Permit CITY OF TIGARD PLUMBING PERMIT
14 -- " COMMUNITY DEVELOPMENT Permit #: PLM2012 00285
Date Issued: 10/01/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S114BA16000
Jurisdiction: Tigard
Site address: 16205 SW COPPER CREEK DR
Project: Nordgren Subdivision: COPPER CREEK STAGE 4 Lot: 125
Project Description: Replace 40' of water service
Contractor: EXCELLENCE PLUMBING LLC Owner: NORDGREN, WARREN E & DORA D TRS
7520 SW 140TH AVE 16205 SW COOPER CREEK CT
BEAVERTON, OR 97008 TIGARD, OR 97224
PHONE:
PHONE: 503 - 643 -3459
FAX: 503 - 643 -2815
FEES
Quantity Description Date Amount
40 If Water Service 10/01/2012 $62.54
Specifics: 10 ea Minimum Fee Adjustment - 10/01/2012 $9.96
Plumbing
Type of Use: SF 1 12% State Surcharge - 10/01/2012 $8.70
Plumbing
Class of Work: OTR
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 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
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: 0� 19-70,2_, / e� j / 0
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.
09/27/2012 15:08 5036269149 POSTALANNEX PAGE 02/02
Plumbing Permit ApplicatM . . ED
Site Utilities SEP 2 7 201Z Fob; ()Ff•1( : ltii; ON1.\
City of Tigard pl /Qh 42, rie'i pcnnit No/o(ifa20 /� - Doa�.s
III 1312.5 SW Hall Blvd. Tigard, OR 972231 t c� + i K K! LI Plan Review
to Phone: 503,718.2439 Fax: 503.5' :t9dOf 'ir; i'vti!.t 1a Date/By: other Permit No.:
, i y' 671 Sec 1'nt:e all r
inspection Line: 503.639.41'15 Dale Rendy/By;
f
1 i < 1.1 f) int erne www. or.gov Notified/Method: i l7 �pPldncet al lormati nn
...
:
❑ New construction ❑ Demolition For ' oda! r orntndon ace check,
hecklkx
Description aft . Ea Total
® Addition/alteration/replacement ❑ Other: New 1- 2- ramlly dwellings (Includes 1001E for each utility connection)
.;,'•.: • ' ' G' ikiti6abRi''ti1<t - ; �, ; . = $1:R (1) bath 31/70
® l- and 2- family dwelling ❑ Commercial/industrial
SFR (2) bath 437.78
SFR (3) bath 50032
❑ A building ❑ Multi - family Each additional bath/kitchen 25.02
❑ Master builder El Other. Faro sprinkler ( sq. ft.) Page 2
Cate h basin or Inca drain 18.76
Job site address: 16205 SW Copper Creek Dr
_, 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.: Project name: Nordgren Manuflictumd home utilities 50.03
Cross sU et/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no, linear Il.: ,) Page 2
Storm sewer (no. linear ft.: ) Page 2
Water service (no. linear 1L: O0) 1 Page 2 _ 62.54
Subdivision: I Lot no.: Fixture or item:
Tax map/petrel no.: Bacldlow prcvmiter 31.27 `
Backwater valve
b � � b1�1- 0F'"'Va+DRt�= • 25.02
Replace water aervlee ._,. Dishwasher 25.02
Drinking fountain 25.02
Ejcctora/suntp 25.02
;.•:..,
14zinfr60' = <.
1 Itiokr; .. xranslon tank 115 l
Fixture/sewer cap 25.02
Name:
- Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25,02
City/State/ZIP: Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
'{ , ••APPn(Ai _, ' < ❑ -C 04 fl9ON - tntcreeptor /grease MP 25.02
Business name Medical gas (value: $ ) Page 2
Primer 12.51
Contact name: Roof drain (commercial) 12.51
Address: Sink/basin/lavatory 25.02
City /State/ZIP: Solar units (potable water) 62.54
Phone: ( ) I Fax:: ( ) Tub /shower /shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
<; ' 0b C'1 .. ; :.; Water heater
...'. , •
.... .. _ _..... 37.52
Business name: Excellence .Plumbing, L1,C Water piping/DWV 56.29
Address: 8269 SW Cirrus Dr. Otter. 25.02
City /Strue/7_rP: Beaverton, OR - Subtotal
lone: (503) 64.3 -3459 Fax: (503) 643 -2815 Minimum permit fee: $72.50 72.50
CCB Lie.: 175768 Plumbing Lie. no.: P11344 Plan review (25% of permit fee)
A State surcharge (12% of permit fcc) 8.70
Authorized signature: / / . ,t, A TOTAL. PERMIT FEE 81,20 or
Print name: Shelly Eugenio ` / Date: 9 - 2012 This permit eppliratirm aspires if a permit is net ohtnined within 180 days
after it has been accepted as complete.
"Fee methodology set by Tri- C:oimty Building Industry Service Bard.
t\nuildina r,nitmpar- rermhnpp.doe 15 /01 9 Maa6isr(in/Ovcomtwenl