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Permit CITY OF TIGARD PLUMBING PERMIT n a; COMMUNITY DEVELOPMENT Permit #: PLM2012 -00286 • TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/03/2012 Parcel: 2S 102 DB08500 • Jurisdiction: Tigard Site address: 9092 SW HILL ST • • Project: Mize Subdivision: CHELSEA HILL NO.2 Lot: 62 Project Description: Move ice maker, move stack to upstairs and replace kitchen sink. Contractor: RAYBORN'S PLUMBING INC Owner: MIZE, LOA M & JON M 19990 SW CIPOLE RD 9092 SW HILL ST TUALATIN, OR 97062 TIGARD, OR 97223 P PHONE: 503 - 639 -2268 PHONE: 503 -692 -4139 FAX: 503 - 691 -2328 .'r FEES Quantity Description Date Amount 1 ea Ice Maker 10/03/2012 $12.51 Specifics: 1 ea Water Piping /DWV 10/03/2012 $56.29 1 12% State Surcharge - 10/03/2012 $8.70 Type of Use: SF Plumbing Class of Work: ALT 4 ea Minimum Fee Adjustment - 10/03/2012 $3.70 • Plumbing 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 Notifica ••- - -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 q -scions to OUN..y c- 'ng 503.232.1987 or 1.800.332.2344. /J Issued ;y: / / • j �6' ✓7 U l Perm ittee Sign re: j � / if.. 1 -' 4 / 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 • 02:18:16 p.m. 10 -02 -2012 2 /2_ Plumbing Permit Aa licatio Er, f., ivpi Building Fixtures FOR (11 :1 i. SE c). °1.1 City of Tigard OCT 0 2 2012 Received ^ • 13125 SW Hall Blvd., Tigard, OR 972 ?9J. .• } DatuBy: /O //'s (.4--- o n Permit N o.: l e /J�Q6? •tea& Phone: 503.639.4171 Fax: 503.598.7966 Y �t a "7P4kT4.1 Plan Revie Inspection Line: 503.639.4175 {p F iP� i4ls'r °su a Dar /By: Other Permit No.: J'T�p /� -GO i 1 [; n It [) Internet: Line: g 03.63 gov �" "" _ .. ` f : � Date Ready /By: na H S Pa 2 for NotitiMiMethod: Supplemental Information • TYPE OF WORK- FEE* SCHEDULE ❑ New construction ❑ Demolition Forspec /a//nforeradonusechecklist W. Addition /alteration/replacemenl ri Qty. Ea. Total ❑ Other New I- 2- family dwellings (includes 100 ft. for each utility connection) CATEGORY OF CONSTRUCTION • SFR (1) bath 31 2.70 kI- and 2- family dwelling CI Commercial /industrial SFR (2) bath 437.78 ❑ Accessory building ❑ Multi - family SFR (3) bath 500.32 ❑ Master builder Each additional bath/kitchen 25.02 ❑ Other. Fire sprinkler JOB SITE INFORMATION AND LOCATION Site P sq. ft.) Page 2 utilities: . Job site address: 9i 94 $1 k i i C Catch basin or area drain 18.76 City /Stale/ZIP: / 'Tit i , , f ©� Q _f7.11 3 Drywell, leach line, or trench drain 18.76 Suite/bldgJapt. no.: Proj " name: Z Fooling drain (no. linear ft.: �) Page 2 Manufactured home utilities 50.03 Cross street/directions to job site: l Manhoes 18.76 Q 4 _ • , • 1071.11111111111 Rain drain comtector 18.76 1. Sanitary sewer (no. linear R: ) 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 WORK Backwater valve 12.51 Clothes washer 25.02 • _ V_.._.4 ``• • .Z.. - ./ Dishwasher 25.02 . - , I • . ! Drinking fountain 25.02 Ejectors/sump 25.02 ❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: 7YL t>2 Fixture/sewer cap 25.02 Address: 90 y� i , J , `�/ / Floor draiNaloor sink/hub 25.02 7 _ tit. j /� � u f~ Hose bib 25.02" City/State/ZIP: L // x' Hose bib 25 02 Phone: ( ) Fax: ( ) Ice maker 12.51 1 Z ❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02 Business name: Medical gas (value: S _ ) Page 2 Contact name: Primer 12.51 Address: Roof drain (commercial) 12.51 Sink/basin/lavatory 25.02 City/State/ZIP: Solar units (potable water) - 62.54 Phone: ( ) Fax: : ( ) Tub/shower /shower pan 12.51 E -mail: Urinal 25.02 CO ' • CTOR Water closet 25.02 Business name: F ■ , , s I L Water heater - 37.52 Address: r j 6 • Waterpipin• DWV ( 56.29 ,1 Other. Gt J 0 City/State/ZIP: j `� �G id�� 2o.02 Phone: b ` Subtotal �' V v� 6g -y13 Fax: (� 6G /��� ye� Minimum pennit fee: 572.50 i.: S dT8 Plan review (25% pennit fee) CCB Lic.: 626 Pj bing Lic. A Authorized signature: nalir, 4 State surcharge (12% of pennit tee) ID di, nip f j/ a j TOTAL PERMIT FEE r L 1K� � ,� Date: 0 1711 This permit application esplres if a permit is not obtained within ISO days after it has been accepted as complete. •Fee methodology set by Tri- County Building Industry Service Board. I. Building P rnns PLM(I- PenmiApp doe 10 0109 14 0 - 1616T( 10 0?.COM.WrB)