Permit PLUMBING PERMIT
" s: y CITY OF TIGARD
COMMUNITY DEVELOPMENT Permit#: PLM2o1500377
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/10/2015
Parcel: 2S103BA00111
Jurisdiction: Tigard
Site address: 12005 SW ANN ST
Project: Pugh Subdivision: LERON HEIGHTS Lot: 11 &PT
Project Description: Replace tile shower.
Contractor: KENNEDY PLUMBING Owner: PUGH, THOMAS
13985 SW FARMINGTON RD 12005 SW ANN STREET
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503-643-5535 PHONE: 503-459-2592
FAX:
FEES
•
Quantity Description Date Amount
1 ea Tub/Shower/Shower Pan 11/10/2015 $12.51
Specifics: 1 12%State Surcharge- 11/10/2015 $8.70
Plumbing
Type of Use SF 60 ea Minimum Fee Adjustment- 11/10/2015 $59.99
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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 4 Permittee Signature:
g17—'
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 ApplicIECEIVEP
Building Fixtures toff OFI R I I til 0\I.1
City of Tigard
NOV 1 U 2015 Received ,i.�1�
Iii . - 1312y SW Hall Blvd.,Tigard,O �j t u Date/By. r 01.1 ' I/ / Permit Nge94/1(20/5!DO977
Phone: 503.718.2439 Fax: to . I I(,ARI) Plan Review
Date/By: Other Permit No.:
Inspection Line: 5(13.639.4 It
iT I G A R D �� ILDING DIVISION Date Read /B o Juris ® See Page e 2 for
Internet: www.ti and-or. o Notified/Method
Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. I Ea. I Total
M Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
M l-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building SFR(3)bath 500.32
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: 12005 SW Ann St. 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: 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
Replace tile shower
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
M PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Tom Pugh
Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 12005 SW Ann St.
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)459-2592 Fax:( ) Ice maker 12.51
M 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 1 12.51 12.51
E-mail:jdirickson(a)kennedyplumbing.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Kennedy Plumbing Water piping/DWV 56.29
Address: 13985 SW Farmington Rd. Other: 25.02
City/State/ZIP:Beqaverton,OR 97005 Subtotal 12.51
Phone:(503)643-5535 Fax:( ) Minimum permit fee: $72.50 72.50
CCB Lie.: 10967 Plumbing Lie.no.:34-42PB Plan review (25%of permit fee)
State surcharge(12%of permit fee) 8.70
Authorized signature: :■ �-_________ TOTAL PERMIT FEE 81.20
Print name:Joel Dirickson Jl Date. 11-10-15 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'PL -PermitApp.doe 10/01/09 440-4616T(10/02/COM/WEB)
Location:
Record Type:
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Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
12005 SW ANN ST, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
December 4, 2015 at 9:46:57
AM
PLM2015-00377
Don Sylvester
Violation Summary:
Inspector Contractor