Permit No CITY F T I R D PLUMBING PERMIT
o""s PERMIT #: PLM2007 -00225
COMMUNITY DEVELOPMENT DATE ISSUED: 6/1/2007
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.:94w 13125 SW H Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134CB-01500
SITE ADDRESS: 12220 SW SUMMER ST ZONING: R - 4.5
SUBDIVISION: SUMMER HILLS PARK LOT: 016 JURISDICTION: TIG
PROJECT: CARPENTER
Project Description: Replace 50' of water service.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
CLIFF CARPENTER
12220 SW SUMMER ST Description Date Amount
TIGARD, OR 97224 [PLUMB] Permit Fee 6/1/2007 $72.50
[TAX] 8% State Surcha 6/1/2007 $5.80
Phone : 503- 704 -6441 Total $78.30
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS
Contact # : PRI 643 -5535
Reg #: LIC 10967
PLM 34 -42PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuance, o • is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility ■ •tification Cen - . Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
the • rules or direct questio to 0. • • calling 503.246.6699 or 1.800.332.2344.
1
Iss ed By: / o� ` 6" i� I Permittee Signature: / / �
•
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.
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Plumbing Permit Application FOH OFFICE u SE ONLY:
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,PV .W.:7,1 R eceived '
C o f Ti 6 r Permit No.: 0 7 e6
n 13 125 SW Hall Blvd., Tigard, OR 97223 Date/By: Ow
Plan Review Other Permit No.:
a� Date
/By:
: . ?. Phone: 503.639.4171 Fax: 503.598.1960
Date/By:
ftr= yt D Inspection Line: 503.639.4175 /y El See Page 2 for
AR Date Ready/By: �
T I G flirria+ene�r;; Internet: www.tigard or.gov NotifiediMethod: i & Supplemental Information
. TYPE OF WORK F SCHEDULE • '
❑ New construction ❑ Demolition For special information use checklist.
Description 1 Qty. 1 Ea. 1 Total
❑ Addition /alteration /replacement ❑ Other: New 1- 2- family dwellings (includes 100 R. for each utility connection)
CATEGORY, OF CONSTRUCTION SFR (1) bath 249.20
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
Each additional bath/kitchen 45.00
❑ Master builder ❑ Other: -
Fire sprinkler ( sq. ft.) Page 2
. JOB SITE INFORMATION AND LOCATION Site utilities
Job site address: 12220 SW Summer Street Catch basin or area drain 16.60
City /State /ZIP: Tigard, OR 97224 / Drywell, leach line, or trench drain 16.60
IPg ( 2 Footing drain (no. linear ft.: _) Page 2
Suite /bldg. /apt. no.: ( Project name: ( �J 1 r L f
Manufactured home utilities 110.00
Cross street/directions to job site:
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: _) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: Lot no.: Water service (no. linear ft.: 50) Page 2 55.0
Fixture or item
Tax map /parcel no.: -
Absorption valve 16.60
DESCRIPTION .OF WORK' Backtlow preventer Page 2
Replace water service Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
. ®, PROPERTY OWNER . ' 1 - ❑ TENANT .
Ejectors /sump 16.60
Name: Cliff Carpenter
Expansion tank 16.60
Address: 12220 SW Summer Street Fixture /sewer cap 16.60
City /State /ZIP: Tigard, OR 97224 Floor drain /Floor sink /hub 16.60
Phone: (503)704 -6441 Fax: ( ) Garbage disposal 16.60
® APPLICANT ® CONTACT PERSON Hose bib 16.60
' Ice maker 16.60
Business name: Kennedy Plumbing
Interceptor/grease trap 16.60
Contact name: Roy Pierce Medical gas (value: $ ) Page 2
Address: 13985 SW Farmington Road Primer 16.60
City /State /ZIP: Beaverton, OR 97005 Roof drain (commercial) 16.60
Phone: (503 -) 643 -5535 Fax:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR' ` Water closet 16.60
Business name: Kennedy Plumbing Water heater 16.60
Address: 13985 SW Farmington Road Other:
City /State /ZIP: Beaverton, OR 97005 Subtotal
Minimum permit fee: $72.50
72.50
Phone: (503 -) 643 -5535 Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 10967 \� Plumbing Lic. no.: 34 -42 Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5.80
Authorized signature: ` J' v TOTAL PERMIT FEE 78.30
Print name: Sherry Hess Date: 5 - 31 - 07 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: \Bu!Id ing \Permits \PLiI- Pernit App .doc 06/25/06 440- 4616T( I 0 /02 /COM /WEB)
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00225
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/1/2007
Phone: (503) 639 -4171 1 , , .� ,., 1c i'I( I ' .
Inspection Requests (24 Hrs.): (503) 639 -4175 A —^
INSPECTION WORKSHEET FOR DATE: 6/6/2007 TIME: 7:01AM PAGE: 33
SITE ADDRESS: 12220 SW SUMMER ST CLASS OF WORK:
SUBDIVISION: SUMMER HILL; PARK LOT #: 016 TYPE OF USE:
PROJECT NAME: CARPENTER
DESCRIPTION: Replace 50' of water service.
OWNER: CARPENTER, CLIFF PHONE #: s03- 704 -6441
CONTRACTOR: KENNEDY PLUMBING PHONE #: f 3- 5fJ3E,
Inspection Request Scheduled For: Date: 6/6/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message y)
330 Water service 049713 01 503. 643 -(535 N
Corrections /Comments /Instructions:
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PASS n PARTIAL`APPROVAL CANCEL NO ACCESS
n FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspecto : V Date: c *--/ Phone #: (503) 718