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Permit CITY OF TIGARD PLUMBING PERMIT I COMMUNITY DEVELOPMENT Permit#: PLM2017-00345 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/28/2017 Parcel: 25111 CC13200 Jurisdiction: Tigard Site address: 10295 SW HIGHLAND DR Project: CARRINGTON Subdivision: SUMMERFIELD NO.4 Lot: 183 Project Description: (1)ice maker and(1)shower pan. Contractor: ASSURED PLUMBING INC Owner: CARRINGTON, RENEE M PO BOX 230816 10295 SW HIGHLAND DR PORTLAND, OR 97281 TIGARD, OR 97224 PHONE: 503-985-9093 PHONE: FAX: 971-249-3145 FEES Quantity Description Date Amount 1 ea Ice Maker 08/28/2017 $12.51 Specifics: 1 ea Tub/Shower/Shower Pan 08/28/2017 $12.51 Type of Use: SF 1 12%State Surcharge- 08/28/2017 $8.70 Plumbing Class of Work: ALT 47 ea Minimum Fee Adjustment- 08/28/2017 $47.48 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: f// li,41 Permittee Signature: /J /47,,e' 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. 1T Plumbing Permit Application iS4 ''''1.'''' Building Fixtures � � FOR OFFICE USE ONLY r 11 City of Tigard f� ,}�` (\'\� Rte.ceived 1 v to/B �� Permit No.: -0 03q5 j [� '� 13125 SW Hall Blvd.,'Tigard,OR 97223 y 1 / 7 ,L�.2U(7 V 0V�✓ 11 IN_ I Phone: 503.718.2439 Fax: 503.598.1960 �� 4'.n R view e Other Per mitNo. / Inspection Ione: 503.639.4175 .' ' c ' �'�.ZO��`U��� TIGARD i 01.,„,t tk11V. eady/By: Jens 0 See Page 2 for Internet: www.tigard-or.gov �� Notitied/Method V t' Supplemental Information TYPE OF WORK4. FEE* SCHEDULE 1 qg �^ L❑New construction ❑Demol in" For special information use checklist. a Description 1 Qty. 1Ea. Total pi Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection) CATEGORY OF CONSTRUCTION SFR(l)bath 312.70 jij 1-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78 - - ❑Accessory building SFR(3)bath 500.32 ❑Multi-family ❑ Master builderEach additional bath/kitchen 25.02 0 Other: Fire sprinkler( sq.ft.) Page 2 - JOB SITE INFORMATION AND LOCATION Site utilities: ------------i Job site address: /62 9.,r5 ) /71/74/4,,,..j ,�y Catch basin or area drain 1 8.76 � Drywell,leach line,or trench drain 18.70 City/State//11: "/! r O p..._ 972-21.1 - Footing drain(no.linear ft.. ) p t c 2 Suite/bldg/apt.no.: Project name: Manufactured home utilities Cross street/directions to job site: Manholes I S 76 Rain drain connector 18.70 I Sanitary sewer(no.linear ft.:_) Paas 2 Storm sewer(no.linear ft.: ) Paz(:2 Water service(no.linear ft.: ) Page 2 Subdivision: Lot no.: --� Fixture or item: _ fax map/parcel no.: Backflow preventer � 31.27 DESCRIPTION OF WORK Backwater valve 12.51 i ZGe a v-e✓ t . 1 S�w�� �� Clothes washer 25.02 Ij p Dishwasher 25.02 11 Drinking fountain 125.02 Ejectors/sump 25.02 1 ��PROPERTY OWNER ❑ TENANT Expansion tank 12.51 Name: r.,ev e,� GLy -yl et .- Fixture/sewer cap '5.02 �( �J Floor drain/floor sink/hub 25.02 Address_ /,,Z � 5 /7 it/4i2 4 - -- Garbage disposal 25.02 City/Stale/LIP: �sY� 1 LZq Flow bib 25 Phone:(77/ ) 6 Z Fax: 1 �, ! ( ) Ice maker Ite.si ,1d APPLICANT CONTACT PERSON Interceptor/grease trap 02 � Business name: --t� Medical gas(value:$ ) E fi p, e 2 ) L �e,6,.e.¢1 t- e,,,-,,,,i.„.„,1,,-,./.1 -Contact name: CI e S ii ice_ Primer 12.51 I�' q Roof drain(commercial) S I 1 11 Address: Ag'QX /L��OI Sink/basin/lavatory x,.02 City/State/III': LC3 Ot O4J'e'S 0 9?03.1 Solar units(potable water) 62.54 Phone:03 )'7o.� 7/ // ((// Fax: :( ) Tub/shower/shower pan - 1 • 5! r � � 1. F-mail: f fOe l'),-.4© 7Z,p-`G „ ()14/1 Urinal 25 02 CONTRACTOR Water closet 25.02 ��.� Water heater 37.52 Business name: A 0 td V O V b,:0, ►/L G J , J Water piping/DWV 56.29 Address: - ----- C 6 X 2.30 g1, Other: 25.02 (. City/State/LIP: eee,y ,�t �lc� ,rx p p 7 2-g ( Subtotal Phone:(54:33) 1 R'5 ct to (�� Fax:(( l� ) 6 P6 7/1/16 Minimum permit fee: $72.50 CCB Lie.: /� hi/� / ( Plumbing Lic.no.: / 6-� Plan review (25%of permit fee) /l State surcharge(12%of permit fee) Authorized signature: "'i j - 1-:-� ! TO FAL,PERMIT FIT This permit application expires if a permit is not obtained within 180 days L Print name: e:gale 1 1)©lead, Date: e9g__2 /-7 after it has been accepted as complete. "Fee methodology set by.1ICountyBuilding Industry Sen-ice BOnrd. I Ituildin*APerm is,Pl.MU-Per mil App.doc 10/01/09 440-4616'[(10/02/COM/WEB) City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 Tel: 503.718.2439 Location: Inspection Date: 10295 SW HIGHLAND DR, TIGARD, OR, 97224 October 23, 2017 at 10:33:46 AM Record Type: Record ID: Residential - Plumbing PLM2017-00345 Inspection Type: Inspector: 399 Plumbing final Aaron Cillo-Gobel Result: PASS - NoCofO Comments: Violation Summary: Inspector Contractor