Permit (57) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00320
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2017
f�ai'�-EC3 9 Parcel: 2S110DC01000
Jurisdiction: Tigard
Site address: 11285 SW MEADOWBROOK DR 8
Project: Summerfield Appartments Subdivision: WILLOW-BROOK-FARM Lot: 17
Project Description: Clothes washer.
Contractor: PROLINE PLUMBING&SEWER Owner: SUMMERFIELD ASSOCIATES, LLC
3214 NE 58TH STREET BY HSC REAL ESTATE
V,wa 98663 1500 SW FIRST AVE STE 1020
PORTLAND, OR 97201
PHONE: 877-376-2713
PHONE: 503-819-5181
FAX:
FEES
Quantity Description Date Amount
1 ea Clothes Washer 08/15/2017 $25.02
Specifics: 1 12%State Surcharge- 08/15/2017 $8.70
Plumbing
Type of Use: MF 47 ea Minimum Fee Adjustment- 08/15/2017 $47.48
Plumbing
Class of Work: ALT
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 questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
z/Wr,,,Z6,
Issued By: Permittee Signature:
Call 503.639.4175 by 7:00 a.m.for the next available inspection d
i/.
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 RICE%'''. . .
FOR 0141(F [SE 011.1
City of Tigard _ ,r, ;cteeliBveyd: Permit No.:
7,//...?;get
111110/7"-Ce)&24:,
ill 13125 SW Hall Blvd.,Tigard,OR 97223 AU 6 ./ °Plan Review
1111 I Phone: 503.718.2439 Fax: 503.598.1960
Other Permit No.A164:26/7-Ve)CP1-
d.,,,,r,1,i at tokiti
TIGARD Inspection Line: 503.639.4175CITY ijr t 1 I i a e A.e.. /By: Juris: Vi See Page 2 for
Internet: www.tigard-or.gov
wr,ri. t..,,od: Supplemental Information
TYPE OF WORK oittillou u .,, F'EE*SCHEIIULR
For special information use checklist
0 New construction 0 Demolition
Description Qty. Ea. I Total
0 Addition/alteration/replacement i.Other: Lao-id i'ye' (.4,10-51? New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF cori#iibciioi4' ---s f, ''' SFR(1)bath 312.70
0 1-and 2-family dwelling )aCommercial/industrial SFR(2)bath 437.78
SFR(3)bath 500:32
0 Accessory building 0 Multi-family
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOB SITEINFORIVIAT1ON AND LOCATION Site utilities:
Job site address: 1 1 7 g 5" s(..k.: iti,v4,6..(),-.4.i) 6;:) K,) 1:),,r
- . .-- - - Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP: +t 7‘cfct bit 7 z 2 61 ,
Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.:j;-- I Project name: S,) •,,Nef T.,c kl_
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:
Backflow preventer 31.27
Tax map/parcel no.:
12.51
DiscWioNe4woRici Backwater valve
(Itoj_ 1 * ., - , , '''',...: l'• - Clothes washer i 25.02
cel . .-c4-0 k),)1,-S CA t--U/t9A
Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
Expansion tank 12.51
, P 0 PROPERTYOVVISIER , "g, I 1 .,..', * Q TElimrr ,'
Fixture/sewer cap 25.02
Name:
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
*13 APIVCANTI. , ''' ':EVCONTTACT iiktON Interceptor/grease trap 25.02
Medical gas(value:$ ) Page 2
Business name: $tx yt cte_„.A.t f ct...,( C-c."-t fif a-c=-41
Primer 12.51
Contact name: N)cLic./... (.1
Roof drain(commercial) 12.51
Address: i 1 0 .5 C-J k- J/ Lt''' f . a Sink/basin/lavatory 25.02
City/State/ZIP: 4- c &k q7 ?Z I Solar units(potable water) 62.54
,7Phone:( )Th l gi cf ,- 5.) ..,N. Fax::( ) Tub/shower/shower pan 12.51
Urinal 25.02
E-mail: lk)tt.. ..0_,, ,k_vp 4,,,- .,w),-,A , (....,....-._
- ,-, Water closet 25.02
CONTRACTOR Water heater 37.52
Business name: &ob."c fo/u,,,,,hiki.
Water piping/DWV 56.29
Address: K6,,k1 1.1 /1", z77r2--1 574- Other: 25.02
City/State/ZIP: k japte,Levrc- 1/14--- 0*7
63 Subtotal
Minimum permit fee: $72.50
Phone:( '7 37 -2.7/3 Fax:( ) 7///26
CCB Lic.: ' 2.1 i 70'i' Plumbing Lic.no.:10/5/2r
0 „...6..E446.....,, ,
Plan review (25%of permit fee)
State surcharge(12%of permit fee)
TOTAL PERMIT FEE
Authorized signature: 1/1//r
Print name: AI Lc-14- kA/1,,t Izt I Date:%-7-/ i I 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.\Budding\Penntts\PLMU-pennitApp doc 10/01/09 440-4616T(10/02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee Schedule: Residential Fire Suppression Systems:
Site
t e s. Qty. N Fee(ea) :rail ` Square Footage Permit Fee: ,
Footing drain-1"100' 50.03 0 to 2,000 $121.90
2,001 to 3,600 $169.69
Footing drain-each additional 100' 37.52 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 ....Permit Fee:
Storm&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
tal each additional$100.00 or fraction thereof,to
other I pections or Fees �(ty. Fee(ell) `Toand including$10,000.00.
Inspection of existing 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$1.45 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 plan review for revisions 90.00/hr $50,001.00 and up $742.00 for the first$50,000.00 and$1.20 for
each additional$100.00 or fraction thereof.
(minimum charge-1/2 hour)
Subtotal:
Commercial Fixture Work:
Are you capping,adding or replacing fixtures? If"yes",
please indicate work performed by fixture. Failure to ,
k . .
accurately report fixtures could result in increased sewer fees*. flan I evl w for Plumbing Insta atioI!S
Quantity by Fixture Type Plan review is required for any of the following.
Fixture Type for Replace/ Please check all that apply.
Work Performed: Capped Added Relocate 0 Any new commercial building with water service 2"and
Baptistry/Font greater,except systems designed and stamped by licensed
Bath: -Tub/Shower engineer.
-Jacuzzi/Whirlpool 0 New exterior plumbing site utilities for any complex structure
Car Wash: -Each Stall as defined in OAR918-780-0040.
-Drive Thru 0 Medical gas and vacuum systems for health care facilities.
Cuspidor/Water Aspirator 0 Any multipurpose fire sprinkler system.
Dishwasher: -Commercial 0 Any complex structure as defined in OAR918-780-0040.
-Domestic
Drinking Fountain Submit 2 sets of plans with any of the above.
Eye Wash
Floor Drain/sink: -2"
Isometric or,Riser biagram
4"
0 Isometric or riser diagram is required for new buildings
-Car Wash Drain that meet the qualifications above.
Garbage -Domestic non-food
Disposal: -Domestic food related
-Commercial food related
-Industrial food related Comments regarding fixture work:
Ice Mach./Refrig.Drains
Oil Separator(Gas Station)
Rec.Vehicle Dump Station
Shower: -Gang
-Stall
Sink: -Lav/Bar non-food related
-Bradley
-Com/Serv/Util food related
-Service *Note: If the fixture work under this permit results in an
Swimming Pool Filter increase of sewer EDUs,a sewer permit will be issued and
Washer-Clothes fees assessed for the sewer increase must be paid before the
Water Extractor plumbing permit can be issued.
Water Closet-Toilet
Urinal .
Other Fixtures:
I:\Building\Permits\PLMF PermitApp.doc 08/04/2011 2
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11285 SW MEADOWBROOK DR 8, TIGARD, OR,
97224
Record Type: Record ID:
Commercial - Plumbing PLM2017-00320
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor