Permit ,•
CITY OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00244
TI,GARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/14/2007
PARCEL: 2S 103AC -00600
SITE ADDRESS: 11221 SW FONNER ST ZONING: R -4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: EMME
Project Description: Replace 300' 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: 300 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
EMME, LARRY M -
11221 SW FONNER ST Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 6/14/2007 $147.80
[TAX] 8% State Surcha 6/14/2007 $11.82
Phone : Total $159.62
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, 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 rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332 2344.
I'
Issued By: J /, . /At, "` 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 Applicatio r I � _ ' F ORiQFF10 E USEONLY .
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wi� #'" Clt Oaard ive
, y f Tl Tigard JUN 1 4 l U / Rece Date /By t0 /I /UT S Permit No. Pu u5p4- — W Z •
C 't 13125 SW Hall Blvd , Tigard, OR 97223 Plan Review
•, ,a e ; Phone 503 639 4171 Fax 503 598 1 I'Y VOF TIGARD Date /By Other Permit No
-ii A Inspection Line 503.639 4175 BUILDING DIVISION Date Read /B Ju Is Page B Ready /By ®S ee Pa e 2 for
,t,,., r I;ir: --,.. a�_ Internet: www tigard - gov 3� ®IV Notified /Method . 116 — Supplemental Information
T OF WORK - , '- , . , , , ° :< FEE* S ,
❑ New consti uction ❑ Demolition For special information use checklist.
Description I Qty. Ea I Total
® Addition /alteration /replacement ❑ Other: New 1-2-family dwellings (includes 100 ft for each utility connection)
'CATEGORY -OF CONSTRUCTION SFR (1) bath 249.20
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350 00
111 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
lob site address: 11221 SW Former St 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. Pr o3ect name Footing drain (no linear ft. _) Page 2
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 300) 55 Page 2 148
Fixture or item
Tax map /parcel no •
Absorption valve 16 60
' DESCRIPTION OF WORK , Backflow preventer Page 2
Replace water servcie Backwatei valve 16 60
Clothes washer 16 60
Dishwasher 16 60
Di inking fountain 16 60
® PROPERTY OWNER'. ' - ' ,❑ TENANTz,' - . '
' °' - Electors /sump 16 60
Name' Larry Emme
Expansion tank 16 60
Adcliess same Fixture /sewer cap 16 60
City /State /ZIP Floor drain /floor sink/hub 16.60
Phone (503 )639 -3506 Fax: ( ) Garbage disposal 16 60
® APPL_ ICANT ;. , Hose bib 16 GO
❑ .CONTACT PERSON,
Ice maker 16 60
Business name: Kennedy Plumbing
Interceptor /grease fiap 16 60
Contact name: Roy Pierce Medical gas (value $ ) Page 2
Address 13985 SW Farmington Rd Primer 16 60
City /State /ZIP: Beaverton Or. 97005 Roof drain (commercial) 16 60
Phone. (503 -) 643 -5535 Fax. • (503 ) 643 -3335 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 1 3985 SW Farmington rd Other
City /State /ZIP Beraverton Or 97005
Subtotal 148
Minimum permit fee $72 50
Phone. (503 -) 643 -5535 x: ( ) Residential backflow minimum permit fee. $36 25 ill, $b
t
CCB L1c • 10967 P imbing Lic. no 34 -42 -PB Plan review (25% of permit fee)
State surcharge (8% of permit fee) i I .�$.
Authorized signature.
TOTAL PERMIT FEE 159
Print name ^ 0Gt� Date- C9 .–/7--(,) 7 This permit application expires if a permit is not obtained within
180 days after it has been accepted as complete.
*Fee methodology set by Tn - County Building Industry Service Board
I \Budding \Pei nuts \I'LM-Pet nutApp doe 06/26/06 440 -4616 r(10 /02 /COM / \VEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007- 00244
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/14/2007
Phone: (503) 639-4171 i ti ��
Inspection Requests (24 Hrs.): (503) 639 -4175 '.
INSPECTION WORKSHEET FOR DATE: 6/15/2007 TIME: 7:02AM PAGE: 75
SITE ADDRESS: 11221 SW FONNER ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: EMME
DESCRIPTION: Replace 300' of water service.
OWNER: ENMME, LARRY M, PHONE #:
CONTRACTOR: KENNEDY PLUMBING PHONE #: 643-5535
Inspection Request Scheduled For: Date: 6/15/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 050283-01 503.643 -5535 itil
Corrections/Comments/Instructions
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►! SS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL WALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: P Date: A Phone #: (503) 718- •