Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2020-00516
Date Issued: 12/29/2020
T 1 f;A R.I) 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Parcel: 2S104AB04700
Jurisdiction: Tigard
Site address: 13401 SW BENISH ST
Project: Our Redeemer Lutheran Church Subdivision: None Lot: None
Project Description: 130 ft.of water service.
Contractor: CORNELS PLUMBING INC Owner: OUR REDEEMER LUTHERAN CHURCH
5235 SW 153RD AVE 13401 SW BENISH ST
BEAVERTON, OR 97007 TIGARD, OR 97223
PHONE: 503-317-9659 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 If Water Service 12/29/2020 $62.54
Specifics: 1 12%State Surcharge- 12/29/2020 $8.70
Plumbing
Type of Use: COM 10 ea Minimum Fee Adjustment- 12/29/2020 $9.96
Class of Work: ALT Plumbing
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 not started within 180 days of
issuance, or if work is suspended for • ore the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rul:. tare set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OUNC by calling 'r..232.1987 or 1.800.332.2344.
1
Issued By: / / Permittee Signature: Q1/ 7-74-1
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
Thi,- 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 Annlicati EC E I V E D
Building Fixtures DEC 2 8 2020 1 tlnt to 1111( 1 I ''.11 (1.I 1
City of Tigard Dtere( 20) 2020 :/:;f PenmtNo.:p 20(IJ"OO511.
III 13125 SW Ilan Blvd.,Tigard,OR 9720 VTY OF TI GAR G Plan Roy.p, Other Permit No.:
I Phone: 503.718.2439• Fax: 503.5041 1301-?IRN(a DIVISION Date/By:
Inspection Line: 503.639.4175 Dale Ready/By: fmQd-CAd Ems: 85 See Page 2 for
T l G,11L U Notified/Method: ~rat! Supplemental Information
Internet www.tigerd-or.gov `.� *Ce fqd
TYPE OF WORK. VA-^`''r" f "6*,aEDULE
For special information use checklist
❑New construction ❑Demolition Description I Qty. I Be. I Total
Addition/alteration/replacement 0 Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70437.78
SFR(2)bath
❑ t-and 2-family dwelling fa Commercial/industrial SFR(3)bath $00.32
❑Accessory building 0 Multi-family Each additional bath/kitchen 25.02
❑Master builder ❑Other. Fire sprinkler(_sq.ft.) Page 2
JOB SITEINFORMATION AND LOCATION Site utilities:
Catch basin or area drain 18.76
Job site address: 61691 $W 544ish S71- Drywell,leach line,or trench drain 18.76
City/State/ZIP: Ti.Jprd .o4 Rm.fi Footing drain(no.linear ft.:__) Page 2
Suite/bldg./apt.no.: I Project name:( tedat iec fjlrpn awl Manufactured home utilities 50.03
Cross street/directions to job site:
Manholes 18.76
Rain drain connector 18.7E
Sanitary sewer(no.linear R.:,_) Page 2
Storm sewer(no.linear ft.:_. Page 2
Water service(no.linear ft.:1,l) ) I Page 2 I
Subdivision: Lot no.: Fixture or item:
Backflow pteventer 31.27
Tax map/parcel no.. Backwater valve 12.51
DESCRIPTION OF WORK Clothes washer 25.02
IttcI 4 II f%u.l W v fetnnio ( "i30f+) Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
PROPERTY OWNER ID TENANT
Expansion tank 12.51
Fixture/sewer cap 25.02
Name: Oar R-ockY-ynfti 1.vfarran Otwrr,l. f(.ornt/V1 it Auvtj Floor drain/floor sink/hub 25.02
Address: S E As M Qtn AddYrv,) Garbage disposal 25.02
Hose bib 25.02
City/StatrlZlP: 2.51
Phone:603 ) v02- 705y Fax:( ) 1
Ice maker 12.51
1 APPLICANT [3 CONTACT PERSON Intercept rigrease trap
2
Medical gas(value:$ ) Page 2
Business name: CorrlEI'S r�7 lumlai 05 Primer 12.51
Contact name: Kitom MDYanu Roof drain(contmercial) 12.51
Address: 5216 sV jc grd Atte Sink/basin/lavatory 25.02
City/State/LIP: p Solar units(potable water) 62.54
C48NVLY•IWl i DK- Om7 Tub/shower/shower pan 12.51
Phone:(5p; ) /.�f1lf9 I Fax :( -'f� 25.02
Urinal
E-mail: (prttst(,{@ coatis a(vnibinf.lo1M Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: C(yyptt,1•i- Ply otits t, Water piping/DWV 56.29
Address: Si 19S APPL I CiANT Other: 25.02
Subtotal
City/State/ZIP: Minimum permit fee' $72.50
Phone:( ) Fax:( ) tl Plan review (25%of permit fee)
CCBLiC:: ZZ(a jog Plumbing Lic.no.: 31.mPB State surcharge(12%of permit fee)
Authorized signature: "A ito TOTAL PERMIT FEE 31.2-0
r I 7 This permit application expires if a permit is not obtained within 180 days
Print name:MURd /��/,c4:OYi Date:12/Z3/�( 0 after it has bees accepted as complete.
✓ f *Fee methodology set by Tri•Cnunty Building industry Service Board.
I:NBuiaiainPamitstPLMU-PamilApp.doe 10/01/09 4464616T(10/02/COMIWPa)