Permit CITY OF TIGARD PLUMBING PERMIT
` :' COMMUNITY DEVELOPMENT Permit#: PLM2021-00359
T€GA R)_7 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 8/26/2021
Parcel: 2S 110 DC01000
Jurisdiction: Tigard
Site address: 11175 SW MEADOWBROOK DR
Project: Summerfield Apartments Subdivision: WILLOW-BROOK-FARM Lot: 17
Project Description: Replace building shut off valve.
Contractor: ANYTIME PLUMBING& DRAIN CLEANING Owner: SUMMERFIELD ASSOCIATES LLC
PO BOX 495 BY GREYSTAR RS NW LLC
LAKE OSWEGO, OR 97034 1125 NHW COUCH ST STE 450
PORTLAND, OR 97209
PHONE: 503-894-8241 PHONE:
FAX: 971-255-1965
FEES
Quantity Description Date Amount
25 Misc Other Fee 08/26/2021 $25.02
Specifics: 1 12%State Surcharge- 08/26/2021 $8.70
Plumbing
Type of Use: MF 47 ea Minimum Fee Adjustment- 08/26/2021 $47.48
Class of Work: ALT 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
L �
Issued By.;.,(1, r + 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 Appl cati ECE'v ED
Building Fixtures 9FOR OFFICE USE ONLY
City of Tigard AUG 1 S 2021 Received
Date/By: O S L Z. I 410 PermitNop1,.120 it -003S1
■ 13125 SW Hall Blvd.,Tigard,OR 9722,311Ty 0 TIGARD Plan Review
Phone: 503,7182439 Fax: 503.598. f�l'.Qc10N AataBy: Other Permit No.:
T1GARD Inspection Line: 503.639.4175 BU�L��NC. Daze Ready/By: Z�/,Zy /2 lwis: ® See Page2for
Internet: www.ttgard-or.gov Notified/Metbod. / / "� L Supplemental Information
6 _� 'L, f
`�"� ak'� 1� -- �`; TYPE OF WORK C f , S(-r t,,.�"7 FEE* SCHEDULE
0 New construction ❑Demolition For special information use checklist
Description I Qty. I En. I Total
:A Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(I)bath 312.70
z t D 1-and 2-family dwelling [ICommerctallindusirial SFR(2)bath 437.78
SFR(3)bath • 500.32
❑Accessory building It]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: i i 1-1 5 S - o w 600K. L�FZ Catch basin or area drain 18.76
Drywety i , n t- 1l V i Footing
t,leach line,or trench drain 18.76
City/State/ZIP: 1 V Footing drain(no.linear ft.: ) Page 2
Suite/bldgapt.no.: ,i i i'S Project name: Svti`Yirn ir-() 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 servile(no.linear ft.: ) Page 2
Subdivision: Lot no.: Fixture or item:
Tax map/parcel no.: Backflow preventer 31.27
Backwater valve 12.51
Jj��r � ' DESCRIPTION OF WiO�R,,KI y �/ `/ washerClothes 25.02 i
a 1' y y N 4 93 Li)f s iT fA! 1' r Y �C Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: C(Awl r(1 e-�_i i eta) Fixture/sewer cap 25.02
v s� in, /� �n Floor drain/floor sink/hub 25.02
Address: I i VI'� _SINfli k71 )O Pi P>at)Lt/ be-. Garbage disposal 25.02
. City/State/Z1P: 'f j i e r 0 i2- Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT. ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name: n 1�ji I p�t i o/Ne Medical gas(value:$^) Page 2
1 primer 12.51
Contact name: A S(.ttc.--t r/l i Lti-7 -'" Roof drain(commercial) 12.51
Address: T V "(bo�Y rLi+a S Sink/basin/lavatory 25.02
City/State/ZIP: La-i OsiYf�0 •
.. 0 i- ph, Solar units(potable water) 62.54
Phone:(' %)p$'Qi 4_ g i.,f i (��yy •
Faax�::(� ) Tublshower/showerpan 12.51
25.02
E-mail:&c IL']rkA1/1; finii.p! i1 fi z_ S Urinal
t °JS ""i s'i t Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: k iV 9 •i i me e i'I iW& Water piping/DWV 56.29
r
Address: 0 16OX ( i s r Other: d 25.02 Zs,d7
City/State/ZIP: LAVIF. DSO(Hip, 02 11O3°- Subtotal ys,py
Phone:(5 ) g a 4 • t ,4 f '/•' Fax( ) Minimum permit fee: $72.50 'I.c')
i A i Z fl _I g iA 4 e iz Plan review (25%of permit fee)
CCB Lic.: [� Plumbing Lic.no.: "2 r✓
This permit application
surcharge(12°10 of permit fee) $�1 D
Authorized signature: l /'� TOTAL PERMIT FEE g J. dip
Date: silot ation expires if a permit is not obtained within 180 days
Print name: aSL �� �. after it bat been accepted as complete.
'Fee methodology set by Tri-County Building Industry Service Board.
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