Permit CITY OF TIGAR® PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit #: PLM2010 -00181
T F ARP 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/08/2010
Parcel: 1S134CB11800
Jurisdiction: Tigard
Site address: 12183 SW MILLVIEW CT
Subdivision: MILL VIEW Lot: 18
Project: Barnes
Project Description: Installing Backflow preventer.
Owner: FEES
BARNES, JEFFREY G Quantity Description Date Amount
12183 SW MILLVIEW CT
TIGARD, OR 97223 1 ea Backflow Preventer 06/08/2010 $31.27
PHONE: 1 12% State Surcharge - 06/08/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 06/08/2010 $41.23
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.- : r. 32.2344.
Issued By: / - ermittee Signature:
�i C:
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.
Plumbing Permit Application 'I���
Building Fixtures ,� 4175
639 ''�' ° +, { t 1 `';FOR..oF 'roam ; °1 F t 4 , ,x -
Q�0 r 'i L t"? ro �91N�Y i�861 tb 1'._ i _ ': ',.',74:,„71 a': Y r C i t y of Tigard \`N Received
Date /By: 1 l U 6TT Permit No: PO 10 o(I( 1
13125 SW Hall Blvd., Tigard, OR 97223 Review
Phone: 503.6394171 Fax: 503.598.1960 '�lr) Other Permit No.:
40 0 Inspection Line: 503 �� vl y
tTIGARD C1� A l � � Date R eady /By: Juris: 1 ® See Page 2 for
.1+em,rity pligl, Internet: www.t or.gov ` �1\`t� Notified /Method: ` I if } Supplemental Information
. TYPE O WORK .B. FEE* SCHEDULE •
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. 1 Ea. 1 Total
❑ Addition /alteration /replacement ❑ Other: New 1 - 2 - fancily dwellings (includes 100 0. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
® 1- 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: 12183 SW Nlillview Court Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard, OR 97223
Footing drain (no. linear ft.: _) Page 2
Suite /bldg. /apt. no.: Project name:
V`N`eS 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 0.: _) Page 2
Subdivision: 1 Lot no.: Fixture or item:
Tax map /parcel no.: Backtlow preventer 31.27 31.27
DESCR OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
Install new bacicflow device Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY :: O WNER . I ❑ TENANT Expansion tank 12.51
Name: Jeff Barnes Fixture /sewer cap 25.02
Floor drain /floor sink /hub 25.02
Address: 12183 SW N1illview Court
Garbage disposal 25.02
City /State /ZIP: Tigard, OR 97223 1lose bib 25.02
Phone: (503)310 - 6002 Fax: ( ) Ice maker 12.51
' ® APPLICANT': ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Kennedy Plumbing Medical gas (value: $ ) Page 2
Printer 12.51
Contact name: Sherry
Roof dram (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 piping/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 6 1 ( 1.6 / /1 Plumbing Lic. no.: 34 - 42PB
State surcharge (12% of permit fee) 8.70
Authorized signature: U.< '.'4A/ \ TOTAL PERMIT FEE 81.20
Print name: Sherry lless Date: G -8 -201 U 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.
I - A Building VPermitsVPLMU- PermitApp.doc 10/01/09 4-0- 46101(10 /02 /COM/WEB)