Permit a CITY OF TI GARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00106
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 3/16/2007
//NS PARCEL: 2S110DC -01000
SITE ADDRESS: —1-10 SW MEADOWBROOK DR 5 ZONING: R -25
SUBDIVISION: WILLOW BROOK FARM LOT: 014 JURISDICTION: TIG
PROJECT: SUMMERFIELD APTS
Project Description: Washer install.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SFA WASHING MACH: 1 BACKFLOW PREVNTRS:
OCCUPANCY GRP: R1 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
.LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: ft
WATER CLOSETS: WATER LINE: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
SUMMERFIELD ASSOCIATES, LLC Description Date Amount
BY SUMMET REAL ESTATE MANAGEME
5320 SW MACADAM AVE [PLUMB] Permit Fee 3/16/2007 $72.50
PORTLAND, OR 97201 [TAX] 8% State Surcha 3/16/2007 $5.80
Phone : Total $78.30
Contractor:
RAY'S PLUMBING
15200 NE CAPLES SUITE C
BRUSH PRAIRIE, WA 98606 REQUIRED ITEMS AND REPORTS
Contact # : PRI 360- 892 -8700
FAX 360 - 892 -9644
Reg #: LIC 33217
PLM 37 -149PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other
applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of
these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: 4314.—at � Permittee Signature
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.
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Plumbing Permit Applicatio FOIL OFFICE 1:51: o L1
City of T' and 11 �a i 2U ° "� i` ss •� Q
: . 503.598.1960 .
� 13125 SW Hall Blvd., Tigard, OR199223- �e/By. 7 07 AY Permit N Z'�� -o ) Ji
Phone: 503.6394171 Fax: 5035981960 �;� d , ; N D By. a Other Permit No.:
Inspection Line: 503.639.4175. 1 ` 'iL ''. 4'1' ;r � p Readym AIM: ® See Page 2 for
- r I G A Ii l) Internet: www.ti d-0r. ob " Y
g 7. Notified Supplemental Information
TYPE OF W ORK FEE* SCHEDULE
❑ New construction 0 Demolition For special information use checklist
Description I 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 249.20
❑ I- and 2-family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building Multi - family SFR (3) bath 399.00
❑ Master builder Each additional bath /kitchen 45.00
❑� Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION
J /� Site utilities
Job site address: / j n /S' S IA) /e).e u d ew Aro u 44, Catch basin or area drain 16.60
City /State/ZIP: r s ia r 0 97 .? , 3 Dr ywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Ac a Project name: S Lt. M lin tit ( /o+ Footing drain (no. linear ft.: _) Page 2
Manufactured home utilities 110.00
Cross street/dire job site: Manholes 16.60
14, A 0.t-. Rain drain connector 16.60
Sanitary sewer (no. linear R: __) Page 2
Storm sewer (no. linear ft.: _J Page 2
Subdivision: wit a ea t4r C/ 0 4 '/ r s ,, ' I Lot no.: Water service (no. linear ft.: ) Page 2
Tax map/parcel no.: / Fixture or item
Absorption valve 16.60
DESCRIPTION OF WORK
Back flow preventer Paget
[J p 4 P It /`r✓ 5 far f Backwater valve 16.60
Clothes washer t 16.60
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT
Drinking fountain 16.60
/ Ejectors/sump 16.60
Name: �+ ln� rbt 212 �, a 10 a S C
J N- Expansion tank 16.60
Address: S3 2 0 51.9 /0 G L a► ry As, at} e , Fixture/sewer cap . 16.60
City/State/ZIP: por' 1 I oo Tao + Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
,a APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: S k Dr a � S • Interceptor /grease trap 16.60
Contact name: A `« is it RN Medical gas (value: $ ) Page 2
Address: / 9A Air /0 Q i i A Primer 16.60
City/StaterilP: ,c'e• t 6 F 4" r /f w ' . 9PC V L Roof drain (commercial) 16.60
J Sink/basin/lavatory 16.60
Phone: (3 60 546 / 6 2 5 I Fax: : ( )
Tub/shower /shower pan 16.60
E-mail:
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: Baas /0 /0 N R i NS Water heater 16.60
Address: ./5 0 o A9 g_ G f /) / 4. s Pt d, Stw.fit C- other:
/ Subtotal
City /State/ZIP: 6ir ,,s Pte1t: r c , W
I � ' qtl p fo o b
Minimum permit fee: $72.50
Phone:
6o) at 4 a A) 7 p o Fax: ( ) Residential backflow minimum permit fee: $36.25
CCB Lic.: -33r7 Plumbing Lic. no.: 31 iget pA Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: TOTAL PERMIT FEE 2X�
I Print name: 4\ S 4 Q UN I Date:3 -ism) This permit application expires if a permit is not obtained within
180 days after it has been' accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
NBwId'mg\Pam its \PLM- PamitApp.doc 0626/06 4404616T(I0S02/COMIW®)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site Utilities Qty. Fee (ea) - Total Square Footage: Permit Fee:
Footing drain - 1 ° 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' 55.00 Medical Gas Systems:
Water Service - each additional 100' 46.40 • Valuation: Permit Fee:
Storm &Rain Drain - 100' 55.00 $1.00 to $5,000.00 Minimum foe $72.50
Storm & Rain Drain - each additional 100' 46.40 $5,001.00 to $10,000.00 $72.50 for the first $5,000.00 and $1.52 for each
Fixture or Item Qty. Fee (ea) Total additional $100.00 or fraction thereof to and
including $10,000.00.
Commercial Back Flow Prevention Device 46.40 $10,001.00 to $25,000.00 $148.50 for the first $10,000.00 and $1.54 for
Residential Badcflow Prevention Device each additional $100.00 or fraction thereof to
(minimum permit fee $36.25) 27.55 and including $25,000.00.
Rain Drain, single family dwelling 65.25 $25,001.00 to $50,000.00 $379.50 for the first $25,000.00 and $1.45 for
each additional $100.00 or fraction thereof to
Inspection of existing plumbing or and including $50,000.00.
specially requested inspections - per hour 72.50 $50,001.00 and up $742.00 for the first $50,000.00 and $1.20 for
Subtotal: each additional $100.00 or fraction thereof
Fixture Work: Plan Review for Plumbing Installations
Are you capping, adding or replacing fixtures? If "yes ", Plan review is required for any of the following.
please indicate work performed by fixture. Failure to Please check all that apply.
accurately report fixtures could result in increased sewer fees *. ❑ Any new commercial building with water service 2" and
Oaaotlty by (Fixture) Work Performed greater, except systems designed and stamped by licensed
Fixture Type: R engineer.
• Previous Copped Added Existing ❑ New exterior plumbing site utilities for any complex structure
Baptistry/Font as defined in OAR918 780 - 0040.
Bath - Tub/Shower • ❑ Medical gas and vacuum systems for health care facilities.
- .1awm/Whirlpool ❑ Any multipurpose fire sprinkler system.
Car Wash - Each Stall ❑ Any complex structure as defined in OAR918- 780-0040.
-Drive Thru
Cuspidor/Water Aspirator Submit 2 sets of plans with any of the above.
Dishwasher - Commercial
- Domestic I or Riser Diagram
Drinking Fountain g
Eye Wash • ❑ Isometric or riser diagram is required for new buildings
Floor Drain/sink - 2" that meet the qualifications above.
- 3"
Car Wash Drain Comments regarding fixture work:
Garbage - Domestic
Disposal - Commercial
- Industrial
Ice Mach./Refrig. Drains
Oil Separator (Gas Station)
Rec. Vehicle Dump Station
Shower -Gang
-Stall *Note: If the fixture work under this permit results in an
Sink - Bar/Lavatory increase of sewer EDUs, a sewer permit will be issued and
- Bradleeercial fees assessed for the sewer increase must be paid before the
-Service plumbing permit can be issued.
Swimming Pool Filter
Washer - Clothes
Water Extractor
Water Closet - Toilet
Urinal .
Other Fixtures:
is Idinawermits\PLM.PamitApp.doc 09(22106
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00106
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/16/7.007
Phone: (503) 639 -4171 ta�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 4/9/2007 TIME: 7:01AM PAGE: 63
SITE ADDRESS: 11015 SW MEADOWBROOK DR 5 CLASS OF WORK:
SUBDIVISION: WILLOW BROOK FARM LOT #: 014 TYPE OF USE:
PROJECT NAME: SUMMERFIELD APTS
DESCRIPTION: Washer install. (3/22/07 address corrected)
OWNER: SUMMERFIELD ASSOCIATES, LLC, PHONE #:
CONTRACTOR: RAY'S PLUMBING PHONE #: 360-892 -8700
Inspection Request Scheduled For: Date: 4/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 046134 -30 503-310-7187 N
Corrections/Comments/Instructions:
L 94
sz PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C11'11. Date: Li / /0'7 Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION • PERMIT #: PLM2007-00106
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/16/2007
Phone: (503) 639- 4171 �..�� I �>a
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 3/23/2007 TIME: 7:03AM PAGE: 39
SITE ADDRESS: 11015 SW MEADOWBROOK DR 5 CLASS.OF WORK:
SUBDIVISION: WMLLOW BROOK FARM LOT #: 014 TYPE OF USE:
PROJECT NAME: SUMMERFIELD APTS
DESCRIPTION: Washer install. (3/22107 address corrected)
OWNER: SUMMERFIELD ASSOCIATES, LLC, PHONE #:
CONTRACTOR: RAY'S PLUMBING PHONE #: 360 -892 -8700
Inspection Request Scheduled For: Date: 3/23/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 045293-10 503-310-7187 N
Corrections /Comments/ Instructions:
-PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FO INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: i V Date: V`.- / Phone #: (503) 718-