Permit (153) gym,
CITY OF TIGARD PLUMBING PERMIT
IIIIIN - COMMUNITY DEVELOPMENT Permit#: PLM2018-00558
T[ AR.D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/13/2018
Parcel: 1S133DD10800
Jurisdiction: Tigard
Site address: 11958 SW 125TH CT
Project: ANDERSON Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 145
Project Description: Water Heater replacement.
Contractor: OWNER Owner: ANDERSON, JESSICA L
JESSICA ANDERSON 11958 SW 125TH CT
11958 SW 125TH CT TIGARD, OR 97223
TIGARD, OR 97223
PHONE: 503-804-3044 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Water Heater 12/13/2018 $37.52
Specifics: 1 12%State Surcharge- 12/13/2018 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment- 12/13/2018 $34.98
Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is no •.tarted within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow tJe I•s adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-009,9(7 You :y obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 • !a a 2.2344. l /
f
Issued By: ..ilifr Permittee Signature: l• /
V W
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures B1C'EIV 1 FOR OFFICE USE ONLY
Received
City of Tigard Permit No.:
gi 13125 SW Hall Blvd.,Tigard,OR 97223 DEC 1. Q 2 o 1 a Date/By: `a,/�,3/),K , J"" "t f17 XII-* 10337'
:III ■ Phone: 503.718.2439 Fax: 503.598.1960 U Paan Review 1 Other Permit No.:
Inspection Line: 503.639.4175 (� r(/�`IIIA y
T 16 ARD Internet: www.tigard-or.gov CITY OF 1, eady/By. Suns H See Page 2 for
� �Iethod: Supplemental Information
TYPE OF WORK I$U1L1)ING FEE* SCHEDULE
El New construction ❑Demolition For special information use checklist
Description 1 Qty. 1 Ea. I Total
®Addition/alteration/replacement El Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CAT GORY OF CONSTRUCTIONSFR(1)bath 312.70
® 1-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building El Multi-family
Each additional bath/kitchen 25.02
El Master builder ❑Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION ' ^` Site utilities:
Job site address: 11958 SW 125th CT Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard OR,97223
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: 1 Project name: Water Heater Replacement Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
125th CT in Tigard-Off of Scholls Ferry RD&SW 130th Ave 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: 1 Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
' tEs ' I TIO3 OF WORK Backwater valve 12.51
R
Clothes washer 25.02
Un-expected Replacement of Broken Water Heater Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER1] TENANT Expansion tank 12.51
Name:Chris&Jessica Anderson Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 11958 SW 125th CT
Garbage disposal 25.02
City/State/ZIP:Tigard OR 97223 Hose bib 25.02
Phone:(503)8043044 Fax:( ) Ice maker 12.51
0 APPLICANT es CONTACT PEEN Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Chris Anderson
Roof drain(commercial) 12.51
Address: 11958 SW125th CT Sink/basin/lavatory 25.02
City/State/ZIP:Tigard OR 97223 Solar units(potable water) 62.54
Phone:(503)8043044 Fax: :( ) Tub/shower/shower pan 12.51
E-mail:cande25@gmail.com Urinal 25.02
, - ' Water closet 25.02
CONTRACTOR
Water heater 1 37.52 37.52
Business name:N/A rC4 Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: Subtotal 37 S
Phone:( ) Fax:( ) Minimum permit fee: $72.50 7 ,5--z)
CCB
CCB Lic.: Plumbing Lic.no.: Plan review (25%of permit fee) --
State surcharge(12%of permit fee) r.-70
Authorized signature: iTOTAL PERMIT FEE I,Jo
Print name:Chris And Date: 12/12/18 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\Permits\PLMU-PernitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11958 SW 125TH CT, TIGARD, OR, 97223 December 14, 2018 at
10:28:05 AM
Record Type: Record ID:
Residential - Plumbing PLM2018-00558
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor