Permit CITY OF TIGARD PLUMBING PERMIT
1111111 COMMUNITY DEVELOPMENT Permit #: PLM2012 -00051
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/07/2012
Parcel: 2S115AD05600
Jurisdiction: Tigard
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Site address: 10650 SW RIVER DR
Project: CONKLIN Subdivision: DOVER LANDING Lot: 39
Project Description: Replacing 60 ft. of water service. Electrical permit may be required if replacement piping affects house grounding.
Contractor: KENNEDY PLUMBING Owner: CONKLIN, RICHARD & JANICE
13985 SW FARMINGTON RD LIVING TRUST
BEAVERTON, OR 97005 BY RICHARD P /JANICE C CONKLIN TR
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3145 NW 100TH AVE
PORTLAND, OR 97225
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PHONE: 503 - 643 -5535 PHONE:
FAX:
• FEES
Quantity Description Date Amount
60 If Water Service 03/07/2012 $62.54
Specifics: 1 12% State Surcharge - 03/07/2012 $8.70
. Plumbing
Type of Use SF 10 ea Minimum Fee Adjustment - 03/07/2012 $9.96
Class of Work: ALT . Plumbing
Type of Const:
Occupancy Grp:
Stories:
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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
issuar ork is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
• ity Notification -r. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0090. You may obtain a copy of the rules
.r direct questions to OU by - g 51 .232.1987 or 1.800.332.2344.
sued By: • 490 / Permittee Signature: �t
Call 503.639.4175 by 7:00 a.m. for the next available • = section date.
This permit card shall be kept in a conspicuous place on the j.. ite until completion of the project.
Approved plans are required on the job site • e time of each inspection.
Plumbing Permit Application . 0 ). 4 c)
Site Utilities C,f)
� FOR OFFICE USE ONLY
City of Tigard R eceiveed -7 permit No.: nn
511 • . q 131 SW Hall Blvd., Tigard, OR 7223 QA Date/ By: 3 /� (?..77- ` "Uhp id_ - 3 -(
Phone: 503.718.2439 Fax: 503.598.1 ,c, .. ∎Q p to n Review 1eW Other Permit No.:
T 1 G A R D Inspection Line: 503.639.4175 Q� Date Ready/By: Juris: Vi See Page 2 for
Internet: www.tigard or.gov ` Notified/Method: WM.- Supplemental Information
TYPE OF WORK „kW .4i)% FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. 1 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
® 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 SITE INFORMATION AND LOCATION Site utilities:
Job site address: 10650 SW River Dr. Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City /State /ZIP: Tigard, OR 97224
Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.: I Project name: c‘zAII.(, 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.: 60) I Page 2 62.54
Subdivision: I Lot no.: Fixture or item:
Tax map /parcel no.: Back flow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
replace water service Dishwasher 25.02
. Drinking fountain 25.02
Ejectors /sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: Janice & Richard Conklin Fixture /sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 3145 SW 100 Ave
Garbage disposal 25.02
City /State /ZIP: Portland, OR 97229 Hose bib 25.02
Phone: (503)292 -6375 Fax: ( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON 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 I Fax: : (503 -) 643 -3335 Tub /shower /shower pan 12.51
E -mail: jdirickson @kennedyplumbing.com Urinal 25.02
Water closet 25.02
CONTRACTOR
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: (503) 643 -3335 Minimum permit fee: $72.50 72.50
CCB Lic.: 10967 Plumbing Lic. no.: 34 -42PB Plan review (25° of permit fee)
State surcharge (12/0 of permit fee) 8.70
Authorized signature: f � TOTAL PERMIT FEE 81.20
Print name: Joel D ir i ckson I Date: 3 -7 -12 a fter it has been a
This permit ap expires if a permit is not obtained within 180 days
accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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