Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit : PLM2013 -00243
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/18/2013
Parcel: 2S 109AD02700
Jurisdiction: Tigard
Site address: 14670 SW 130TH AVE
Project: Lapp Subdivision: WOODFORD ESTATES Lot: 19
Project Description: Remodel master bath, relocate existing shower and tub.
Contractor: RAYBORN'S PLUMBING INC Owner: LAPP, RAYMOND UDONNA L
19990 SW CIPOLE RD 14670 SW 130TH AVE
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 -692 -4139 PHONE:
FAX: 503 - 691 -2328
FEES
Quantity Description Date Amount
2 ea Tub /Shower /Shower Pan 07/18/2013 $25.02
Specifics: 1 12% State Surcharge - 07/18/2013 $8.70
Plumbing
Type of Use SF 47 ea Minimum Fee Adjustment - 07/18/2013 $47.48
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 OUNCbyy calling 503.232.1987 or 1.800.332.2344.
Issued By: p . Permittee Signature:
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.
07- 16- 13;09:32 ;Rayborn's Plumbing ;5036912328 # 1/ 2
•
Plumbing Permit Application
Site Utilities RECEIVED 014 IL I. l Sl. ONJI.1
City of Tigard Received
71 NI 13125 S W Hall Blvd., Tigard, OR 97223 Date/ y; 7/� �/ 3 4911V- amir No to 0 2€ i3 O 0,2 4 4 , 5
R Phone: 503.639.4171 Fax: 503.59840L 1 6 2013 Plan Review
Dale /By: Other Permit No.:
r ►11 n it n Inspection Line: 503.639.4175 Date Ready/By:
Internet: www•tigard or,gov OF ®® n Notified/atlrod See Page for
�,I TlljllP � / Supplemental i informatio
TYPE OF `..11 . r. _ 1 is .. FEE* SCHEDULE'. ,.:': • ,
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. i Ea. I Total
Addition/alteration/replacement ❑ Other: New I- 2- family dwellings (includes 100 R for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
21 1- and 2- family dwelling ❑ Commercial/industrial SFR(2) bath 437.78
❑ Accessory building ❑ Multi - family SFR (3) bath 500.32
❑ Master builder Each additional bath/ldtchen 25.02
❑ Other Fire sprinkler ( sq. ft) Page 2
.A , ; :. °, ,,,'; JOB SITE INFORMATION AND. LOCATION , . Site utilities:
Job site address: /5'420 St.() 13 Q T R I4 it Catch basin or area drain 18.76
City / State/ZIP: 2 91��� Drywall, leach lint, or trench drain 18.76
Footing drain (no. linear ft.: _ ) Page 2
Suite/bldg. /apt.no.: Project name: La l"p T � Manufactured home utilkies 50.03
Cross street/directions to job site: � Manholes 18.76
�� , ` et .. a mmim Rain drain connector 11.11 18.76
._ -A. r 0 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 preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
C . - ot hes washer 25.02
I n A --.6 _' . A . r L . ' 4 t 4 _ ' . #'�13! • ` ClDishwasher 25.02
'r _ t , Prinking fountain 25.02
Ejectors/sump 25.02
WI PROPERTY OWNER ❑ TENANT Expansion tank ME 12.51
Name: Fixture/sewer cap 25.02
Address: e, + t J
Floor dminitloorsittlJhub 25,02
• Garbage disposal 25.02
City / State/ZIP: Z 4 4eza g Diz. Hose bib
25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 111 25 02
Business name: Medical gas (values $ �._ ) Page 2
Contact name: P " m0C 12.51
Roof drain (commercial) 12,51
Address:
City / State/Z[P; Sink/basin/lavatory 25.02
Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub/shower /shower pan NM 12,51 '
E -mail: Urinal 25.02
CONTRACTOR Water closet 111 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 _ s' -451
Phone (503) 692 -4139 Fax: (503) 691 -2328 Minimum permit fee: 572.50
CCB Lic.: 87852 t mbing Lie, no. :3. 166P6 Plan review (25% of permit fee)
WI State surcharge (12% of pennit fee)
Authorized signature: ,
I �a , ` IL_ Lti TOTAL PERMIT FEE _
' t I , r. Date: M� 'MIN permit application expir if a permit ix not obtained within 180 days
after it hay been accepted as complete.
*Fee methodology set by Tr6County Building Industry Service Board.
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
14670 SW 130TH AVE, TIGARD, OR, 97224 2013 - 12 - 04 00:00:00
Record Type: Record ID:
Residential - Plumbing PLM2013 - 00243
Inspection Type: Result:
399 Plumbing final PASS - No C of 0
Comments:
Violation Summary:
Inspector Contractor