Permit CITY OF TIGARD PLUMBING PERMIT.11111 ' COMMUNITY DEVELOPMENT Permit#: PLM2017-00169
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/09/2017
T[ � g Parcel: 2S103CB01500
Jurisdiction: Tigard
Site address: 12340 SW JAMES ST
Project: Rosson Subdivision: WILLAMETTE NO.2 Lot: 40
Project Description: Natural gas water heater replacement.
Contractor: OWNER Owner: ROSSON, CHASE
CHASE ROSSON 12340 SW JAMES ST
12340 SW JAMES ST TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 916-871-8890 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 05/09/2017 $37.52
Specifics: 1 12%State Surcharge- 05/09/2017 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment- 05/09/2017 $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 7u may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1_8.011332.2344.
Issued By: 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
Building Fixtures RECEIVED FOR OFFICE USE ONLY
City of Tigard RECEIVED Received /
t1 -p Date/By: 2/ �J�7 #7,7_, Permit No.: // �[�" r
a 13125 SW Hall Blvd.,Tigard,OR7� 8 2,11 I rYi
Phone: 503.718.2439 Fax: 503. 960 Plan Review
R Date/By: Other Permit No.:M 0i 7-6041.
Inspection Line: 503 639 4175 ��ARV / -�1�
TI GA RD g g ����/d O� Date Ready/By Juns El See Page 2 for
Internet: www tt and or ov 1 v
9,' i "/ Notified/Method: Supplemental Info
..... :-... _.: t th:, * pl r ons
e up Information
Kt ��D
❑New construction ❑Demolition For special information use checklist
Description Qty. Ea. Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
cf EG R o TR b SFR(1)bath 312.70
k...14;?-4E:2',..
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
❑Master builder Each additional bath/kitchen 25.02
❑Other
Fire sprinkler( sq.ft.) Page 2
y _ , ......: ,fi OB O. • :SIO A LOC O I Site utilities:
Job site address:12340 SW James St Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97223
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name:Water Heater Replacement 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
: : : , 1 E CRB Q1kI 1 .9 1 `* Backwater valve 12.51
s ..... i..:.:... ... ,. ,.,_ten F,4.7.,%, 11::::.1,30 _ Clothes washer 25.02
Replace existing 40 gallon natural gas water heater with new unit
Dishwasher 25.02
A.O.Smith model G12-FDT404ONV Drinking fountain 25.02
Self install Ejectors/sump 25.02
... `}� FRO t x , S ' Ex ansion tank
,._, sF ,...: W .., ..., Alm P 12.51
Name:Chase Rosson Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 12340 SW James St
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(916)871-8890 Fax:( ) Ice maker 12.51
Interce tor/ ease tra
. " �.... ..”, .._►®* �4 �* o [I GOCT'� OW �'' P gr P 25.02
Business name: Medical gas(value:$ ) Page 2
Contact name:Chase Rosson
Primer 12.51
Roof drain(commercial) 12.51
Address:12340 SW James St Sink/basin/lavatory 25.02
City/State/ZIP:Tigard,OR 97223 Solar units(potable water) 62.54
Phone:(916)871-8890 Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
... vto . ...:.. .,..., ONT .CTQR ..' r *:. Water heater 1 37.52 37.52
Business name: 0Gt-/3 / Y WaterP�i in
P g/DWV 56.29
Address: Other:
25.02
City/State/ZIP: Subtotal 37.52
Phone:( ) Fax:( ) Minimum permit fee: $72.50 .2.I
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) ,�g.�-
State surcharge(12%of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 81.20
Print name: , (,A.q5 0550✓ Date:s/Q'' 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\PLMU-PermitApp doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
12340 SW JAMES ST, TIGARD, OR, 97223 June 27, 2017 at 8:29:25 AM
Record Type: Record ID:
Residential - Plumbing PLM2017-00169
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Replace water heater. Approved
Violation Summary:
Inspector Contractor