Permit CITY OF TIGARD PLUMBING PERMIT
: 4 COMMUNITY DEVELOPMENT Permit#: PLM2017-00043
13125 SW Hall Blvd.,Ti Date Issued: 02/15/2017
TIC;;klif) and OR 97223 503.718.2439 9
Parcel: 2S114BA10600
Jurisdiction: Tigard
Site address: 16355 SW WOODCREST AVE
Project: Singley Subdivision: COPPER CREEK STAGE 2 Lot: 59
Project Description: Install clothes washer,ice maker&sink.
Contractor: ASSURED PLUMBING INC Owner: HAMMERQUIST, RICHARD C
PO BOX 230816 SINGLEY, KARIN L
PORTLAND, OR 97281 16355 SW WOODCREST AVE
TIGARD, OR 97224
PHONE: 503-985-9093 PHONE:
FAX: 971-249-3145
FEES
Quantity Description Date Amount
1 ea Clothes Washer 02/15/2017 $25.02
Specifics: 1 ea Ice Maker 02/15/2017 $12.51
1 ea Sink 02/15/2017 $25.02
Type of Use: SF 1 12%State Surcharge- 02/15/2017 $8.70
Class of Work: ALT Plumbing
Type of Const: 10 ea Minimum Fee Adjustment- 02/15/2017 $9.95
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: j� \ /^ /� Permittee Signature:
1�J (�rS/ r 4
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 '� FOR (1FFlt F 1 SF ()NEN
„0-41'= A Received
City of Tigardd- /V /7 / Permit No.: 40y/9417-1,9/3
il 13125 SW Hall Blvd.,Tigard,OR 97223 Plan Re Date/By:
■ y i Plan Review
Phone: 503.718.2439 Fax: 503.598;x' 1Date Other Permit No.:
Inspection Line: 503 639.4175
T I C Re ReadyBy: Juns ® See Page 2 for
Internet: www.tigard-or.gov '1Notified/Method: Supplemental Information
'�.�� Z 1.. t r� PP
"t� �
`: TYPE"O , ° t _>'. trl�'t` FEE*.SC D1�
0 New construction ■ Demolition 1 For special informal on use checklist
Description I Qty. Ea. Total
Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF'CON TRUCTIO T 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
❑Accessory buildingSFR(3)bath 500.32
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: 16355 SW Woodcrest Ave 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: tt iJ a C�y 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
13ESCRIPUON -WORK ,
Backwater valve 12.51
Clothes washer 1 25.02
1 ice maker box/1 washer box Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
014 tiorsittit OO R .,. 0 `rt.NOT' . u . . Expansion tank 12.51
Name:Karin Singley Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:16355 SW Woodcrest Ave
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 1 12.51
A ? or eil "conrraeT r4 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
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
Water closet 25.02
N " ' Water heater 37.52
Business name:Assured Plumbing Inc Water piping/DWV 56.29
Address: PO BOX 230816 Other: 25.02
City/State/ZIP:Portland,OR 97281 Subtotal
Minimum permit fee: $72.50 7a.5-0Phone:(503)985-9093 Fax:( ) .
CCB Lic.:1.99423 19VY2-3 Plumbing Lic.no.:PB1055 Plan review (25%of permit fee)
State surcharge(12%of permit fee) S1'.10
Authorized signature: TOTAL PERMIT FEE g'(,3-0
Print name:Miguel Dorantes Date:2/12/17 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.
I:\Building\Permits\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
16355 SW WOODCREST AVE, TIGARD, OR,
97224
Record Type: Record ID:
Residential - Plumbing PLM2017-00043
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor