Permit CITY OF TIGARD PLUMBING PERMIT
t; - COMMUNITY DEVELOPMENT Permit #: PLM2013 -00218
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01/2013
Parcel: 25111 DB09100
Jurisdiction: Tigard
Site address: 15510 SW OAKTREE LN
Project: Subdivision: SUMMERFIELD NO.10 Lot: 552
Project Description: Replace tub /shower.
Contractor: RAYBORN'S PLUMBING INC Owner: UPRIGHT, COLLEEN M
19990 SW CIPOLE RD 15510 SW OAKTREE LN
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 07/01/2013 $12.51
Specifics: 1 12% State Surcharge - 07/01/2013 $8.70
Plumbing
Type of Use: SF 60 ea Minimum Fee Adjustment - 07/01/2013 $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 � ODUN ] C by calling 503.232.1987 or 1.800.332.2344.
Issued By: /(/ / Permittee Signature: 0 _ _ p L / e ��0AI
`!C 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.
06- 27- 13;10:06 ;Rayborn's Plumbing ;5036912328 # 1/ 2
Plumbing Permit Application
Building Fixtures RECEI FOR OFFU"F. 1 fi'r1.v
City of Tigard Received 4VA Permit No.1O( � -00 02/,
mg ill 131 25 SW Hall Blvd., Tigard, OR 97223 JUN 2 U 13 Plan Review
>e Phone 503. .6394171 Fax: 503 598 . 1960 Date/By: Other Permit No.;
T 1 G A R D Inspection Line: 503.639.4175 CITY OF Ts'AF1n Date Ready /By: ,� Sec Pate ental 2 for
I nternet: www.tigard-or.gov �e Notifled/Meth
- r , ' ��� i od• � Sepple 1 rorm
• . ' . , ' TYPE OF. WOR*1"t. tI ,! �i ., ,y r , . FEE *, SCHEDUL1 ti n
: - I
N • onstruction El Demolition For special in ornra ion use d eck /itL
Description Qty, Ea, Total
Addition /alteration/replacement [] Other. New 1 dwellings (includes 100 ft. for each utility connection)
I 'r' ` '
' u):.' 'Y' - ^ � "�•�CATEGOR�.;OF= CONSTRU�'TION t -; : `• „� SFR (1)bath 312.70
. 'y I- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi- family Each additional bath/ldteben 25.02
In Master builder ❑ Other: Fire sprinkler (,,,,_ sq. It) Page 2
t':::,:.1.'"::.':::: n,„ :JOD'•;SITE- INFORMATION "AND, LOCATION "p .., '• :• t' r,;` _Site. utilities:
Job site address: / crhd JCS at 4- fir, L Catch basin or rum drain 18.76
City/ State/ZIP �� Drywell, leach line, or trench drain 18.76
g a �, d 4 Footing drain (no. linear R: ) Page 2
Suite/bldgJapt. no.: 1 Project name: UpV T
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 prevonter 31.27
, DESCRIPTION OF WORK,': ' Backwater valve 12.51
" Clothes washer 25.02
- - ► / / Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25 -02
. ' ❑ PROPERTY oiyNERR•:.' T. []_ TENANT:; Expansion tank 12.51
Name: v` /J/z l v / co L (£ Fixture/sewer cap 25.02
/ Floor drain/floor sinWhub 25.02
Address; S'61-'4/ Garbage disposal 25.02
City /State/ZIP: Hose bib _ 25.02
Phone: ( ) Fax: ( ) Ice maker 1251
...a�APPLICANT. ❑ CONTACT' P RSON . "" Interceptor /grease trap 25.02
Business name: y 6, / S ? I ' b) A m I A 1... Medical gas (value: s ) Page 2
Contact name: A , e_ «l, V Primer 12.51
Roof drain (commercial) 12.51
Address: CC' D S G✓ s"� le . • ' Sink/basin/lavatoiy 25.02
City /State /ZIP: O► ;4 .2, Solar units (potable water) 62.54
PhonC (9),3 ) (4'..- 4 1 3 Fax;
�" Fax; : (4-03 )6R � g Tub/shower /shower pan r 12.51
E -mail: p r
tF . 1 Y
y ,„� s ,. c_4, t--_,_ Urinal 25.02
/ _
CONTRACTOR " Walcrclosa 25.02
Water heater 37.52
Business name: ext y 1 o r6U f 1 1 I V tA , L ,L t 4_1 1- C_ Water piping/DWV 56.29
Address: o(L(ec o .5 w Gt ra /e R.:C Other. 25.42
City/ State/ZIP" y (a ' L � 0 t._ . OC - Subtotal
Phone:
c �03 ) 4, (3 4' Fax: ( ) .c i ,/ g - Minimum permit fee: $72-50
Plan review (25% of permit fee) '
CCB Lic.: ■ f " Plumbin_ Lic. no.: 31.- - is State surcharge of permit fee) t-..
Authorized signature: � TOTAL PERMIT FEE
Date' This permit application expires Ire permit is not obtained within SO days
after It host been accepted us complete.
*Fee methodology act byTri- County Building Industry Se+viee taoard.
Ii13uildingTetmirs1PLMU •PemitApp.doc III/01/09 449-4616T(I0/07/COM/WE13)