Permit CITY OF TIGARD PLUMBING PERMIT
s gl Permit #: PLM2011 -00325
2 , - COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718 2439 Date Issued: 11/01/2011
Parcel: 2S 111 AB09000
Jurisdiction: Tigard
Site address: 9365 SW VIEW TER
Project: Irwin Subdivision: PENROSE TERRACE Lot: 35
Project Description: Replacement of less than 100' of water service Electrical permit may be required if replacement piping effects
house grounding
Contractor: KENNEDY PLUMBING Owner: IRWIN, LOURDES C
13985 SW FARMINGTON RD 9365 SW VIEW TERRACE
BEAVERTON, OR 97005 TIGARD, OR 97224
PHONE: 503 - 643 -5535
PHONE 541 - 941 -7218
FAX:
FEES
Quantity Description Date Amount
100 If Water Service 11/01/2011 $62 54
Specifics: 1 12% State Surcharge - 11/01/2011 $8 70
Plumbing
10 ea Minimum Fee Adjustment - 11/01/2011 $9.96
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090 You may obtain a copy of the rules
or direct q ions to C by call i s 503.232.1987 or 1 800 332 2344. e
I,
Issued y: _ i e Permittee Signature:
_-/ Call 503.639.4175 by 7:00 a.m. for the next ay. ..le inspection date.
This permit card shall be kept in a conspicuous place on a job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
4
Plumbing Permit Applica�tion� rk I
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Building Fixtures m FORsOFFI .USE 4 ONLY ° = "':
2011 ,. ,,..,_. . . c..:: fa ,.,. ?� .� to > K . � --__ . . ,.
t'r r �` City Of Tigard 1\1 \I 0 Eew � Pernut No /// `/ ( ] 3125 S W Hall Bd ,Tigard, OR 97223 2 r: Phone. 503 718 2439 Fax 50399�0 I G t D
1 r t ` Date /By Other Permit No :
Line 503 639.4175 . 1 ,,, Date Ready/By: lures See Page 2 for
TIGARD Inspection Line 1 it�i �$Vilt'�I�9
Internet. www tigard - gov �Ajl �t� Notified/Method Supplemental Information
- i!,::,:;1 ,
TYPE OF sWORKu -`` : - ' ; ` .4, ,FEE * `fSCHEDULE` - , . , , .
M New construction ❑ Demolition For special information use checklist.
Description Qty. Ea I Total
El Addition /alteration /replacement ❑ Other New 1 - 2 - family dwellings (includes 100 ft for each utility connection)
'” CATE004:) -• ;; 4 � :. ; „ ° c'` SFR (1) bath 312.70
- - � ,. 4 . seam
l I- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437 78
building SFR (3) bath 500.32
0 Accessory g ❑ Multi- faintly
Each additional bath/kitchen 25 02
9 . Master builder ❑ Other: Fire sprinkler ( sq. ft) Page 2
' y , JOB -SITE INFORMATION AND, LOCATION r ° " t Site utilities:
Job site address• 9365 SW View Terrace Catch baste or area dram 18 76
Drywell, leach line, or trench dram 18.76
City /State /ZIP: Tigard, OR 97224
Footing dram (no linear ft _) Page 2
Suite/bldg /apt no • 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 ft.: _) Page 2
Water service (no linear ft • MO) Page 2 62 54
Subdivision: Lot no.: Fixture or item:
'ax map /parcel no.. Backflow preventer 31 27
^ ^s i, >•' 4 ;, ",, . ,. ,. e. - , 4 - ,, , , i,:s 11i<: i:; -° Backwater valve 12.51
__t`�W � ',, z -, ; ' , 'F D ES CR IPT[ON , °.'WORK_rii. R, „:,.„,,,,,i - , -, , ';+°
4
�� ” Clothes washer 25.02
Re place water service Dishwasher 25.02
Drinking fountain 25.02
4.! Ejectors /sump 25.02 --
..... r" P . .. i "i e �K,:S " '�; =''` t r. ;,td .._ - ; ;5 , . x
. ,, ., ® E, ' . —•, - -, i X j : , -i—v - ,.t.°• ` °,IF : "`�, ^ '' J, 11_ IENAN'P , � r, °14° .p =iii Expansion tank 12 51 P
Name Lourdes Irwin
Fixture /sewer cap 25.02
Floor drain /floor sink /hub 25.02
Address: 9365 SW View Terrace Garbage disposal 25 02
City /State /ZiP• Tigard, OR 97224 Hose bib 25 02
Phone (541)941 - 7218 Fax: ( ) Ice maker 12 51
`° .„ .'° ®'e'APPLTCANTs. 1 v; ° -''." ° .:u;''`® C PERSON°:', '" Interceptor /grease trap •25 02
Business name: Kennedy Plumbing Medical gas (value $ ) a Page 2
Primer 12.51
Contact name: Joel/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
:Plione: (503 - 643 - 5535 Fax: : ( ) Tub /shower /shower pan 12 51
Email: Urinal 25.02
y r '
; �'' r '• :, v - , ' : ; r , .. . . , t .. ,. —: - 5 ,�, .,, ;" " ;; :r, ''';;;',:::,:r.; Water closet 25 02
;
'„ ; r ° , ": m r' TRAG TO '44.+.,a ;,3; „' '' „ 'C• : .
'; : . a ” . °° Water heater 37.52
Business name: Same Water piptng/DWV 56.29 .
:Address: Other 25 02 _,
City/State /ZiP: Subtotal
Phone: ( ) / 2 Fax: ( ) Minimum permit fee: $72 50 . 72 50
CCB Lic.: 10967 e L✓ Plumbing Lie. no.: 34 - 42PB Plan review (25% of permit fee)
74 / , V State surcharge (12% of permit fee) 8.70
; Authorized signature. (1 / < ( TOTAL PERMIT FEE 81 20
4 Tl 3t R _A t'ry 11 J .
Thi permit application expires it a permit is not obtained within 180 days
Print name: Sherry Hess Date: 9 -20 -2011 after it has been accepted as complete.
*Fee methodology set by Tn- County Building Industry Service Board
. 1 \Building \Permits \PLMU- PeimitApp doc 10/01/09 440- 46I6T(10 /02 /COM /WEB)