Permit N -a CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2009 -00017
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/30/2009
PARCEL: 1 S133DC -12500
SITE ADDRESS: 13338 SW SHORE DR ZONING: R -12
SUBDIVISION: ARI GREEN LOT: 016 JURISDICTION: TIG
PROJECT: GRONKE
Project Description: Replace 50 ft. of water service.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF . WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
ROGER GRONKE
13338 SW SHORE DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/30/2009 $72.50
[TAX] 12% State Surch 1/30/2009 $8.70
Phone : Total $81.20
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 643 -5535
Reg #: LIC 10967
PLM 34 -42PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
� ^ o t C
Issued By: l Q Permittee Signature:
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 RECE 1
Site TAilities FOR OFFICE USE ONLY
;e. „N !n I' R eceived
Cit of Ti and \ �,. Q p
y g Date/By: ( o -t lam{ J � Permit N o.: 191.Sna0 O , . 0 O % (7
' 1 3125 SW Hail Blvd., Tigard, OR 97223 Ian Review v -
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIG ' ' le ate /By: Other Permit No.:
TIGARD Inspection Line: 503.639.4175 y y, g
at'd - or. ov BUILDING DIVIS (._ Read /B �ry rs:�f If See Page 2 for
g g Notified/Method: I I C� Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use check list.
Description I Qty. I Ea. I Total
Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft for each utility connection)
CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
® I - and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi - family SFR (3) bath 399.00
❑ Master builder ❑ Other: Each additional bath/kitchen 45.00
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 13338 SW Shore Drive Catch basin or area drain 16.60
City /State /ZIP: Tigard, Oregon Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: _ ) Page 2
Manufactured home utilities 110.00
Cross street/directions to job site: Winter Lake Drive
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: _ ) Page 2
Subdivision: I Lot no.: Water service (no. linear R.: 50) Page 2 55.00
Fixture or item
Tax map /parcel no.:
Absorption valve 16.60
DESCRIPTION OF WORK
Backflow preventer Page 2
Backwater valve 16.60
Replace water service Clothes washer 16.60
Dishwasher 16.60
® PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: Roger Gronke
Expansion tank 16.60
Address: 13338 SW Shore Drive Fixture /sewer cap 16.60
City /State /ZIP: Tigard OR 97223 Floor drain /floor sink/hub 16.60
Phone: (503)521 -0909 Fax: ( ) Garbage disposal 16.60
® APPLICANT ❑ CONTACT PERSON Hose bib 16.60
•
Ice maker 16.60
Business name: Kennedy Plumbing
Interceptor /grease trap 16.60
Contact name: Roy Pierce Medical gas (value: $ ) Page.2
Address: 13985 SW Farminginton Road Primer 16.60 .
City /State/ZIP: Beaverton, OR 97005 Roof drain (commercial) 16.60
Sink/basin /lavatory 16.60
Phone: (503) 643 -5535 Fax::( )
Tub /shower /shower pan 16.60 .
E -mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Same Water heater 16.60
Address: Other: .
City /State /ZIP: Subtotal
Minimum permit fee: $72.50 72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 10967 Plumbing Lic. no.: 34 -42P6 Plan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
Authorized signature:
„Le_ 1 TOTAL PERMIT FEE I 81.20
Print name: Sherry Hess I Date: 1 -30 -09 I 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:\ Building \Permits \PLMU- PcrmitApp.doc 12/27/06 440- 4616T(10/02/COM /WEB)
N -a CITY OF TIGARD PLUMBING PERMIT
° COMMUNITY DEVELOPMENT PERMIT #: PLM2009 -00017
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/30/2009
PARCEL: 1 S133DC -12500
SITE ADDRESS: 13338 SW SHORE DR ZONING: R -12
SUBDIVISION: ARI GREEN LOT: 016 JURISDICTION: TIG
PROJECT: GRONKE
Project Description: Replace 50 ft. of water service.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF . WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Owner:
FEES
ROGER GRONKE
13338 SW SHORE DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 1/30/2009 $72.50
[TAX] 12% State Surch 1/30/2009 $8.70
Phone : Total $81.20
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 643 -5535
Reg #: LIC 10967
PLM 34 -42PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
� ^ o t C
Issued By: l Q Permittee Signature:
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.
CITY OF TIGARD
BUILDING DIVISION , � P _, IT #: P . 2009.0001
13125 SW Hall Blvd., Tigard, OR 97223 ^ � W D : 1/30/;1009
Phone: (503) 639- 4171uNmiiulfl�� l� / ,
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 2/2/2009 TIME: 7 :OQAM PAGE: 7
SITE ADDRESS: 13338 >W SHORE DR CLASS OF WORK:
SUBDIVISION: ARI GREEN LOT #: 015 TYPE OF USE:
PROJECT NAME: GRONKE
DESCRIPTION: Replace 50 ft of water service.
OWNER: GRONKE, ROGER PHONE #:
CONTRACTOR: KENNEDY PLUMBING PHONE #: 503 -643 -5535
Inspection Request Scheduled For: Date: 2/2/2009 Pour Time:
Code # Inspection Description Confirm # Contact # Mes-ge
330 Water seiwic :e 080189 -01 503-(4 3., 5535 Y
C /Comments /Instructio s:
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PASS ❑ PARTIAL APPROVAL ❑ CANCEL L NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
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Inspector: ✓ D ate: Phone #: (503) 718