Permit ' CITY OF TIGARD PLUMBING PERMIT •
a.
COMMUNITY DEVELOPMENT Permit #: PLM2009-00334
T I GARS) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/20/2009
Parcel: 2S112CB09500
Jurisdiction: Tigard
Site address: 15254 SW KENTON DR
Subdivision: Lot: 0
Project: Thomas
Project Description: Replace water heater
Owner: FEES
THOMAS, ERIC D & DENISE E Quantity Description Date Amount
15254 SW KENTON DR
TIGARD, OR 97224 1 ea Water Heater 11120/2009 $37.52
PHONE: 1 12% State Surcharge - 11/20/2009 $8.70
Plumbing
35 ea Minimum Fee Adjustment - 11/20/2009 $34.98
Contractor: Plumbing
OWNER
PHONE:
FAX:
Type of Use: SF
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
issuan • ..rk is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
U ' Notification - -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain a copy of the rules
.r direct questions to 0 C by calling 503.246.6699 or 1.800.332.2344.
Issued By: /' X/elike Permittee Signature: ( c
•
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 f`(g C oloo - 005
Building Fixtures FOR OFFICE USE ()NIA
City of Tigard R eceived /� & p � / Permit No.: �/a 7 -�33
71 a 13125 SW Hall Blvd. Tigard, OR 97223 Plan Re :
: C Phone: 503.639.4171 Fax: 503.598.1960 Plan Review Other Permit No.:
Inspection Line: 503.639.4175 Date
Ins Ready/By: 1 Ci A It n P� Date ReadyBy: lun-- ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: j Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 1 Qty. i Ea. 1 Total
® 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
I - and 2- family dwelling ❑ Comercial/mdustrial 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 SITE INFORMATION AND LOCATION Site utilities:
Job site address: 15254 SW Kenton Dr. Catch basin or area drain 18.76
City/State/ZIP: Tigard, OR 97224 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 J
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 water heater
Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
►:1 PROPERTY OWNER ( ❑ TENANT Expansion tank 12.51
Name: Eric Thomas Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 15254 SW Kenton Dr
Garbage disposal 25.02
City/State/ZIP: Tigard, OR 97224 Hose bib 25.02
Phone: (503)639 -5381 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Business name: Medical gas (value: $ ) Page 2
Primer 12.51
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Contact name: same
Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City / State/ZIP: Solar units (potable water) 62.54
Phone: ( ) Fax: : ( ) Tub /shower /shower pan 12.51
E -mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater / 37.52 £ 7,531
3
Business name: owner Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal
Phone: ( ) Fax: ( ) Minimum permit fee: $72.50 7,91 50
CCB Lic.: Plumbing Lic. no.: Plan review (25% of permit fee) �' -
State surcharge (12% of permit fee) .7 0
Authorized signature: (- gyK, TOTAL PERMIT FEE r , X
Print name: Eric Thomas Date: 11 - 20 - 09 ' 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 \Pennits\PLMU- PcnnitApp.doc 10 /01 /09 440 - 4616x(10 /O2ICOM/WEB)