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CITY OF TIGARD PLUMBING PERMIT
11111
11, COMMUNITY DEVELOPMENT Permit #: PLM2009-00041
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/26/2009
Parcel: 2s102ca00205
Jurisdiction: TIG
Site address: 13285 SW ASH DR
Subdivision: Lot:
Project: BURGESS
Project Description: Replace 60' of water service.
Owner: FEES
SHELLY BURGESS Quantity Description Date Amount
13265 SW ASH DR
TIGARD, OR 97223 1 [PLUMB] Permit Fee 02/26/2009 $72.50
1 [TAX] 12% State 02/26/2009 $8.70
PHONE: 503 - 643 -5535 Surcharge
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005
PHONE: 503 - 643 -5535
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp: R3
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 -0100. You may obtain a copy of the rules
or direct quest' s to OUNC by calling 503.246.6699 or 1.800.332.2344.
pr % ir tat)
Issued By: , ,,f.ch-l_s2,..1 RR. ` . 1Q. vV`4 Permittee Signature: C ? R _ , pp `a 1 n
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Call 503.639.4175 by 7:00 a.m. for an inspection that business day. ( C � ` `�
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.
v CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2009 -00041
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/26/2009
13 PARCEL: 2S 102CA -00207
SITE ADDRESS: 43-263 SW ASH DR ZONING: R -4.5
SUBDIVISION: VIEWCREST TERRACE LOT: 005 JURISDICTION: TIG
PROJECT: BURGESS
Project Description: Replace 60' of water service.
CLASS OF WORK: ALT 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: 60 It
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SHELLY BURGESS
13265 SW ASH DR Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 2/26/2009 $72.50
[TAX] 12% State Surch 2/26/2009 $8.70
Phone : 503- 643 -5535 Total $81.20
Contractor:
KENNEDY PLUMBING
13985 SW FARMINGTON RD
BEAVERTON, OR 97005 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503 - 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, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rule e _ - questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issu; d By: _ ;� � �/4/ Permittee Signature:
% y` •
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 •
Building Fixtures t , , , FORS , •OFFICE USE ONLY
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is '" City of Ti Date /By: O` kg 6 Permit No.: , `� / /i.�/! �
I tt = a 1 3125 SW Hall Blvd., Tigard, OR 97223
Plan Review
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Phone: 503.639.4171 Fax: 503.598.1960 Other Permit No.:
T t :1"2: Ready /By: n Page Inspection Date Rea /B ection Line: 503.639.4175 Date /By: ni i S Pa e 2 for
• .t,:.4. , Internet: www.tigat'd or.gov Notified /Method eet Supplemental Information
T YPE OF WORK FEE *'.SCHEDULE'
Ell New construction ❑ Demolition For special information use checklist.
Description I Qty. Ea. Total
❑ Addition /alteration /replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
• - - CATEG,ORY.•OF CONSTRUCTION', - „. SFR (1) bath 249.20
® I - 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 .
28x Site utilities •
Job site address: SW Ash Drive Catch basin or area drain 16.60
City /State /ZIP: Tigard, OR 97223 Drywell, leach line, or trench drain 16.60
Suite bldg. /apt. no.: Project name: Footing drain (no. linear ft.: _) Page 2
Manufactured borne 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. lincat ft.: 60 Page 2
Fixture or item
Tax map /parcel no.:
. Absorption valve 16.60
- '. DESCRIPTION OF WORK."'„ ' ' BackFlow preventer Page 2
Replace water service Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
®PROPERTY OWNER , . ❑ TENANT r Drinking fountain 16.60
Ejectors /sump 16.60
Name: Shelly Burgess
Expansion tank . 16.60
Address: 13265 SW Ash Drive Fixture /sewer cap 16.60
City /State /ZIP: Tigard, OR 97223 Floor drain /floor sink /hub 16.60
•
Phone: (503)624 -6126 Fax: ( ) Garbage disposal 16.60
® APPLICANT ' Hose bib 16.60
'
❑ CONTACT PERSON
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: Same Water heater 16.60
Address: Other:
City /State /ZIP: Subtotal 72.50
Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: 10967 Plumbing Lie. no.: 34 -42PB Plan review (25% of permit fee)
State surcharge (12% of permit tee) 8.70
Authorized signature: I �y� �
V1Jlc 1, TOTAL PERMIT FEE 81.20 k
Print name: Sherry Hess Date: 2 -25 -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.
1 ABudding \ Permits \PLMF -Pei mitApp doe 1 2/27/06 440- 4616T( l 0 /02 /COM /AVEB)
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City of Tigard, Oregon- _ ,,,,Page 1 of 2
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City of Tigard, Oregon
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Property Owner Info
Tax ID Number:
Tax Account Number:
Site Address:
Site City:
Site ZIP:
Owner Address:
Owner City:
Owner State:
Owner ZIP:
Acres:
Sq Ft:
Bldg SF:
Bldg Value:
Land Value:
Total Value:
Taxable Ass'd Value:
Sale Price:
Sale Date:
Year Built:
District & Community Info
Municipality:
Tigard Urban Sery Bndry:
Tigard Neighborhoods:
L Name Link to Website
Area 6 Ared 5 Neighborhood News
School Attendance Areas:
L School District Name District Number Elemental
TIGARD - TUALATIN 23J Templeton
Tigard Parks District:
Water Service Area:
Garbage Hauler:
L Hauler Residential Residential Hauler Commei
Name Hauler Phone Hauler
Pride Pride Disposal (503) 625 -6177 Pride Dis
Disposal
Precinct:
L Precinct
406
Phone Service Areas:
http: / /www.tigardmaps.co... 3/9/2009