Permit q
CITY OF TIGARD PLUMBING PERMIT
1111 s COMMUNITY DEVELOPMENT
Permit A: PLM2015 00186
13125 SW Hall Blvd.,Tigard OR 97223 503.718,2439
Date Issued: 06/09/2015
TIGARD Parcel: 1S134BD07600
Jurisdiction: Tigard
Site address: 11651 SW PENN CT
Project: BRANDT Subdivision: PENN LAWN ESTATES Lot: 4
Project Description: Installing 50 ft.of water service and(1)hose bib.
Contractor: PIPELINE PLUMBING Owner: BRANDT, GEORGE E&ALISSA J
333 S STATE ST SUITE V-108 11651 SW PENN CT
LAKE OSWEGO, OR 97034 TIGARD, OR 97223
PHONE: 503-624-1906 PHONE:
FAX: 503-624-1926
FEES
Quantity Description Date Amount
50 If Water Service 06/09/2015 $62.54
Specifics: 1 ea Hose Bib 06/09/2015 $25.02
1 12%State Surcharge- 06/09/2015 $10.51
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $98.07
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 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 0 32.2344.
Issued By: Alle. Permittee Signature: , /�
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
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
Site Utilities ��IV FOR OFFICE USE ON 1 1
Received /}
City of Tigard Date/By. /./11 1(g d p Permit No.///1173 0 i 5=0 0(d/
:� w 13125 SW Hall Blvd.,Tigard,OR 9 Plan Review Y` l( �/, OtQ
>: Phone: 503.718.2439 Fax: 503.598.1960 015 Date/By: Other Permit No.:
I I G A R D Inspection Line: 503.639.4175 ``�` - 4 Date Ready/By: Juns 65 See Page 2 for
Internet: www.tigard-or.gov , Notified/Method: ram . Supplemental information
_ TYPE OF WORK ,irK`u csit 501 FEE* SCEIRDIKE
❑New construction ❑ Demolition i W" For special information use checklist
Description 1 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 312.70
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
El Accessory building SFR(3)bath 500.32
❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB'SUE INFORMATION AND LOCATION Site utilities:
Job site address:11651 SW Penn Court Catch basin or area drain 1 8.76
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.: I 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.:50) 50 Page 2 62.54
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Installing new water service and hose bib Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
1. PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Alissa&George brandt
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:11651 SW Penn Court
Garbage disposal 25.02
City/State/ZIP:Tigard OR 97223 Hose bib 1 25.02 25.02
Phone:(503)381-4412 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:Pipeline Plumbing Medical gas(value:$ ) Page 2
Contact name:Sam Hill Primer 12.51
Roof drain(commercial) 12.51
Address:333 S State Street Suite V-108 Sink/basin/lavatory 25.02
City/State/ZIP:Lake Oswego,OR 97034 Solar units(potable water) 62.54
Phone:(503)624-1906 Fax::(503)624-1926 Tub/shower/shower pan 12.51
/ 1 Urinal 25.02
E-mail:sam @pipelineplumbing.net
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:Pipeline Plumbing Water piping/DWV 56.29
Address:333 S State Street Suite V-108 Other: 25.02
City/State/ZIP:Lake Oswego,OR 97034 Subtotal _ 87.56
Phone:(503)624-1906 Fax:(503)624-1926 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.:158260 ' Plumbing Lic.no.:3-510pb
State surcharge(12%of permit fee) 10.51
Authorized signature: TOTAL PERMIT FEE 98.07
Print name:Samantha ill Date:06-04-2015 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:I Building VPennits\PLMU-PennitApp.dor 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
11651 SW PENN CT, TIGARD, OR, 97223
Residential - Plumbing
330 Water service
FAIL
PLM2015-00186
David Young
No access for inspection. No one home 9:44 am. Called contractor on way per message,
am requested.
Violation Summary:
Inspector Contractor