Permit (23) CITY OF TIGARD PLUMBING PERMIT
'`11 g COMMUNITY DEVELOPMENT Permit#: PLM2016-00103
T[GARB 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 03/02/2016
Parcel: 25111 DB03700
Jurisdiction: Tigard
Site address: 9160 SW SUMMERFIELD CT
Project: CAMPBELL Subdivision: SUMMERFIELD NO.8 Lot: 423
Project Description: (1)kitchen sink and(1)ice maker for kitchen remodel.
Contractor: ASSURED PLUMBING INC Owner: CAMPBELL,VIRGINIA L/DAVID
PO BOX 230816 9160 SW SUMMERFIELD CT
PORTLAND, OR 97281 TIGARD, OR 97224
PHONE: 503-985-9093 PHONE:
FAX: 971-249-3145
FEES
Quantity Description Date Amount
1 ea Ice Maker 03/01/2016 $12.51
Specifics: 1 ea Sink 03/01/2016 $25.02
1 12%State Surcharge- 03/01/2016 $8.70
Type of Use: SF Plumbing
Class of Work: ALT 35 ea Minimum Fee Adjustment- 03/01/2016 $34.97
Type of Const: Plumbing
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee 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 N�C‘
ReceivedCity of TigarVgjt‘
Date/By: / 110 /7-- Permit No.: /J,_^�.�/6 /v
IN ig 13125 SW Hall Blvd.,Tigard,OR 9 /91/4420/6.-.00/0 L!� ' V!
Plan Review
I Phone: 503.718.2439 Fax: 503.598.1960 4 '7-f*
-f* Date/By: Other Permit No.:�o -COIN
Inspection Line: 503.639.4175 MPR Date ReadyBy: Juris: ® See Page 2 for
i i c ,a RI> Internet: www.tigard-or.gov
��f i NNotified/Method: �Q Supplemental Information
TYPE OF WORK ,V)1ltz �V�}�CI1o� FEE* SCHEDULE
0 New construction 0 De%tili �, 1i"I For special information use checklist
��11 Description I Qty. 1 Ea. I Total
®Addition/alteration/replacement ❑ er: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath _ 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address:9160 SW Summerfield Ct Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywell,leach line,or trench drain 18.76
Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: ""• v` 4 ry y'r(jr)( 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
DESCRIPTION OF WORK Backwater valve ; 12.51
Clothes washer 25.02
1 ktichen sink,1 ice maker ,
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
® PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:David&Virgina Campbell Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:9160 SW Summerfield Ct.
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 1 12.51 /4,5)
0 APPLICANT ® CONTACT PERSON Interceptor/grease trap 25.02
Business name:TL Remodel&Construction Inc Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Tim Labunsky
Roof drain(commercial) 12.51
Address:PO Box 1996 _ Sink/basin/lavatory 1 25.02 0,1.,
City/State/ZIP:Lake Oswego,OR 97035 Solar units(potable water) 62.54
Phone:(503)984-2783 Fax::( ) Tub/shower/shower pan 12.51
E-mail:TLRemodel@yahoo.com Urinal 25.02
CONTRACTOR Water closet 25.02
Water heater 37.52
Business name:Assured Plumbing Inc WaterPip g/t to DWV 56.29
Address: PO BOX 230816 Other: 25.02
City/State/ZIP:Portland,OR 97281 Subtotal 37 53
Phone:(503)985-9093 Fax:( ) Minimum permit fee: $72.50
Plan review (25%of permit fee) ....---
CCB Lic.:19423 Plumbing Lie.no.:PB1055
State surcharge(12%of permit fee) IF,70
Authorized signature: V TOTAL PERMIT FEE g.f,
Print name:Miguel Dorantes Date:2/26/16 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.
1:\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
9160 SW SUMMERFIELD CT, TIGARD, OR,
97224
Residential - Plumbing
399 Plumbing final
PASS - No C of O
PLM2016-00103
Don Sylvester
Violation Summary:
Inspector Contractor