Permit CITY OF TIGARD PLUMBING PERMIT
1 II
s ' COMMUNITY DEVELOPMENT Permit #: PLM2013 00118
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/10/2013
T t �'' p 9 Parcel: 1 S133DC12100
Jurisdiction: Tigard
Site address: 13412 SW LAURMONT CT
Project: Willcox Subdivision: ARI GREEN Lot: 12
Project Description: Replace 50' water service
Contractor: RAYBORN'S PLUMBING INC Owner: WILLCOX FAMILY REVOCABLE TRUST
19990 SW CIPOLE RD 13412 SW LAURMONT CT
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
50 If Water Service 04/10/2013 $62.54
Specifics: 1 12% State Surcharge - 04/10/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 04/10/2013 $9.96
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.
Issued By: /► Permittee Signature: / `4 PLIco4
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 01:02:11 p.m. 04 -09 -2013 1 /2
Plumbing Permit Application
Site Utilities RECEI VE Lg Reeeved Cty of Tigard Oate /By: c. _ Permit .:
• 13125 SW Hall Blvd., Tigard, OR 97223 U f C3 No .: AA ac 3v�3 (�(� //
' 11 Phone: 503.639.4171 Fax: 503.598.1' r ! PR 0 9 2 013 Plan Review Other Permit No.:
Inspection Line: 503.639.4175 Date /By:
l 1 xi A I: I P Date Ready /By: lu
Internet: www.tigard or.gov +j
CITY OF TIGARD Notified/Method: _j t b HI See Pa ge 2 for
Supplemental Information
TYPE OF W `ILDINC DIVISION FEE• SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty, I Ea. I Total
® Addition/alteration/replacement El Other: New 1-2-faintly dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 31 2.70
® I- and 2- family dwelling 11 Commercial/industrial SFR (2) bath 437.78
CI Accessory building SFR (3) bath 500.32
rY g ❑ Multi - family
.
❑ Master builder Each additional bath/kitchen 25.02
❑ Other: Fire sprinkler (_ sq. ft.) Page 2
_„... ,. , r , JOB SITE INFORMATION AND LOCATION _ Site utilities:
Job site address: / 3 y/,.,__ s W L„ , v „„,0,,,,, + G+ Catch basin or area drain 18.76
City/State/ZIP: `� rL � 0 v r l D- ? Drywell, leach line, or trench drain 18.76
l r Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: f 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: l Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Q Clothes washer 25.02
t p \a i_-.e \/.) CJ.9.,C Y •' ( vi C -e Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank
12.51
Name: Fixture /sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
City /State /ZIP:
Garbage disposal 25.02
Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
__Q- ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name e ' �'� I U ` t n Q �� Medical gas (value: $ ) Page 2 vt
Contact name: AjGCt f__ V a \ k A Primer 12.51
Act. _ Roof drain (commercial) 12.51
Address: q 1
` "� �' `J 1 { � (e `\,(. Sink/basin/lavatory 25.02
City /State /Zle"17:a 1 , ;(_k_2 4 Ci k q x 766.. Solar units (potable water) 62.54
Phone: (, 3 ) �t 4 4 D _ 4 3Q Fax:: (i:1 ) (q _ � 3. c ot e Tub /shower /shower pan 12.51
,1a 4. ,e V V Urinal 25.02
E -mail:
/ ' r t.t t • t lr_
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name: RAYBORN'S PLUMBING INC
Water piping/DWV 56.29
Address: P.O. Box 69
Other: 25.02
City /State /ZIP: Tualatin, OR 97062 Subtotal
Phone: (503) 692 -4139 Fax: (503) 691 -2328 Minimum permit fee: $72.50 n
CCB Lic.: 87852 Plu bing Lic. noi 66PB _ Plan review (25 % of permit fee)
Authorized signature:��
State surcharge (12% of permit fee)
�� // . TOTAL PERMIT FEE
Print name: 4 d I 1 r� D ateY-9'-/3 This permit application expires if a permit is not obtained wit ISO days
after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
t: Ruilding Permits PLMC- PernioAOO.doc 1001.09 ,,,, ,. nn, ...,.....
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13412 SW LAURMONT CT, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
05/02/2013 10:39
PLM2013-00118
PASS - No C of O
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13412 SW LAURMONT CT, TIGARD, OR, 97223
Residential - Plumbing
330 Water service
05/02/2013 00:00
PLM2013-00118
PASS
Water pipe replacement was plastic for plastic.
Violation Summary:
Inspector Contractor