Permit CITY OF TIGARD PLUMBING PERMIT
Ili 3 • COMMUNITY DEVELOPMENT Ii Permit#: PLM2015-00220
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 V p Date Issued: 07/15/2015
Parcel: 1S133DD02200
Jurisdiction: Tigard
Site address: 12878 SW VILLAGE PARK LN
Project: Bull Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 61
Project Description: Remodel:add(1)washer&(1)lay,relocate(1)toilet,(1)shower&(1)lay. 8/6/2015 REPRINT permit to add(1)
bathtub. ----�---�
Contractor: JERRY LEE BROWN Owner: O'LOUGHLIN, MICHAEL
43578 NW PURDINO RD 12878 SW VILLAGE PARK LN
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503-709-4433 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 07/15/2015 $25.02
Specifics: 2 ea Lavatories 07/15/2015 $50.04
1 ea Tub/Shower/Shower Pan 07/15/2015 $12.51
Type of Use: SF 1 ea Water Closet 07/15/2015 $25.02
Class of Work: ALT 1 12%State Surcharge- 07/15/2015 $13.51
Type of Const: Plumbing
Occupancy Grp: 1 ea Tub/Shower/Shower Pan 08/06/2015 $12.51
Stories: 0 12%State Surcharge- 08/06/2015 $1.50
Plumbing
45 Misc Administration Fee 08/06/2015 $45.00
Total $185.11
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 Noti on e - . Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direc •uestions to OUNk by c. g 503.232.1987 or 1.800.332.2344.
Issued By: ti /°// ,' / Permittee Signature: . t1( i • ,
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.
CITY OF TIGARD PLUMBING PERMIT
14 • COMMUNITY DEVELOPMENT Permit#: PLM2015-00220
T IG AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/15/2015
Parcel: 1 S 133DD02200
Jurisdiction: Tigard
Site address: 12878 SW VILLAGE PARK LN
Project: Bull Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 61
Project Description: Remodel:add(1)washer&(1)lay,relocate(1)toilet,(1)shower&(1)lay.
Contractor: JERRY LEE BROWN Owner: O'LOUGHLIN, MICHAEL
43578 NW PURDINO RD 12878 SW VILLAGE PARK LN
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503-709-4433 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 07/15/2015 $25.02
Specifics: 2 ea Lavatories 07/15/2015 $50.04
1 ea Tub/Shower/Shower Pan 07/15/2015 $12.51
Type of Use: SF 1 ea Water Closet 07/15/2015 $25.02
Class of Work: ALT 1 12%State Surcharge 07/15/2015 $13.51
Type of Const: Plumbing
Occupancy Grp:
Stories:
Total $126.10
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 questi UNC by calling 503.232.1987 or 1.800.332.2344. ,
Issued B Permittee Signature: ><_, -
G
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.
Plumbin Permit A lice '
Building Fixtures CEIVEP
City of Tigard Received e 7 / /S Permit No.: Llyav/S-OU�7-t:,
: 13125 SW Hall Blvd.,Tigard,OR 1 5 7015 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit No.:
t� Date/By:
Inspection Line: 503.639.41750TV OF f 1(Ak1 Date Ready/By: Jam. ® See Page 2 for
I I I.I I;1 Internet: www.ti ardor. ov I OF y g
g g Notified/Method: Supplemental Information
TYPE I ' S1V!` FEE* SCHEDULE
❑New construction ®Demolition For special information use checklist
- Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑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 ❑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:12878 SW Village Park Lane 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.: I Project name: Manufactured home utilities 50.03
Cross street/directions to job site: 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.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02 ,0a.5-4 9'
move toilet,shower,lay,add washer,add lay
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name:Curt and Diana Bull Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 13822 SW 162nd Ter
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97223 Hose bib 25.02
Phone:(503)3139637 Fax:( ) Ice maker 12.51
❑ APPLICANT 1 ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:mark dawson construction llc Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Mark dawson
_ Roof drain(commercial) 12.51
Address:41290 SW sandstrom rd Sink/basin/lavatory 2 25.02 -012 4
City/State/ZIP:gaston,or 97119 Solar units(potable water) 62.54
Phone:(503)805-0814 Fax::( ) Tub/shower/shower pan 1 12.51 /9,..5/
E-mail:sbdawson(att.net
Urinal 25.02
CONTRACTOR Water closet 1 25.02 g sic
Water heater 37.52
Business name:Jerry Brown Plumbing Water piping/DWV 56.29
Address:43578 NW Purdin rd Other: 25.02
City/State/ZIP:Forest Grove,Or 97116 Subtotal -a?rre
Phone:(503)7094433 Fax:( ) Minimum permit fee: $72.50 ,-1
CCB Lic.:150256 Pl Lic.no.:34-405P6 Plan review (25%of permit fee) r 3. 3+.'111^
State surcharge(12%of permit fee) 1.5-A4.
Authorized signature: /1 ' � TOTAL PERMIT FEE 1-M.59-
Print name:Jerry Brown Date:7-11-15 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.
1:\Building\Permits\PLMU-PermitApp.doe I0/01/09 440-4616T(10/02/COM/WEB) 4/91 ' k
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
12878 SW VILLAGE PARK LN, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
FAIL
PLM2015-00220
George Heimos
NOTE Inspected tub drainage and lav final inspections, lavs ok
1. Correct tub hot cold reversed water pipes. 415.0
2. Inspection for toilet, shower and re-inspection for tub faucet to come. 103.5.4
3. Recall inspection when corrections are completed. 103.5.6.1
All else ok
Violation Summary:
Inspector Contractor
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
12878 SW VILLAGE PARK LN, TIGARD, OR,
97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00220
George Heimos
Violation Summary:
Inspector Contractor