Permit (26) CITY OF TIGARD PLUMBING PERMIT
.
COMMUNITY DEVELOPMENT Permit#: PLM2017-00101
T f Ga AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/27/2017
Parcel: 2S103BB01800
Jurisdiction: Tigard
Site address: 12475 SW BROOK CT
Project: KEOUGH Subdivision: BROOKWAY Lot: 18
Project Description: Replacing water piping throughout house.
Contractor: PATRIOT PLUMBING AND MECHANICAL INC Owner: KEOUGH, DOUGLAS J AND MARSHA D
PO BOX 18668 12475 SW BROOK CT
SALEM, OR 97305 TIGARD, OR 97223
PHONE: 503-302-4387 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Piping/DWV 03/27/2017 $56.29
Specifics: 1 12%State Surcharge- 03/27/2017 $8.70
Plumbing
Type of Use: SF 16 ea Minimum Fee Adjustment- 03/27/2017 $16.21
Class of Work: ALT Plumbing
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: L1� ittae.Signature: obt.e.e...)&
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
Building Fixtures ,
City of Tigardi i;, Received -7 r
` Y= �/ 7 Permit No.: L7`"i7,-..01.Q
RI 13125 SW Hall Blvd.,Tigard,OR 97223 . = ` '.A' Dates 'ti// f. t i
I Phone: 503.718.2439 Fax: 503.598.1960 " '-` r tan Review
asy: Other Permit No.:
Ti C,\R D Inspection Line: 503.639.4175 �, Y ta�LeadyBy. loris: H See Page 2 for
Internet: www.tigard-or.gov (s' , Notified/Method: 72 Supplemental Information
TYPE OF WORK °) ? g,•1" _ FEE* SCHEDULE
0 New construction 0 Demolition For special information use checklist
Description Qty. I Ea Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling ❑Commercial/mdustrial SFR(2)bath 437.78
❑Accesso buildi SFR(3)bath 500.32
rY ng ❑Multi-family
o Master builderEach additiot._:i bath/kitchen 25.02
0 Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:12475 SW Brook Ct 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.: I Project name:Keough Residence Re-pipe Manufactured home utilities
50.03
Cross street/directions to job site:SW 124th Ave 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
Residential Re-pipe Clothes washer 25.02
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
0 PROPERTY OWNER I 0 TENANT Expansion tank
12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP: Hose bib
25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name:Patriot Plumbing and Mechanical,Inc. Medical gas(value:$ ) Page 2
Contact name:Lori Pile Primer 12.51
Roof drain(commercial) 12.51
Address:P.O.Box 18668
Sink/basin/lavatory 25.02
City/State/ZIP:Salem,OR 97305 Solar units(potable water) 62.54
Phone:(503)812.8404 Fax::( ) Tub/shower/shower pan 12.51
E-mail:I.pile@patriotpandm.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Patriot Plumbing and Mechanical,Inc.
Water piping/DWV 56.29 45.Z, el
Address:P.O.Box 18668 Other: 25.02
City/State/ZIP:Salem,OR 97305 Subtotal
Phone:(503)812.8404 Fax:( ) Minimum permit fee: $72.50 72.5t)
CCB Lic.:205069 IVO Plumbi Lic.no.:PB1553 ;7/, /1 Plan review (25%of permit fee)
����� State surcharge(12%of permit fee) .r, "-
Authorized signature: TOTAL PERMIT FEES�I,
Print name:David A.Pile Date:3/21/17 This permit application expires if a permit is not obtained wit in 180 days
after it has been accepted as complete.
*Fee methodoloev set by Tri-County Buildine Industry Service Board.
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12475 SW BROOK CT, TIGARD, OR, 97223
Record Type: Record ID:
Residential - Plumbing PLM2017-00101
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Corrections are complete, plumbing final -approved.
2. Note: protect water line located on out side of bldg. for irrigation system from freezing.
Violation Summary:
Inspector Contractor