Permit CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit #: PLM2010 -00098
J [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/06/2010
Parcel: 2S110DC01000
Jurisdiction: Tigard
Site address: 11165 SW SUMMERFIELD DR 6
Subdivision: SUMMERFIELD APARTMENTS Lot: 0
Project: Summerfield Apartments
Project Description: Water and drain for stack washer & dryer.
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: 360 - 686 -3730
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 q - ions to O b C by calling 503.246.6699 or 1.800.332.2344.
Issued = : / A, 4 % / / / Permittee Signature: / A
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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 a , T
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r' ";• ^� �',�; Receive
i + City Of Tig Pe rmit No.:
;r, . 0 , 13125 SW Hall Blvd. Tigar OR 9722 APR 0'6 2010 DateBy: y Co io ( /D- OdO1`��
C Phone: 503.639.4171 Fax: 503.598.1960, Plan Review
.r t - .
Dace Read
Date/By:
Permit No.:
Inspection Line: 503.639.4175 .i1 i T (.6, I It B Juris : ® See Page 2 for
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Internet: wwwti g g BUILDING �t �I�I0I l Notified/Method: Supplemental Information •
TYPE OF WORK ' FEE* .SCHEDULE
❑ New construction ❑ Demolition For special information use checklist
Description 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
A l- 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: / . 0 6 �6.i 4 kt gib Catch bas 18.76
Drywell, leach in or area line, dr or t rench drain 18.76
City /State /ZIP: ,,A, G , 1 a y Footing drain (no. linear ft.: _) Page 2
Suite/bldg. /apt. no.:
^ Project name: S' Ltvet rn NlrGte id < p¢. 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
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DESCRIPTION OF WORK . Backwater valve 12.51
/ Clothes washer 1 25.02
/ of /Cie 1 .'!eti;v 4',-- S'ler h/ ,) Dishwasher 25.02
Drinking fountain 25.02
Ejectors /sump 25.02
8 PROPERTY OWNER I ■ TENANT Expansion tank 12.51
P I Fixture /sewer cap 25.02
Name:
45C J l .p e S { Lt t Floor drain/floor sink/hub 25.02
Address: /5 . ui 5+ ot v-�
I ll / ,,QQ Garbage disposal 25.02
City /State /ZIP: 1 `GNc OV . 9 72 0 I Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
+a APPLICANT ❑ CONTACT PERSON .. Interceptor /grease trap 25.02
Business name: S Medical gas (value: $ ) Page 2
" `z C . Primer 12.51
Contact name: /
c ll h Lid KC Roof drain (commercial) 12.51
Address: /5-9O8 A f f / 6' " et v e_ Sink/basin/lavatory 25.02
City/State /ZIP: ., e e r JJ G,, 9i 6 yz Solar units (potable water) 62.54
Phone: (j 6 5 /6, Fax:: ( (.) re_b / 3 O Tub /shower /shower pan 12.51
E -mail: / Urinal 25.02
G `t c ,( c S / / I a/6 r r; / 0,,51 . Co p•wi Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: ,Q c , 5 / / , 6 / ,; .t/ y Water piping/DWV 56.29
Address: P- 0 .do x a 7., i Other: 25.02
City /State /ZIP: 6 e t Ie �h Ou,,, 11, 9dc0 c./ Subtotal
Phone: (3�) : • q P Fax: ( ) Minimum permit fee: $72.50 7 ^ , J�
Plan review (25% of permit fee) -f
CCB Lic.: / ' 5 8 � 0 q )P II Plumbing Lic. no.: 10 $ 2 3 State surcharge (12% of permit fee) Q .7 U
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Authorized signature: ✓� -, 7/, /,1 TOTAL PERMIT FEE ¶ / , '-,v
,, "` JJjj ^^^ / Da te. ( / This permit application expires if a permit is not obtained within 180 days
Print name: ��L
K R. eeu 7J -v 6 -/ t) after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
t:' Building \Permits\PLMU- PermitApp.doc 10/01/09 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities • Qty. 'Fee (ea) Total Square Permit Fee:
Footing drain - 1" 100' 50.03 0 to 2,000 $121.90
Footing drain - each additional 100' 37.52 2,001 to 3,600 $169.69
3,601 to 7,200 $233.20
Sewer - 1st 100' 62.54 7,201 and greater $327.54
Sewer - each additional 100' 37.52
Water Service - 1st 100' 62.54 Medical Gas Systems:
Water Service - each additional 100' 37.52
Storm &Rain Drain - 1st 100' 62.54 Valuation:.' 'Permit Fee: .
$1.00 to $5,000.00 Minimum fee $72.50
Storm & Rain Drain - each additional 100' 37.52 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for
.
Other Inspections or -Fees Qty. Fee (ea) • Total each additional $100.00 or fraction thereof, to
P and including $10,000.00.
Inspection of existing plumbing or for $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
which no fee is specifically indicated 90.00/hr each additional $100.00 or fraction thereof, to
(minimum charge - 1/2 hour) and including $25,000.00.
Inspections outside of normal business 90.00/hr $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
hours (minimum charge - 2 hours) each additional $100.00 or fraction thereof, to
Reinspection Fees 90.00/hr and including $50,000.00.
Additional plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
(minimum charge 1/2 hour) each additional $100.00 or fraction thereof.
Subtotal:
Commercial Fixture Work:
Are you capping, adding or replacing fixtures? If "yes ", Plan Review for Plumbing: Installations
please indicate work performed by fixture. Failure to Plan review is required for any of the following.
accurately report fixtures could result in increased sewer fees *. Please check all that apply.
Quantity by (Fixture) Work Performed ❑ Any new commercial building with water service 2" and
Fixture Type: Replace greater, except systems designed and stamped by licensed
Previous Capped Added Existing engineer.
Baptistry/Font
Bath - Tub /Shower ❑ New exterior plumbing site utilities for any complex structure
as defined in OAR918 780 -0040.
- Jacuzzi/Whirlpool
Car Wash Each Stall ❑ Medical gas and vacuum systems for health care facilities.
Drive Thru ❑ Any multipurpose fire sprinkler system.
Cuspidor/Water Aspirator ❑ Any complex structure as defined in OAR918- 780 -0040.
Dishwasher - Commercial
Domestic Submit 2 sets of plans with any of the above.
Drinking Fountain
Eye Wash • Isometric, or: Riser Diagram .
Floor Drain/sink - 2" ❑ Isometric or riser diagram is required for new buildings
3 that meet the qualifications above.
•
- 4" -
Car Wash Drain
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Garbage - Domestic
Disposal - Commercial
- Industrial Comments regarding fixture work:
Ice Mach. /Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall
Sink - Bar/Lavatory
- Bradley
- Commercial *Note: If the fixture work under this permit results in an
- Service increase of sewer EDUs, a sewer permit will be issued and
Swimming Pool Filter fees assessed for the sewer increase must be paid before the
Washer - Clothes
Water Extractor plumbing permit can be issued.
Water Closet - Toilet
Urinal
Other Fixtures:
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