Permit (122) 71 CITY OF TIGARD PLUMBING PERMIT
al COMMUNITY DEVELOPMENT Permit#: PLM2017-00508
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/11/2017
Parcel: 2S111CC13800
Jurisdiction: Tigard
Site address: 10235 SW HIGHLAND DR
Project: McKee Subdivision: SUMMERFIELD NO.4 Lot: 189
Project Description: Installation of hose bib,dishwasher and sink for kitchen remodel.
Contractor: ASSURED PLUMBING INC Owner: MCKEE, CAROL T
PO BOX 230816 10235 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 Dishwasher 12/11/2017 $25.02
Specifics: 1 ea Hose Bib 12/11/2017 $25.02
1 ea Sink 12/11/2017 $25.02
Type of Use: 1 12%State Surcharge- 12/11/2017 $9.01
Class of Work: Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $84.07
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: r Permittee Signature: �� Qp"G.i e 0
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 -.
E Iiii,,,,,
Building Fixtures "
City of Tigard Received
2 g DateBy:I //f// '� Permit No c� 7�>/7. ®Sb�J
13125 SW Hall Blvd.,Tigard,OR 97223 ��E 2017 Plan Review �f/
_ Phone: 503.718.2439 Fax: 503.598.1960
Other Permit No.:DateBy:
Inspection Line: 503.639.4175 wY L q9!USe3TIGARD Date
Ready/By: ��f� Juris S See Page 2 for
Internet: www.tigard-or.gov w _ NNotified/Method/2��/ 17 ,tom!'
UILDI„ DIVISIONG Supplemental Information
-c l` E:OF W I :�t L FEE* SGI I%C
❑New construction 0 Demolition For special information 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 01?CONS RUCTION SFR(1)bath 312.70
® 1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
0 Accessory building 0 Multi-family SFR(3)bath 500.32
Each additional bath/kitchen 25.02
0 Master builder 0 Other:
Fire sprinkler( sq.ft.) Page 2
JOH strE.INFORMATION'; i'411LOCATION Site utilities:
Job site address:10235 sw Highland 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.: Project name:McKee 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
DESS TtO1+I O ,
Backwater valve 12.51
" Clothes washer 25.02
Kitchen Sink and dishwasher Dishwasher 125.02
Drinking fountain 25.02
Ejectors/sump 25.02
go.pit orER '';O Ng f,TENANTExpansion tank 12.51
Name:Carol McKee Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:10235 SW Highland DR
Garbage disposal 25.02
City/State/ZIP:Tigard OR 97224 Hose bib I 25.02
Phone:(503)3602399 Fax:( ) Ice maker 12.51
a.',Ap1LK V4T t, . .'21 CONTACTpups Interceptor/grease trap 25.02
Business name:TL Remodel&Construction Medical gas(value:$ ) Page 2
Primer 12.51
Contact name:Chris Kyle
Roof drain(commercial) 12.51
Address:PO BOX 1996 Sink/basin/lavatory I 25.02
City/State/ZIP:Lake Oswego OR 97035 Solar units(potable water) 62.54
Phone:(503)7057611 Fax::( ) Tub/shower/shower pan 12.51
E-mail:Chrisk@tlremodel.com Urinal 25.02
Water closet 25.02
C!1I1NTRA TO Water heater 37.52
Business name: `• Ca s V ccO \,,,,,„,47.. ,..C r'V \,,,,,.., Waterpiping/DWV 56.29
Address: QS O, 1)nx 2)&\6 \ JJ Other: 25.02
City/State/ZIP: 1 ,Y N\,, , O.t 9,),Z5\ Subtotal 7.5>Qk,
Phone: (� ) Minimum permit fee: $72.50
'/ ( 2 ) q�s 1�,q� Fax: ,>9 3\Is
`r CCB Lia: `q 14 r)_.3 Plumbing Lic.no.: 44,1 Plan review (25%of permit fee)
State surcharge(12%of permit fee) gj q,C?
Authorized signature: M\ l� (?b 1dS�p 12_ TOTAL PERMIT FEE Q
^� This permit application expires if a permit is not obtained within 180 days
NN,Print name: / 1., Q\ D _ ,-.A.�'
tZJ. Date:�.�/\r/\i
��Vafter it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:\Building\Pennits\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:
10235 SW HIGHLAND DR, TIGARD, OR, 97224 January 26, 2018 at
10:49:22 AM
Record Type: Record ID:
Residential - Plumbing PLM2017-00508
Inspection Type: Inspector:
399 Plumbing final David Young
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor