Permit CITY OF TIGARD PLUMBING PERMIT
1111 ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00093
TIGA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/25/2015
Parcel: 1 S 136AC00500
Jurisdiction: Tigard
Site address: 10525 SW 71ST AVE
Project: Cooper Subdivision: METZGER ACRE TRACTS Lot: 2
Project Description: Installation of 50'of water service,replacement of water piping&DWV,install new shower and relocate lay&
laundry sump.
Contractor: COUCHLEY PLUMBING Owner: COOPER, M JOHN& NANCY A
8717 N LOMBARD 10525 SW 71ST AVE
PORTLAND,OR 97203 TIGARD,OR 97223
PHONE: 503-286-4431 PHONE: 503-545-9231
FAX:
FEES
Quantity Description Date Amount
50 If Water Service 03/25/2015 $62.54
Specifics: 1 ea Ejectors/Sump 03/25/2015 $25.02
1 ea Lavatories 03/25/2015 $25.02
Type of Use: SF 1 ea Tub/Shower/Shower Pan 03/25/2015 $12.51
Class of Work: OTR 2 ea Water Piping/DWV 03/25/2015 $112.58
Type of Const: 1 12%State Surcharge- 03/25/2015 $28.52
Occupancy Grp: Plumbing
Stories:
Total $266.19
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable law. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of
issuan suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Uti' Notification Center. Thos- ujes are set forth in OAR 952-001-0010 through OAR 952-001-0090. You ay obtain a copy of the rules
o direct questions to OUNC b -fling 503.23 .1987 or 1.800.332.2344.
-sued By: A /O _ ,.1 Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures RECEIVED IOIt 0, , l( l i sI 0\I.1
City of Tigard �Oived 2 n � ■ Permit No.: n^ p
w 13125 SW Hall Blvd.,Tigard,OR 97 s Date/By: d 0��7 /�� UIJ�-�`3
2 5 2015 Plan Review Other Permit No.:
■ Phone: 503.718.2439 Fax: 503.59 :'► Date/By:
TIC A R O Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By: Juis: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
TYPE 0)""y ING DIVISION i FEES SCHEDULE
❑New construction ❑Demolition For special information use checklist.
Description I Qty. j Ea. I Total
�Addi/// ��'
tion/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
Xl-and 2-family dwelling El Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(___sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:/)5Z$ sc.) 71 STA vE Catch basin or area drain ' 18.76
ty P 77 4 1 9??.23 Drywell,leach line,or trench drain 18.76
Ci /State/ZI
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: ,0fj CDC)A Manufactured home utilities 50.03
Cross street/directions to job site: 5t..) cm r__. s Manholes 18.76
W! OM/�S G o"ICE P `p GE sS G2. Rain drain connector 18.76
A140: 1 1 7-: 'S.#11% Lot.);^122..7 Co_s9 Sanitary sewer(no.linear ft.:_) Page 2
L !./-+l • �f so_s9 sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.:5Q) l Page 2 Ga.54
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
(J4Th L UCC, gEP/px V P Ry Ae PJT Dishwasher 25.02
/
g r rthien.) 64 n40-o0/4-1 Cj )0(I N SThLL€/, Drinking fountain 25.02
NEo s' f j (/(7CQ- � �./�(4 L+A.h.i p Ejectors/sump I 25.02 �S.oz
PROPERTY OWNER I ❑ TENANT S • •T Expansion tank 12.51
Name: jQ FAN GOO PE Fixture/sewer cap 25.02
Address:fps 5c) 7/ ST-4v4 Floor drain floor sink/hub 25.02
4 Garbage disposal 25.02
City/State/ZIP:77 412. fCV-F-60 om) G 7223 Hose bib 25.02
Phone: 51/5- Cr 2_3( Fax:( ) N//{ Ice maker 12.51
APPLICANT XCONTACT PERSON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name:Ge0C.Z. ,AL (),461 k.r. . CO, l QC Primer 12.51
Contact name 7 1,, cr y(/J f�.�_
/ Roof drain(commercial) 12.51
Address: g7( f 3 Ao,4/ 4- ST- Sink/basin/lavatory ` 25.02 15.02
City/State/ZIP: 47 t4 Qgf_C.o IJ 47 72-03 Solar units(potable water) 62.54
/
Phone:( 23)5506262._ Fax: :( ) Tub/shower/shower pan t 12.51 12.,5
�ANL1G /E� 7,Qc&V/111.400 I COrl -Urinal 25.02
E-mail::
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name:CO:D( /W? PLUM 6(tjG GU, ( Ai L ater pipin V►' _ 56.29
a.
Address: g7(7 A)s LOtMMei ST Other: 25.02 ++��
City/State/ZIP: pb 1/,/ g /3 -L .7Q3 Subtotal �31.
Phone:$3J -{4f 3( Fax:(�j3)2� 1113 2-. Minimum Permit fee: $72.50
-
CCB Lie.: !/ L( ix/l 7 Plumbing Lic.no.:243,-2(f Plan review (25%of permit fee)
State surcharge(12%of permit fee) 1i52
Authorized signature: ', '' ,�finn / 141 TOTAL PERMIT FEE Z� /G'q
Print name: /f/w�vl` Date:912.4(?jL(Its This permit application expires if a permit is not obtained within 180 days -
( after it has been accepted as compkte.
•Fee methodology set by Tri-County Building Industry Service Board.
1:\Bmldineennits\PLMU-PennitApp.doc 10/01/09 440-4616T(i0/02/coM/WEB)
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10525 SW 71ST AVE, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00093
George Heimos
Electrical grounding pass provided on permit ELC2015-00615
Violation Summary:
Inspector Contractor