Permit a CITY OF TIGARD PLUMBING PERMIT
a COMMUNITY DEVELOPMENT Permit #: PLM201000078
T [ G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/17/2010
Parcel: 2S115AD05900
Jurisdiction: Tigard
Site address: 10627 SW TUALATIN DR
Subdivision: Lot: 0
Project: Vanderheiden
Project Description: Replace up to 100 feet water service.
Owner: FEES
VANDERHEIDEN, ANN Quantity Description Date Amount
10627 SW TUALATIN DR
TIGARD, OR 97224 100 If Water Service 03/17/2010 $62.54
PHONE: 1 12% State Surcharge - 03/17/2010 $8.70
Plumbing
10 ea Minimum Fee Adjustment - 03/17/2010 $9.96
Contractor: Plumbing
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005
PHONE: 503 - 643 -5535
FAX:
Type of Use: SF
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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: f 1 n Permittee Signature: '
''"-Qn CaII 503.639.4175 by 7:00 a.m. for an inspection th usiness day.
This permit card shall be kept in a conspicuous place on the site until completion of the project.
Approved plans are required on the job site tg the time of each inspection.
Plumbing Permit Applicati � ,--
Building Fixtures 'F. y i t' FOR OFFICE USE ONLY
City of Tigard MAR 17 2013 Received Permit No.
r . 13125 SW Hall Blvd., Tigard, OR 97223 Date /By: / J 200
Plan Review
Phone: 503.639.4171 Fax: 503.598196a Other Permit No.:
D a t e /B y:
Inspection Line: 503.639.4175 - •
TIGARD i „, Date Ready /By: Juris: ® See Page 2 for
F3 f �
Internet: WWW.t or.gov 1 rl,?`,i',, . Notified /Method: % 1 Ci Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. I Ea. 1 Total
❑ Addition /alteration/replacement ❑ Other: New 1 - 2 - family dwellings (includes 100 11. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
Z I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
SFR (3) bath 500.32
❑ Accessory building ❑ Multi - family
Each additional bath /kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10627 SW Tualatin Drive Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard, OR 97224
Footing drain (no. linear ft.: _ ) Page 2
Suite /bldg. /apt. no.: I 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 11.: _ ) Page 2
Water service (no. linear ft.: 50) Page 2 62.54
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backtlow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Replace water service Drinking fountain 25.02
Ejectors /sump 25.02
® PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Anne Vanderheiden Fixture /sewer cap 25.02
Floor drain /floor sink/hub 25.02
Address: 10627 SW 'Tualatin Drive
Garbage disposal 25.02
City /State /ZIP: Tigard, OR 97224 Hose bib 25.02
Phone: (503)747 - 6252 Fax: ( ) Ice maker 12.51
❑ APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Kennedy Plumbing Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Joel
Roof drain (commercial) 12.51
Address: 13985 SW Farmington Road Sink/basin/lavatory 25.02
City /State /ZIP: Beaverton, Or 97005 Solar units (potable water) 62.54
Phone: (503) 643 - 5535 Fax:: ( ) Tub /shower /shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: Same Water p€l
i p m DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 72.50
Plan review (25% of permit fee)
CCB Lic.: 10967 Plumbing Lic. no.: 34 - 42PB
State surcharge (12% of permit fee) 8.70
Authorized signature: f 1 , , TOTAL PERMIT FEE 81.20
l � J This p ermit application expires if a permit is not obtained within 180 days
Print name: Sherry Hess Date: 3 -16 -10 after it has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board.
1 \ Building \ Permits \PLMU- PeunitApp. doc 10/01/09 440- 4616T(10/02/COM /WEB)