Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2013 -00203
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/25/2013
Parcel: 1S135CA02100
Jurisdiction: Tigard
Site address: 11375 SW 95TH AVE
Project: Coleman Subdivision::HERS ADDITION TO GREENBURG HE Lot: 1
Project Description: Install 50' of water service.
Contractor: WESTERN PLUMBING Owner: COLEMAN, MATTHEW JAMES
9460 SW TIGARD AVE SUITE 101 11375 SW 95TH AVE
TIGARD, OR 97223 TIGARD, OR 97223
PHONE: 503 -639 -5296 PHONE:
FAX: 503 -684 -9015
FEES
Quantity Description Date Amount
50 If Water Service 06/25/2013 $62.54
Specifics: 1 12% State Surcharge - 06/25/2013 $8.70
Plumbing
Type of Use: SF 10 ea Minimum Fee Adjustment - 06/25/2013 $9.96
Class of Work: OTR
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 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.
v Issued By: Perrnittee Signature:
Call 603.639.4175 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.
06/24/2013 10:50 50368490 WESTERN PLUMBING INC PAGE 01/02
• - act 1�
Piumb Pe rmit Apuhcah _
Building Fixtures JUN 2 4 2013 F OR OFFICE USE ONLY
City of Tigard CITY OF TIGARD s le . _ Na p vyao/3 2o3
+i 13125 SW IIal1 Elvd., Tigard, OR :* Rh" a IIVG DIVISI ®PI Plea lfeview
Phony 503.639.4171 Pax; 503. ` . ' • i Other Permit No.:
T I GA .It D Inspection Line: 503.639.4175 Dan I... ' See Page 2 roc
Internet: www.tigard - - Notified/Method: ( SupPle Iniormafion
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❑ New d:onstluaion [,] Demolition ' Fay dal irq�ormiadon arse e�teddiaR
ent 0 Oth. New Description . Zf Qty. ( Fa [ Total
4 Addition/alteration/
r�eplacenn New 1- 2- •1'arni(y dwellings (includes 100 R, for each utility connection)
.' '\ '1'i '; 3Jf ,,',,;:' ',;.'t ; ', SFR(1) 312.70
1` 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 437.78
a SPR (3) bath 500.32
Q Accessory building 171 Multi famil.Y
Each additional bath/kitchen 25.02
❑ Master builder ❑ mar: Firs sprinkler ( sq. R•) Page 2
' ''' �, !' , ; iiii i `•f� Ivl ?i ,' 'tt3,± ;'l�? ` ' ' • . " s utilities= J .
Job site address: 11 5 &,, J �`� 11 Plf4x.., Catch basin or area drain 12.76
City/StateJZIP.� � (��`� � leach line, °r trench d� t E.76
�" Footing drain (no. linear R: _) Page 2
Suite/bldg. /apt, no.: Project name: G .�r r�m) kv51(;W,1`l \L` 9 . Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
.. Sanitary sewer (no. linear 1t.: Page 2
Storm sower (no. linear ft.: _•.) Page 2 q !�ol��
Water service (no. linear R.:; 'b) t Page 21 �45` (t
Subdivialiea: Lot no.: Fixture or item:
Tux map/parcel no.;
mac'" l 31.27
n q' _ Backwater valve 12.51
�" Clothes washer 25.02
\\C\ -\10,_ (1 4� Dislrwaahcx 25.02
\1 �}.")J \ 1 i X ti V i( \Ke Drinking fountain 25.02
' Ejeotors/suatp 25.02
qi*l _ C jE�t4 - _' , ./ , ' _ Expansion tank 12.51
Name Fixture/sewer e/sewer cap 7.5.02
Floor drain/floor sink/hub 25.02
Address: Garbage disposal 25.02
City /State/ZIP: hose bib 25.02
Phone: ( ) Pax ( ) Ice maker 12.51
. ''-', � 1rd ,,•, l�l p
�. ( '' ! -' . , haerce aura 25.02
Business neater „ Medical gas (value; $ ) Page 2
Primer 12.51
Contact name: Roof drain (conimero►al)
12.51
Address: Sink/basin/lavatory 25.02
City /State/ZIP: ' Solar units (potable water) T 62.54
Phone: ( ) [ Fax : ( ) Tub/shower /shower pan 12.51
E -mail: Urinal 25.02
Any ;A :1,:•',` " °Y+i :A:�;k.;it ,; ,ya,4`j 0 '�y;1�� .r � .,. ' fl.,'-_P - ',j•. t . Water closet 25.02
,;,4 4 1 . . , y % 5 ;1- 7�D$ 4.•:rv' ] n i . . , . . , N , V ' S J i i l % v ; � . . ; , i( ? � 4 F C. )., ;': ` c -1. •'.,. " , - , WeterbeaSet' 37.52
Business name: Western Phuubing. Inc. Water piping/DW V 56_29
Address: 9460 SW Tigard Avenue Suite 101 other: 25.02
City/State/ZIP: Tigard, OR97223 subtotal IKYd i,{
e: (503) 639-5296 Fan (503)68490x5 B permit fee: 572.50 VF-.00
CCB Lic_ 2439 Plumbing Lac. no.: 34 -29PB Play review (25% of permit fee) State ; AO 1., Authorized signature: P ./' :49A of ccyy,, , 11 , T TAL PERMIT FEE q O% .go
Print name: Dana Jensen �-{/ J D l `I` 13 This penult snow-mitt/1 e=ntree it a permit is not obtained within 180 days
after st has been accepted as complete.
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