Permit x PLUMBING PERMIT
. It CITY OF TIGARD
f a
"r a COMMUNITY DEVELOPMENT Permit #: PLM2010 00223
7tGA R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
, Date Issued: 07/14/2010
4 § ,, a ,, ; ,, z ,.., Parcel: 2S102CD00500
Jurisdiction: Tigard
Site address: 9585 SW OMARA ST
Subdivision: Lot: 0
Project: Boydstun
Project Description: Replacing 100 ft. of water service and installing backflow for irrigation.
Owner: FEES
BOYDSTUN, DENNIS GREGORY & Quantity Description Date Amount
BOYDSTUN, SALLY BAUCUS, 9585 SW
O'MARA ST 1 ea Backflow Preventer 07/14/2010 $31.27
100 If Water Service 07/14/2010 $62.54
PHONE: 1 12% State Surcharge - 07/14/2010 $11.26
Plumbing
Contractor:
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 $105.07
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: Permittee Signature: _
[.--
Call 503.639.4175 by 7:00 a.m. for an inspection that • • mess day.
This permit card shall be kept in a conspicuous place on the j. • ite until completion of the project.
Approved plans are required on the job site - e time of each inspection.
Plumbing Permit A licati C . ' ., .,.\
Building Fixtures 0 .,1 PSLS) • FOR OFFICE USE ONLY
` Rece
City of Tigard O� lV L Permit No.: r� vw
Q 13125 SW Hall Blvd., Tigard, OR 97223 c NG� Date /By: 7/ �lJ � Min - (J(J9 - _
l Plan Review Other Permit No.:
Phone: 503.639.4171 Fax: 503.598.1960'��� Date/By: t�?ni (- "
Inspection Line: 503.639.4175 v y t
TIGARD D ateReady /By: J uris: Ei Se ePage2for
Internet: www.tigard - or.gov Notified/Method: ' Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist.
Description I Qty. 1 Ea. I Total
❑ Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
12 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: 9585 SW Omara Street 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.: I Project name: j j `/� � Manufactured home utilities 50.03
Cross street/directions to job site: FF VV 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.: 100) Page 2 62.54
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Backflow preventer I 31.27 31
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: Sally Boydstun Fixture /sewer cap 25.02
Floor drain /floor sink /hub 25.02
Address: 9585 SW Omara Street
Garbage disposal 25.02
City /State /ZIP: Tigard, OR 97223 Hose bib 25.02
Phone: (503)956 -3256 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Kennedy Plumbing Medical gas (value: S ) Page 2
Primer 12.51
Contact name: Sherry
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 piping/DWV 56.29
Address: Other: 25.02
City /State /ZIP: Subtotal 9 g 1
Phone: ( ) Fax: ( ) Minimum permit fee: 572.50 - 3275(1'
Plan review (25% of permit fee)
CCB Lic.: 10967 Plumbing Lic. no.: 34 -42PB
State surcharge (12% of permit fee) \ I ,ab tr
Authorized signature: . 64t/� TOTAL PERMIT FEE .SL.28'
Print name: Sherry Hess 1' Date: 7 - - 2010 This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete. lf� ,
*Fee methodology set by Tri- County Building Industry Service Board /
I: \Building \Permits \PLMU- PerrnitApp.doc 10/01,09 440- 4616r(I0/02/COM /WEB)