Permit CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2006 - 00478
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 DATE ISSUED: 10/16/2006
PARCEL: 2 S 103 DA -06000
SITE ADDRESS: 13485 SW WATKINS AVE ZONING: R -3.5
SUBDIVISION: FANTASY HILL LOT: 014 JURISDICTION: TIG
Project Description: Replace water service.
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: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 45 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
JERRY HOLCOMBE
13485 SW WATKINS AVE Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 10/16/200€ $72.50
[TAX] 8% State Surcha 10/16/200E $5.80
Phone : 503- 730 -4160 Total $78.30
Contractor:
RAYBORN'S PLUMBING INC
PO BOX 69
TUALATIN, OR 97062 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 692 -4139
FAX 503 - 691 -2328
Reg #: 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 -6699 or 1- 800 - 332 -2344.
Issued By: ' • `�, Permittee Signature: `Z P
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
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.
Oct. 16. 2006 8:54AM Rayborns Plumbing No. 7335 P. 1 RECEIVED
Plumbing Permit Application FOR 01 l lc I •: l)sF ONLY
City of Tigard OCT 6 2006 R eceived ��
Date/By: I 1 Pertn;r No, ,_ // - a) 13125 SW Hall Blvd , Tigard, OR 97223 an Review
CITY OF TIG i •; Plan Perp�jr No.:
Phone- 503. 639.4171 Fax 503.598.19 I AR 2 , ; , L ,,,., : Other
24 HourInspect ionLine : J .. JI ,,. Date/ Re
Internet: www, tigard.or.us Date Resd 1 n ®See Pegs 2 for
a �, , ,Tl Nonfied/Met Snpptemeatsl Information
,I �, ,t\ /J -r e zy i l�m�Hrr l t ' � )f,� -t.3 r 1 ,.. + lt� i1 :; J �: [.i I [� r� r �� i ; y 7 :
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❑ New nstrilction '. .,' •,i:�:, .-.. ��, .., _ _ __ -
❑ Demolition F or special information use checklist
Description I Qty. I Ea. 1 Total
ddition/alteration/rcplacement ❑ r Othe
` rf r tc �i � � +, r 7 , )� } ,t � t I I � I New 1- 2-family dwellings (includes 100 ft. for each utility connection)
I f ,'1'+ . ' ... � ,., .Ir' s . t ,, ,t + �� t ) i .�,'�ii ". �.-".4';.4 ' { ' J 6 'I , ':i SFR (I) bath 24920
We and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other:
rt+ r �+ a r l � Fire sprinkler sq. t.
t' ,! I rl ,A: : hi S +1 :, i SM1 ± L F ,
r o�r r , y } ;' �r I ,r l � , [ �t ply ,t1: .S R ob es
I ) Page 2
,
lob site address: /a y S' s k) C 7 u je - _ 5- , Catch basin or area drain 16.60
City /State/ZIP: / r •9 re oil 9 7 A. Drywall, leach line, or trench drain 16 60
Suite/bldg. /apt. no.; ./ project name: Footing drain (no. linear ft.: ) Page 2
Cross street/directions to job site: Manufactured home utilities 1 10.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.; _) Page 2
Storm sewer (no, linear ft.: ) Page 2
Subdivision: Lot no.; Water service (no. linear R: SSD 1 Page 2 SS, 66 Tax map /parcel no.: Fixture or item +
t T-TCrs r l { � 7, T r r � .. Absorption valve 16.60
4 i F ; 1, [ + ' 1 `I l F r , ) { „ ab orptio vat
�. .. _..._ .t .-, ..: ,. ,.r k . 't1 . , - Bac kflow pre Page 2
. ,.. . ' _ , " - "
• a _ =, ,Q D it �t rye _ , J Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
p ;,,,, „`J < + , r i '; ., t , Drinking fountain 16.60
i :. 1, -Flq. . + ' ,1:._. ,! t , '- 4 1 ,,,, 4 .1t 14 ) „ nl t:',.' ,i 9.21`..3 r i, -[,,:)•:[,,,),:t, �tji t '.:.
;, Electors /sump 16.60
Name a r r tf 140 I caury b e. Expansion tank _ 16.60
Address: 3 5 w w 9 T r-f /1 S A V _Fixture/sewer cap 16.60
City / State/ZIP;
/ i g{.•. 0 t'_ 4 7 " 2.. '21 Floor drain/floor sink /hub 16.60
Phone , 7 Fax ( ) Garbage disposal 16 60
''} Hose c !'I ',l�L �J I �fl r r KTx , ll. ji, I <t rz `t i( , : ,,�1ef t I� 1�, H bib 16.60
fi::! ice maker 16.60
'
' - Interceptor /grease trap 16.60
Contact name: Er !. i
T' 4___ Medical gas (value: $ ) Page 2
Address: an g to X 6 9 / 19?W 0,:., ,/ Primer 16 60
City / State/ZIP; i tot Q tt .4t� / o p f 9 70 - , Roof drain (commercial) 1660
Phone: I Fax: : 9 Sink/basitdlavatory 16.60
I& T a - r J / .3% ✓") 6 9p/' Z.3 Z Tub /shower /shower pan 16.60
E-mail: r l ttr
' Unnat
za f , , ! , s „7::',1 , ---�- 16.60
��,n. :-;-, ��I 1i r r ) 1: , :�(tt') w . : , A,1' , ;-' 1 ,W.,: , 1' } 1 . 1 I 'f I . 1%:. , L'..1......-1.,,' ,, li,r.i _
EM �.�_., ,. . :i , , _ ,�,r .. , _ .. >�,_ . }„ WB ter CIOSet 16.60
Water heater 16.60
Address: 1 8 8 S 11 1 4 4 S Other:
City / State/ZIP: �� r 9r . 6 < 9 7 � Z . _ Subtotal SA". 64) Phone: �l ^ Minimum permit fee: $72.50
(.,s(y3) ( l / 3 c r Fax: (S2 49/- 2,q,2-,4 Residential backflow minimum permit fee. $36.25 7 . � - *
CCB Lic.: 8 77 / � ! Plumbing Lie. no.: 34,t_ i y - - Plan review (25% of permit fee)
Authorized signs . / / State surcharge (8% of permit fee) S. X0
`�" - � A6 TOTAL PERMIT FEE yg. at,
Print name: /1 --` Date: /D-IL .O id This permit application expires If a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board
is SuildireigermitskPLM- PerputApp,doe 06105 440.46l6T(10ro2/COM/WEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2006- 004713
‘,
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/16/7006
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 - 4175 ; ' F'I I—
INSPECTION WORKSHEET FOR DATE: 1012012006 TIME: 7 :01AM PAGE: 64 •
SITE ADDRESS: 13485 SW WATKINS AVE CLASS OF WORK:
SUBDIVISION: FANTASY HILL LOT #: 014 TYPE OF USE:
PROJECT NAME: HOLCOMBE
DESCRIPTION: Replace water 'service.
OWNER: HOLCOMBE, JERRY PHONE #: 50;3- 730 -4160
CONTRACTOR: RAYBORN'S PLUMBING INC PHONE #: 503 - 692-4139
Inspection Request Scheduled For: Date: 10/20/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 038562 -01 503-692-4139 N
�� A/4-<
rrections /Comments/ Instructions:
cur
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FA ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Grl7i Date: /0/Z0/0‘ Phone #: (503) 718- 2