Permit (94) of
CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00121
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 04/10/2017
k�•L 9 Parcel: 25111 CA01500
Jurisdiction: Tigard
Site address: 9625 SW SUMMERFIELD DR
Project: Jordan Subdivision: SUMMERFIELD NO.7 Lot: 338
Project Description: Remodel: replace(1)clothes washer,(1)ice maker,(4)lays, (2)showers&(1)water closet.
Contractor: ASSURED PLUMBING INC Owner: DEL JORDAN
PO BOX 230816 9625 SW SUMMERFIELD DR
PORTLAND, OR 97281 TIGARD, OR 97224
PHONE: 503-985-9093 PHONE.
FAX: 971-249-3145
FEES
Quantity Description Date Amount
1 ea Clothes Washer 04/07/2017 $25.02
Specifics: 1 ea Ice Maker 04/07/2017 $12.51
4 ea Lavatories 04/07/2017 $100.08
Type of Use: SF 2 ea Tub/Shower/Shower Pan 04/07/2017 $25.02
Class of Work: ALT 1 ea Water Closet 04/07/2017 $25.02
Type of Const: 1 12%State Surcharge- 04/07/2017 $22.52
Occupancy Grp: Plumbing
Stories:
Total $210.17
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 stions . •UNC by calling 503.232.1987 or 1.800.332.2344.
Issue By: �. Permittee Signatur=: ---
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 Appl'
Building Fixtures ,, 1 1 *,
City of Tigardp b Received
Date/By: /7 ,L Permit No.iLiyaO!7-Gb
o �
, ,
Plan Review
Phone: 503.7182439 Fax:,M3,591.1960 Date/By: Other Permit No.:/1/4/66:9.49/7_:520a/s"
Inspection Line: 503.639.41-'T5t x `
T I G A R D Internet: www.ti ard- 3 ' Date Ready/By: Jur s: See Page 2 for
Notified/Method: Supplemental Information
0 New construction 0 Demolition For special information use checklist
Description I Qty. I Ea. I Total
®Addition/alteration/replacement 0 Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATI' OR% 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,ANI) CATION Site utilities:
Job site address:9625 SW Summerfield Dr. 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: 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
DES IP It N OP WORK Backwater valve 12.51
Clothes washer 1 25.02
1 ice maker box/1 washer box/2 walk in showers/4 lays/1 water closet Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
a PROP `nt owisrat j a TENANT Expansion tank 12.51
Fixture/sewer cap 25.02
Name:Del Jordan
Floor drain/floor sink/hub 25.02
Address:9625 SW Summerfield Dr
Garbage disposal 25.02
City/State/ZIP:Tigard,OR 97224 Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 1 12.51
0.APPLICANT ct CONTACT P. RSUI4 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 4 25.02
City/State/ZIP:Lake Oswego,OR 97035 Solar units(potable water) 62.54
Phone:(503)984-2783 Fax::( ) Tub/shower/shower pan 2 12.51
E-mail:TLRemodel@yahoo.com Urinal 25.02
Water closet 1 25.02
CONTRACTOR
Water heater 37.52
Business name:Assured Plumbing Inc WaterPip 1 m WV 56.29
Address: PO BOX 230816 Other: 25.02
City/State/ZIP:Portland,OR 97281 Subtotal /g 7.6S
Phone:(503)985-9093 Fax:( ) Minimum permit fee: $72.50
CCB Lic.:199423 Plumbing Lic.no.:PB1055 Plan review (25%of permit fee)
State surcharge(12%of permit fee) SA
Authorized signature: , 4-- TOTAL PERMIT FEE 0,/7
Print name:Miguel Dorantes Date:4-3-17 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\Pennits\PLMU-Perp itApp.doe 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:
9625 SW SUMMERFIELD DR, TIGARD, OR,
97224
Record Type: Record ID:
Residential - Plumbing PLM2017-00121
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor