Permit (206) CITY OF TIGARD PLUMBING PERMIT
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COMMUNITY DEVELOPMENT Permit#: PLM2018-00355
T f G A R o 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/19/2018
Parcel: 1 S 133AD 11200
Jurisdiction: Tigard
Site address: 10682 SW 127TH CT
Project: LYMAN Subdivision: AMART SUMMER LAKE NO.3 Lot: 168
Project Description: Replacing(1)tub valve,(1)shower valve,and the shower pan.
Contractor: KENNEDY PLUMBING Owner: LYMAN, KRISTIN S
13985 SW FARMINGTON RD 10682 SW 127TH CT
BEAVERTON, OR 97005 TIGARD, OR 97223
PHONE: 503-643-5535 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Tub/Shower/Shower Pan 07/19/2018 $25.02
Specifics: 1 12%State Surcharge- 07/19/2018 $8.70
Plumbing
47 ea Minimum Fee Adjustment- 07/19/2018 $47.48
Type of Use: SF Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Yo may obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.8001=144_ Ia
Issued By: ` rmittee Signature: 411.2.�-
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completioV f the project.
Approved plans are required on the job site at the time of each inspec, •n.
Plumbing Permit Application RECEIVED
Building Fixtures (� FOR OFFICE USE ONLY
City of Tigard lJ.. 1 " 2018 Received Permit No.: .p���,
II
13125 SW Hall Blvd.,Tigard,OR 97223 y�/ { g� Date/By: 7���l /�L ��C +J S"
Ill Phone: 503.718.2439 Fax: 503.598.190 L Of !!GAl� Ian Review
ate/By: Other Permit No.:
Inspection Line: 503.639.4175 Juris: See Page 2 forTIGARD ii,DENDVISrbReady/By
Internet: www.ti and-or. ov tified/Method: o Supplemental
Information
a PE OF WO'W . ... ! P,, ' ...,.. 4: gIILI
❑New construction ❑Demolition For special information use checklist
Description Qty. I Ea. Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
,,--,,,,,,,,„-,-,,,,-,„,,,,,,Z, , ,,. .,,,„,,,,,, SFR(1)bat
h 312 70a` AvlffItCI ... . r
11 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑ Master builder ❑Other:
Fire sprinkler( sq.ft.) Page 2
JOB STE 11ii$•4iJON I Tt Site utilities:
Job site address:10682 SW 127th Court 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
, Backwater valve B 1 12.51
,..,, Clothes washer 25.02
Replace tub valve,replace shower valve and shower pan Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
R t d o t t3#Mpray 34 'TEN i T ;: ; � N Expansion tank 12.51
Fixture/sewer cap 25.02
Name:Kristin Lyman
Floor drain/floor sink/hub 25.02
Address: 10682 SW 127th Court
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:( )503-701-6987 Fax:( ) Ice maker 12.51
g .._'eA*.. :; :S� " ❑'CONTACT•P„RSU 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 2 12.51 25.02
E-mail: Urinal 25.02
i • ,, Water closet 25.02� vwo� Or � ,
'. , , �� �. .,, , . �, .,,, ,,, ,,,., :
Water heater 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
Phone:( )503-643-5535 Fax:( ) Minimum permit fee: $72.50 72.50
Plan review (25%of permit fee)
CCB Lie.:10967 Plumbing Lie.no.:34-42PB
State surcharge(12%of permit fee) 8.70
Authorized signature: ---*' TOTAL PERMIT FEE 81.20
Print name:Joel Dirickson Date:7/18/18 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.doe 10/01/09 440-4616T(10/02/COM/WEB)