Permit CITY OF TIGARD PLUMBING PERMIT
V
COMMUNITY DEVELOPMENT Permit#: PLM2016-00054
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 02/03/2016
Parcel: 2S103CDO0700
Jurisdiction: Tigard
Site address: 11555 SW FAIRVIEW LN
Project: SUNDANCE INVESTMENTS LLC Subdivision: HOLLYTREE Lot: 2
Project Description: Replacing all fixtures and plumbing lines in house.
Contractor: ROBERT FOWLER CONSTRUCTION SERVICES Owner: SUNDANCE INVESTMENTS LLC
18350 NE BALD PEAK RD 17420 SW 110TH AVE
NEWBERG, OR 97132 TUALATIN, OR 97062
PHONE: 503-550-5829 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 02/03/2016 $25.02
Specifics: 1 ea Dishwasher 02/03/2016 $25.02
1 ea Garbage Disposal 02/03/2016 $25.02
Type of Use: SF 2 ea Hose Bib 02/03/2016 $50.04
Class of Work: ALT 3 ea Sink 02/03/2016 $75.06
Type of Const: 2 ea Tub/Shower/ShowerP n 02/03/2016 $25.02
a
Occupancy Grp: 2 ea Water Closet 02/03/2016 $50.04
Stories: 1 ea Water Heater 02/03/2016 $37.52
1 12%State Surcharge- 02/03/2016 $37.53
Plumbing
Total $350.27
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 a if work is not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires y u to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-00 09 You may obtai a co of the rul s
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ;�—�Inittee Signature:
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 Application
Building Fixtures Y "
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City of Tigard Received Permit No
13125 SW Hall Blvd.,Tigard,OR Date/By: j
r Plan Review
S Phone: 503.718.2439 Fax: 503.5A
0 Other Permit No.: r6 �-
Date/By:
Inspection Line: 503.639.4175 QQ, ? Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard-or.gov �(v r .,�' tified/Method: Supplemental Information
TYPE OF WORK FEE* SCHEDULE
❑New construction ❑ Deri`14 t>, ,,,, For special information use checklist
Description I Qty- I Ea. Total
®Addition/alteration/replacement ❑OtH�r,1' New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath d7.7
® 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath
❑Accessorybuilding SFR(3)bath g ❑ Multi-familyEach additional bath/kitchen❑Master builder ❑Other: Fire sprinkler( sq.ft.) age
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:11555 SW FAIRVIEW LANE Catch basin or area drain 18.76
City/State/ZIP:7'IGARD,OREGON 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: Project name: Manufactured home utilities 50.03
Cross street/directions to job site:SW 115TH AVE 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: HOLLYTREE Lot no.:2 Fixture or item:
Tax map/parcel no.:2SI03CDO0700 Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 1 25.02 25.02
REPLACE PLUMBING LINES IN THE HOUSE Dishwasher 1 25.02 25.02
REPLACE ALL FIXTURES IN THE HOUSE Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name:SUNDANCE INVESTMENTS LLC. Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address: 17420 SW 110TH AVE
Garbage disposal 1 25.02 25.02
City/State/ZIP:TUALATIN,OREGON 97062 Hose bib 2 25.02 50.04
Phone:(503)9691233 Fax:( ) Ice maker 12.51
® APPLICANT ❑ CONTACT PERSON Interceptor/grease trap 25.02
Business name:SUNDANCE INVESTMENTS LLC. Medical gas(value:$ ) Page 2
Contact name:SCOTT Primer 12.51
Roof drain(commercial) 12.51
Address: 17420 SW 110T"AVE Sink/basin/lavatory 3 25.02 75.06
City/State/ZIP:TUALATIN,OREGON 97062 Solar units(potable water) 62.54
Phone:(503)9691233 Fax: :( ) Tub/shower/shower pan 2 12.51 25.02
E-mail:HMSROBBINS@COMCAST.NET Urinal 25.02
CONTRACTOR Water closet 2 25.02 50.04
Water heater 1 37.52 37.52
Business name: ROBERT FOWLER CONSTRUCTION SERVICES Water pipingIDWV 56.29
Address:18350 NE BALD PEAK RD Other: 25.02
City/State/ZIP:NEWBERG,OREGON 97132 Subtotal T• ��
Phone:(503)5505829 Fax:( ) Minimum permit fee: $72.50 31�.-I4
CCB Lic.:150987 Plumbing Lic.no.:705 Plan review (25%of permit fee)
State surcharge(12%of permit fee)
Authorized signature: • TOTAL PERMIT FEE -31t T'
Print name:SCOTT ROBBINS Date: �� r This permit application expires if a permit is not obtained withinFj-V
s
/ after it has been accepted as complete. .7
*Fee methodology set by Tri-County Building Industry Service B
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
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
11555 SW FAIRVIEW LN, TIGARD, OR, 97223
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00054
Don Sylvester
Violation Summary:
Inspector Contractor