'.( pry O / / ! a
✓✓ Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: I 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: I Lot no.: Fixture or Item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WO Backwater valve 12.51
Clothes washer 25.02
5A04.-C / l /r> Gi:, f 2 5 F 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
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City /State /ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: R G�/ 6 r .S P ' Medical gas (value: S _ ) Page 2
orw Iv r tai
Contact name: Ivy • f e . ,4" ' -`. Roof d 12.51
/ Roof rain (commercial) 12.51
Address: / g44"1 ! L,/�J /G ./ Sink/basin/lavatory 25.02
City/State/ZIP: ,1 ( ( (NO 6.- Solar units (potable water) _ 62.54
Phone: (* 1 6K . ,2_ ) l.t( Fax: : (7 3) 6e( 1 -a 3 Tub/showedshawer pan / mail: �l/le ?.� 3. Cam, -'--- Urinal L 12.51
25.02
E - _
1 CONTRACTOR Water closet 25.02
l � U
Water heater 37.52
Business name: kO r r vi, S 1 (11��n E kr� ,!`C _ Water piping/DWV 56.29
Address: Ictgco S 4) L. �t.2. t�e� Other. 25.02
City/ State/ZIP: 1jti i 1.,. . 0 t/ (V7040- Subtotal
• , Phone: ( 563) 4 L 3 c( Fax: (503) 6.cei - D-3page Minimum permit fee: $72.50
t gB Lic.41/ 2 5 '' 2 _ Jo P mb) g Lic. no.: 3 ci - /66 Plan review (25% of permit fee)
// S tate surcharge (12% of permit fee) e9° Authorized signature: ���/ TOTAL PERMIT FEE r
Print name: 4 - I ■ Date: 6 -1 - (a This permit application expires if a permit b not obtained within 180 days
4. - . after it has been accepted as complete.
*Fee methodology' set by Tri -County Building Industry Service Board. t1(
tr Buildin6 `Permits�.PLMU- PermiApp.doc 100109 440.46167((002COM'WEB) t//
CITY OF TIGARD
BUILDING DIVISION PERMIT #:
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 A t Inspection Requests (24 Hrs.): (503) 639 -4175 ° ° °'' — llit‘
INSPECTION WORKSHEET FOR DATE: _ (1—L2 TIME: PAGE:
SITE ADDRESS: (j y,r y s ii/ l 764. P L CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: �`I2T P 4G, f)--- O0' 6 t
DESCRIPTION:
OWNER: .PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
5 p A/ 7 ,05 r e-G 770 0
Corrections /Comments /Instructions:
/110 i `' h 7C-5 ` P14
•
g pAas ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
14
Inspector: 6 Date: p- Phone #: (503) 718 -