Permit CITY OF TIGARD PLUMBING PERMIT
.74
0 COMMUNITY DEVELOPMENT Permit #: PLM2010 00363
T I G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2010
Parcel: 2S110DC00700
Jurisdiction: Tigard
Site address: 11205 SW SUMMERFIELD DR
Subdivision: Lot: 0
Project: Summerfield
Project Description: Backflow replacement.
Owner: FEES
TIGARD RETIREMENT RESIDENCE LLC Quantity Description Date Amount
600 UNIVERSITY ST STE 2215
SEATTLE, WA 98101 1 ea Backflow Preventer 11/04/2010 $31.27
PHONE: 1 12% State Surcharge - 11/04/2010 $8.70
Plumbing
41 ea Minimum Fee Adjustment - 11/04/2010 $41.23
Contractor: Plumbing
JET FIRE PROTECTION LLC
1935 SILVERTON RD NE
SALEM, OR 97301
PHONE: 503 - 588 -5262
FAX: 503 - 364 -2204
Type of Use: COM
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 503.246.669* : 10.332.2344.
.....0.„....„,‘ ...iiiniiiiiHmik c
Issued By: -^ Pesmittee_Signature:
5 )ii.,
all 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.
FROM (WED)NOV 3 2010 11 : 07 /ST. 11 : /No. 7600000673 P 1
Plumbing Permit ApplicilEc E i v
Site Utilities CC 1 (m (l111( I. 1 ...1 (0.1 1
City Tigard NOV 3 2010 il : a Permit No.: , Id_ .
SW
13125 SW Hall Blvd_, Tigard, OR 97223 Plan Review
.51,1 Phone: 503.639.4171 Fax: 5 iur TIGARD D /gy; Other Pencil No.:
II Inspection Line: 503.639.4175 Date Ready/By: Jura: 8 See Page 2 for
Internet: www.tigard -or.gov BUILDING DIVISION Notified/Method: Sapptementalinfonaation
❑ New construction ❑ Demolition For spedaf ill ormatton use checklist
Description 1 Qty. 1 Ea 1 Total
® Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
'
CATEGORY ' -OF c -. ucrioi*T _` ':; °:s SFR (1) bath 312.70
❑ I and 2- family dwelling Conunerciallndustrial 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
"' , Site utilities:
JOB ; SI!' E�; iNF. E) RMATIOItI ;ATIb ":•
Job site address: 11205 Summerfleld Drive Catch basin or area drain 18.76
Drywell, leach line, or trench drain 18.76
City/State/ZIP: Tigard, OR 97224 Footing drain (no. linear ft.: ) Page 2
Suite/bldg. /apt. no.: 1 Project name: Summed eld DDCVA Manufactured home utilities 50.03
Cross street/directions to job site: Durham Manholes 18.76
Rain drain connector 18.76
Sanitary sewer (no. linear 11.: Page 2
Storm sewer (no. linear ft.: ___.) Page 2
Water service (no. linear ft.: ) Page2
Subdivision: 1 Lot no.: Fixture or Item:
Tax map/paroel no.: Backflow prevcnter 1 31.27 31.27
Backwater valve 12.51
SCR.
'1Diii4iiikr
.. .......... .. , . ... ,., :.:. - .. _ .._ ... .... ... .._ ... Clothes washer 25.02
Replace Double Check Valve Assembly that is not functional and replace with new D i sll wasller
25.02
device. This work is in a vault outside the property. Drinking fountain 25.02
Ejectors/sump 25.02
; :: •: ; s® Expansion tank 1251
". �;•® fl'ROPE�Caf OW�iF.R � 'IENA 1V_T
Name: Sunshine Retirement, LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 550 NW Franklin Avenue
Garbage disposal 25.02
City / State/ZIP: Bend, OR 97701 Hose bib 25.02
Phone: ( ) Fax: ( ) Ice maker 12.51
I'7ICANT
. : AP'• Interceptor/grease or use
Business name: Jet Fire Protection. LLC Medical gas (value: $ , ) Page 2
Primer 12.51
Contact name: Tom Marshall Roof drain (commercial) 12.51
Address: 1935 Silverton Road, NE Sink/basin/lavatory 25.02
City/State/ZIP: Salem, OR 97301 Solar units (potable water) 62.54
Phone: (503) 588.5262 1 Fax: : (503) 364.2204 Tub/shower /shower pan 12.51
E -mail: tom.m@jetindustries.net Urinal 25.02
Water closes 25.02
CONTBACPOR
Water heater 37.52
Business name: Jet Fire Protection, LLC Water piping/DWV 56.29
Address: 1935 Silverton Road, NE Other: , 25.02
City / State/Z1P: Salem, OR 97301 Subtotal 31.27
Phone: (503) 588.5262 Fax: (503) 364.2204 Minimum permit fee: 572.50 7 ✓° 0
CCB Lic.: 162252 Plumbing Lic. no.: .24 4/0 9 /04R, Plan review (25% of permit fee)
State surcharge (12% of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEE 51 7. )t)
Print name: T Marshall Date: 11.03.2010 This permit ap expires if a permit is not obtained within i of days
after it has been accepted as complete.
*Fee methodology set by Tn-County Building Industry Service Board.
I.. Building \Pamils\PLMU•PermitApp.doc 10 440.4616T(I W07/COMM/ED)