Permit q CITY OF TIGARD PLUMBING PERMIT
sa COMMUNITY DEVELOPMENT Permit #: PLM2010 -00106
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/06/2010
7I Gr\Rl? Parcel: 2S110DC01000
Jurisdiction: Tigard
Site address: 11180 SW SUMMERFIELD DR 2
Subdivision: SUMMERFIELD APARTMENTS Lot: 0
Project: HSC Real Estate
Project Description: Install clothes washer.
Owner: FEES
SUMMERFIELD ASSOCIATES, LLC Quantity Description Date Amount
BY HSC REAL ESTATE, 1500 SW FIRST AVE
STE 1020 1 ea Clothes Washer 04/06/2010 $25.02
PHONE: 1 12% State Surcharge - 04/06/2010 $8.70
Plumbing
47 ea Minimum Fee Adjustment - 04/06/2010 $47.48
Contractor: Plumbing
DCS PLUMBING
PO BOX 2721
BATTLE GROUND, WA 98604
PHONE:
FAX: 360- 686 -3740
Type of Use: MF
Class of Work: ALT 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 -0100. You may obtain a copy of the rules
or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: /Ro ,/' Q 1 �.../ �LSC Perm ittee Signature: �n n
(Rat Y L
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
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 f n,„ r
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Build uilding Fixtures d ` s It I Fy'+',31,Tr4 �' i�n.wvl omfg.f!`i` p m`4 iz'ti
ing - ,.y ..:�1 0. ' � tt. :-1v4 ndE E ).ltil�.:. ahl: keZ .f .t.. . ;k'iti 11:1,.*,-,'!,,-
. � :1 r. N'Z . INTIN'Y.l��;L
t ul'iad 't. City and APR 0' 6 2010 Of Tigard Received � t Y rL ��� V V �
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Permit No..
13125 SW Hall Blvd., Tigard, OR 97223
I
N Phone: 503.639.4171 Fax: 503.598.1960E (' ' Date/By: Plan Review
Other Permit No.:
g r 's�, Inspection Line: 503.639.4175 1 %' �' �(�i�1k 1®
1 ,/;i: 1 11 I) y Date ReadyBy: Juris lid See Page 2 for
,t +�a uuc iti,, Internet: www.tigard- or.gov F UiLDIN(. DI VISIO Notified/Method: Supplemental Information
TYPE OF WORK • FEE* SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description I Qty. 1 Ea. 1 Total
y l e Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 312.70
0 _1_ and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 437.78
building SFR (3) bath 500.32
❑ Accessory g ❑ Multi- family
Each additional bath/kitchen 25.02
❑ Master builder ❑ Other:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities: _
6 Job site address: /�/ �'� 61,0-i /2 e� ' Catch basin or area drain 18.7
� Drywell, leach line, or trench drain 18.76
City /State /ZIP: i � ov ,A - X , C) -1... 1 44 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: J I Project name:5 m e ( op f, 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
uC DESCRIPTION OF WORK Backwater valve 12.51
/ Clothes washer l 25.02
1.41 et irJe i1` ,0. ^rl i ` v /(79' .- S' `�G ,,,A Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
8 PROPERTY OWNER I ❑ TENANT Expansion tank 12.51
Name: c Fixture /sewer cap 25.02
4:5c 1-Qad t° S�'t f t
Address: / 5c O S � 5+ � o� Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City /State /ZIP: 1 cA . 9 7 2 0 1 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
'a APPLICANT ❑ CONTACT PERSON Interceptor /grease trap 25.02
Medical gas (value: $ ) Page 2
Business name:
� .,,,"�j�h 1 c 4,1 f' Primer 12.51
Contact name: (L . L / / e ( Roof drain (commercial) 12.51
Address: `5 9c G A i r !' (5/ 1` , Li e. Sink/basin/lavatory 25.02
City /State /ZIP: .t f d r 9 P e , J W 9 i 6 4/ 2 Solar units (potable water) 62.54
Phone: (3 6 0 ) S / 2 y " Fax: : (j4 ��-v'c / e 3 �, Tub /shower /shower pan 12.51
( / Urinal 25.02
E -mail: t= N` A h P S A." tae r r; t 6. -.o"1 9 C o 1+
`� CONTRACTOR Water closet 25.02
n C+ /� Water heater 37.52
Business name: ' 5 / a h, E, . ti [;
/� �J Water piping/DWV 56.29
Address: et : 0 J O t k .77 4 1 Other: 25.02
City /State /ZIP: , j }. j/ �r c , ct / J if y)‘t' t/ Subtotal
Phone: ( 36) 85 2 Cry F 4 O Fax: ( ) Minimum permit fee: $72.50
CCB Lic.: / 7 5 8 c q Plumbing Lic. no.: p Plan review (25% of permit fee)
! ` t State surcharge (12% of permit fee)
Authorized signature: ek- TOTAL PERMIT FEE I .20
Print name: Date. // �i This permit application expires if a permit is not obtained within 180 days
l Ct?`A � 4/ '� after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
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