Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2015-00082
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/18/2015
Parcel: 2S103BB05600
Jurisdiction: Tigard
Site address: 12470 SW 124TH AVE
Project: Miner Subdivision: BROOKWAY Lot: 56
Project Description: Replace water heater.
Contractor: KENNEDY PLUMBING Owner: MINER, MARGARET K
13985 SW FARMINGTON RD 12470 SW 124TH AVE
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503-590-8862
HONE: 503-643-5535
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 03/18/2015 $37.52
Specifics: 1 12%State Surcharge- 03/18/2015 $8.70
Plumbing
Type of Use SF 35 ea Minimum Fee Adjustment- 03/18/2015 $34.98
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 questions to O C by calling 503.232.1987 or 1.800.332.2344.
•
Issued By: Permittee Signature: �,,-�
Call 503.639.4175 by 7:00 a.m.for the next available inspection date. lG��/��
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 ApplicaIRECEIVED
Building Fixtures FOR 011.1( I I sl 0v1.1
MAR 18 2015 Received
1111 gi City of Tigard Datemy: 3/47" Permit N>004/1020/5-67170#"...2,
13125 SW Hall Blvd.,Tigard,OR • OF TIGARD
Plan Review
Phone: 503.718.2439 Fax: 505 8I.L 'NG DIVISION Date/By: Other Permit No.:
TI c.n It t) Inspection Line: 503.639.4175 0 Date Ready/By: iu FA See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
-
TYPE OF WORK'i FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist _
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(1)bath 312.70
® I.and 2-family dwelling LI Commercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
ry g ❑ 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: 12470 SW 124th Ave Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97223 Drywell,leach line,or trench drain 18.76
Footing drain(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.:_) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
water heater replacement Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER l 0 TENANT Expansion tank 12.51
Name:Margaret Miner Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 12470 SW 124th P1 Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)590-8862 Fax:( ) Ice maker 12.51
El APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Kennedy Plumbing Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Joel Dirickson
Roof drain(commercial) 12.51
Address: 13985 SW Farmington Rd 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:jdirickson a)kennedyplumbing.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 1 37.52 37.52
Business name:Kennedy Plumbing Water piping/DWV 56.29
Address: 13985 SW Farmington Rd Other: 25.02
City/State/ZIP:Beaverton,OR 97005 Subtotal 37.52
Phone:(503)643-5535 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: . TOTAL PERMIT FEE 81.20
Print name: iL \_`t1 Date:3-17-15 This permit application expires if a permit is not obtained within 180 days
r: ` v n - after it has been accepted as complete.
"Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12470 SW 124TH AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00082
George Heimos
All corrections completed.
Violation Summary:
Inspector Contractor