Permit J
CITY OF TIGARD PLUMBING PERMIT
1
s COMMUNITY DEVELOPMENT Permit#: PLM2021-00505
Date Issued: 12/15/2021
T I G A R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S 1106D00100
Jurisdiction: Tigard
I
Site address: 11511 SW BULL MOUNTAIN RD
Project: St.James Episcopal Church Subdivision: None Lot: None
Project Description: Replacing 80 ft of water line and installing(1)water heater.
Contractor: COUFFLEY HOME SERVICES Owner: ST JAMES EPISCOPAL CHURCH
15331 32ND AVE SE 11511 SW BULL MOUNTAIN RD
MILL CREEK,WA 98012 TIGARD, OR 97224
PHONE: 856-465-5390 PHONE:
FAX:
FEES
Quantity Description Date Amount
80 If Water Service 12/15/2021 $62.54
Specifics: 1 ea Water Heater 12/15/2021 $37.52
1 12%State Surcharge- 12/15/2021 $12.01
Type of Use: COM Plumbing
Class of Work: ALT
Type of Const:
Occupancy Grp:
Stories:
Total $112.07
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 952-001-0090. You may obtain a copy of the rules
Issued By: Permittee Signature:
Ho-GLAJ Va.w De,Wege, Ow A
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.
RECEIVED
Plumbing Permit Application 110
Building Fixtures NOV 3 21321 FOR OFFICE USE ONLY
City of Tigard11111 CITYOF TIGARD Received �,� il Ii
• 13125 SW Hall Blvd.,Tigard,OR 97 3LDING DIVISION Dan/B : 1vatt U�/`�(/ �
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit No:
TIGARD Inspection Line: 503.639.4175 Date Ready/By. ® See Page 2 for
Internet: www.tigard-or.gov No' ed/Method: i Z /' .( Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Q . j Ea. 1 Total
A
14 Addition/alteration/replacement 0 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 0 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: 1 151,t 5\13 ��1 ` off\- I.-� t"1 d Catch basin or area drain 18.76
\ 1� De well,leach line,or trench drain 18.76
City/State/ZIP:-1-"," ar 1.., Q I
J Cl 17 7
-�-' Footing drain(no.linear fr.: ) Page 2
Suite/bldg./apt.no.: Project name: Si: l/J 1!rs Manufactured home utilities 50.03
Cross street/directions to job site: fr/ u / e4c(l1 t/ 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.:QO) , Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
e t P 1t�c� cdC) c1c k►��Qxk O'(- �}� Dishwasher 25.02
`\ nt, a\ , J`e: \\ b f,` Cj Drinking fountain 25.02
' ,�-�pr `^ems-{c� J Ejectors/sump 25.02
\a PROPERTY OWNER 0 TENANTE Expansion tank 12.51
Nance. l - F�, C� .tom ` ( In 1/� Fixture/sewer cap 25.02
tG 'C k", � ► Floor drain/floor sink/hub 25.02
Address: 115 t, Sw V6 0.k Movva .i i i F-.,C_.
Q Garbage disposal 25.02
City/State/ZIP:'" ` a t\ + O� 122_ 4 Hose bib 25.02
Phone:tjs t(jL -7 c 4(.0 Fax:( ) Ice maker 12.51
0 APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
C I (�` Medical gas(value:$ ) Page 2
Business name: � J
cloti.t,_, l k Primer 12.51
Contact name: tI Roof drain(commercial) 12.51
Address: �()Sox- ' B4 Sink/basin/lavatory 25.02
City/State/ZIP: t <j Sii,ne--- dI. 91021 Solar units(potable water) 62.54
Phone:6o3) (053... 30 t Fax::(5b3) G25^3 "531 a Tub/shower/shower pan 12.51
E-mail: � snrr ll Urinal 25.02
CONTRACTOR Water closet 25.02
c Water heater ` 37.52
Business name: JQ ci_S WoO\l Q' Water piping/DWV 56.29
Address: Other: 25.02
City/State/ZIP: - - Subtotal
Minimum permit fee: $72.50
Phone:( ) Fax:( )
CCB Lic. 2_31 I2A Plumbing Lic.no.:T MJ� Plan review (25%of permit fee)
Vki.c ` j State surcharge(12%of permit fee)
Authorized signa ire: TOTAL PERMIT FEE
Print name: Date: i, AIThis permit application expires if a permit is not obtained within 180 days
1 after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
L\Building\Permits\PLMU-Permit App.doc 10/01/09 440-4616T(t0/02/COM/WEB)
Julie Drinkwater
From: #Building Permit Technicians
Sent: Wednesday, December 15, 2021 11:18 AM
To: permits@mrrooterportland.com
Subject: PLM2021-00505, 11511 SW Bull Mountain, St.James Episcopal Church
Attachments: I nvoice.pdf
Hello Heather
The permit for the St.James Episcopal Church is ready to be issued.The balance due is$112.07. Attached please find the
invoice for your review.
The fees can be paid online at https://aca-prod.accela.com/TIGARD/Welcome.aspx by searching for the permit record
number under the Building tab. There is a service fee of 3%for payments by card, and there no service fee for payments
made by e-check. On the payment screen, select the payment method from the dropdown list next to the 'payment'
field.
Please email the permit technicians at TgardBuildingPermits@tgard-or.gov once the fees are paid so that they can
issue the permit and make it available for pick up.
Thank you
Julie Drinkwater
Permit Technician
City of Tigard I Building Department
13125 SW Hall Blvd
Tigard, OR 97223
503-718-2804
Due to an increased demand for services, please expect longer wait times for responses to emails,voice messages and building
inspections. Requests for permit status may not be responded to until the permit is ready to issue. Other requests deemed non-
essential,such as fee estimates, may take longer to respond. In the meantime, please view this quick guide on how to submit
common service requests.
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