Permit CITY OF TIGARD PLUMBING PERMIT
III ' COMMUNITY DEVELOPMENT Permit#: PLM2015-00114
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/13/2015
Parcel: 2S110DC01000
Jurisdiction: Tigard
Site address: 11225 SW MEADOWBROOK DR 7
Project: Summerfield Apartments Subdivision: WILLOW-BROOK-FARM Lot: 17
Project Description: Unit 7-Rough-in clothes washer and relocate water heater.
Contractor: MODERN PLUMBING Owner: SUMMERFIELD ASSOCIATES, LLC
11120 SW INDUSTRIAL WAY, BLDG 9-3 BY HSC REAL ESTATE
TUALATIN, OR 97062 1500 SW FIRST AVE STE 1020
PORTLAND, OR 97201
PHONE: 503-691-6166 PHONE:
FAX: 503-691-6771
FEES
Quantity Description Date Amount
1 ea Clothes Washer 04/13/2015 $25.02
Specifics:, 1 ea Water Heater 04/13/2015 $37.52
1 12%State Surcharge- 04/13/2015 $8.70
Type of Use: MF Plumbing
Class of Work: ALT 10 ea Minimum Fee Adjustment- 04/13/2015 $9.96
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
or direct que '-• • OUNC by calling 503.232.1987 or 1.800.332.2344.
T
Issue• By: I • ' Permittee Signaturet
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 Anita IVEP
Building Fixtures APR 13 2015 � FOR OFFICE USE ONLY
City of Tigard Received `y 2
,r 13125 SW Hall Blvd.,T' ■ ��jR� 2 Date/By: 45 Permit No.: a94 s-QD )1
Milli
Phone. 503.718.2439 563`5H6. ��" Plan Review Other Permit No.:
Date/By:
Inspection Line: 503.
TIGARD BiING DIVISION
Date Ready/By: orris: B1See Page 2for
Internet: www.tigard Notified/hlethod: Supplemental information
TYPE OF WORK _ = FEE" SCHEDULE •
0 New construction ❑Demolition For special it formalIon use checklis[.
Description 1 Qty. I Ea. I Total
®Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 10011.for each utiiitvconnection)
CATECORI' OF CONSTRUCTION PION SFR(I)bath 312.70
1:1 1-and 2-family dwelling ®Commercial/industrial SFR(2)bath 437.78
❑Accessory building ❑Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler( sq.R.) Page 2
-OB SITE INFORMATION AND LOGATIO;Y <,.. Site utilities:
Job site address: 11225 SW 8tnmlft?Tfiei71 t f t )OW eD(2to P-7DR, Catch basin or area drain I I 18.76
Drywell,leach line,or trench drain 18.76
City/Slate/ZIP:Tigard,OR 97224 Footing drain(no.linear R.: ) Page 2
Suite/bldg./apt.no.:7 I Project name:Summerfield Apartments Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear R.:_) Page 2
Storm sewer(no.linear R.: ) Page 2
Water service(no.linear R.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax map/parcel no.: A j.1 t eft,C 0 i oGb - - Back flow preventer I 31.27
.., DESCRII'[ION OF WORK Backwater valve 12.51
Clothes washer 1 25.02 25.02
Rough in clothes washer and relocate water heater
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER 1 ❑ Tt:NANT Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/Stale/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
0 APP.Ir1C,AN'T'. t .A .. t-;:i=^0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:
Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) I Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
-.- Water heater 1 37.52 37.52
Business name:Modern Plumbing Co. Water Pip Si 1 m DWV 56.29
Address:11120 S\V Industrial 1'ay,Bldg 9-3 Other: 25.02
City/State/ZIP:Tualatin,OR 97062 Subtotal 62.54
Phone:(503)6916166 Fax:(503)6916771 Minimum permit fee: $72.50 72.50
CCB Lic.:87906 lambing Lic.no.:34-250PB
Plan review (25%of permit fee)
State surcharge(12%of permit fee) 8.70
Authorized signature: TOTAL PERMIT FEEL 81.20 lig This penult application expires if a permit is not obtained within ISO days
Print name: �,, - : y '/ Date: after it has been accepted as complete.
•Fee methodology set by Tri-County Building Industry Senicc Board.
1l RuildingiPenuksPi.MU-Permi,App doe 10:01/09 410-1616T(10ro2/COMAVEB)
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-I"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
Valuation: Permit•Fee:
Stout&Rain Drain-1st 100' 62.54 $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 Q4• Fee el Total each additional$100.00 or fraction thereof,to
p and including$10,000.00.
inspection ofesisting 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 S i A5 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 plot 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",
please indicate work performed by fixture. Failure to
accurately report fixtures could result in increased sewer fees`.
Quantity by Fixture Type Plan Review for Plumbing Installations
Fixture Type for Replace/
Plan review is required for any of the following.Performed: Capped Added Relocate
Please check all that apply. g
Baptistry/Font
Both Tub/Shower ❑ Any new commercial building with water service 2"and
Jacuzzi/Whirlpool greater,except systems designed and stamped by licensed
Car Wash -Each Stall engineer.
-Drive Thrum ❑ New exterior plumbing site utilities for any complex structure
Cuspidor/Water Aspirator as defined in OAR918-780-0040.
Dishwasher -Commercial ❑ Medical gas and vacuum systems for health care facilities.
-Domestic ❑ Any multipurpose fire sprinkler system.
Drinking Fountain ❑ Any complex structure as defined in OAR918-780-0040.
Eye Wash
Floor Drain/sink .2" Submit 2 sets of plans with any of the above.
-3"
4.. Isometric or Riser Diagram
Car Wash Drain ❑ Isometric or riser diagram is required for new buildings
Garbage -Domestic-non-food 8 g
Disposal -Domestic-food related that meet the qualifications above.
-Commercial-food related
-Industrial-food related
Ice Mach./Refrig.Drains
Oil Separator(Gas Station) Comments regarding fixture work:
Rec.Vehicle Dump Station
Shower -Gang
-Stall
Sink/Lav -Non-food related
-Bradley
-Commercial-food related
-Service
Swimming Pool Filter
Washer-Clothes *Note: If the fixture work t permit this permit results in an
1
Water Extractor increase of sewer EDUs,a sewer permit will be issued and
Water Closet-Toilet fees assessed for the sewer increase must be paid before the
Urinal plumbing permit can be issued.
Other Fixtures: -
C:\Users\nary\Documents\Downloads\PLMFPermitApp.doc 2
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infogmodernplunibing.us 503.691.61136
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Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
11225 SW MEADOWBROOK DR 7, TIGARD, OR,
97224
Commercial - Plumbing
399 Plumbing final
PASS - No C of O
PLM2015-00114
George Heimos
Violation Summary:
Inspector Contractor