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Permit
Sr Er CITY OF TIGARD PLUMBING PERMIT COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00049 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 2/9/2007 PARCEL: 2S 110DC -01000 SITE ADDRESS: 11210 SW MEADOWBROOK DR 4 ZONING: R -25 SUBDIVISION: WILLOW BROOK FARM LOT: 014 JURISDICTION: TIG Project Description: Unit 4. Clothes washer. CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES: TYPE OF USE: MF WASHING MACH: 1 BACKFLOW PREVNTRS: OCCUPANCY GRP: R1 FLOOR DRAINS; TRAPS: STORIES: WATER HEATERS: CATCH BASINS: FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS: SINKS: URINALS: GREASE TRAPS: LAVATORIES: OTHER FIXTURES: TUB /SHOWERS: SEWER LINE: ft WATER CLOSETS: WATER LINE: ft DISHWASHERS: RAIN DRAIN: ft Owner: FEES SUMMERFIELD ASSOCIATES, LLC Description Date Amount BY SUMMET REAL ESTATE MANAGEME 5320 SW MACADAM AVE [PLUMB] Permit Fee 2/9/2007 $72.50 PORTLAND, OR 97201 [TAX] 8% State Surcha 2/9/2007 $5.80 Phone : Total $78.30 Contractor: RAY'S PLUMBING 15200 NE CAPLES SUITE C BRUSH PRAIRIE, WA 98606 REQUIRED ITEMS AND REPORTS Contact # : PRI 360 -892 -8700 FAX 360 - 892 -9644 Reg #: LIC 33217 PLM 37 -149PB This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued By: , Permittee Signature: Call 503.639.4175 by 7:00 a.m. for an inspection that business day. 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. 02/08/2007 09:07 3605461630 SKYWARD PAGE 22/31 Feb , 07 "C7 02: Ras Plumbing 360 392 9644 p.7 - 6,---N? ! � -• �,, !1 ', , . . YWARD CONSTRUCTION PAGE 87/ 16 Li ,l ii f1,.; c37/2 ©B7 1.4: 41 136054576 0- ti l , i � !!.1 ) am 1) I .) 1 ,. I =1_ j':lumbing.P'ermilt Application FEB 0 J 2007 t;,lt nI I li t t .:I. r,,l'1' . City of Tigard ' p ;12 f • �i ' a • , � SWO ' � _// � � // / i • 5Y rd.OR' A >,. J i..l"ut -S.it i ,IP 11125 SW mall ravel.. Tlae a REVIe Phone! 5(6.639.41 71 F mc: g59> ' 6 9'J l i r: --oil a"l , f^ � Data RoxlydlSy: 1n ecnan lines 5 03 , 699 . 4175° t I • 1{ ` 1 1 5 Inter v ugard -or.Ro r NmILetatictltod! 0 Katy commutation ❑ Demolition For special 1l,JerlrtDtldn au elleCfr lab Bowl Otv. _ ( Ea. ( Total I0, 411ditio •falterativnlroptaccrnd11 ❑Other: N 1- 7. rarnllp TIwntRngt, (inoloda:1(In ft, fee tech utility connecting) r I „ .- ' 1 ; . r . . . ' { ' -' s {. (1)bitth . 249.20 - ❑ 1 • and 2 -i unity tlwcl ring © 09ttlmer iel /indualt1111 SFR (2) hash 150.00 ❑ Accessory building y S R C11 bath 399.i. ❑ 1�Tu1G.tatnil Nth adeltlonal bsthiltire1 tr 15. Mil ❑ Master builder 0 Other: sprinkler ( J . 00 Z Fire sprl _ sq. fl.) Pe rb> ' ': 1::; y, ., , ar ... Siitewintlea ,fob site address: 11210 SW 1 lvlc cIowblrook Dr. Catahbnsinoram dlait =111 rd OR 97224 Dry'aef, leech line, or trench drain ,15.60 Cif• /stile / %1P; T'i� , - Paoting drain (no. linear ft.: 1 Page 2 Snitc/hldg./apt, no.: hd PrnieetnAmo: S mnierfloid At+ts Matmtetnree hams atititios 110.00 Clara stmetiditttliona to jab silo; Manholes 16.60 Rain d ain enereetar MIN 1.6.51) WWII Sari wry sewer (tw, lineal ft.; 11: Storm sewer Otn. linear R.; ) Page 2 Water service (no. liaoar 4.: Page 2 Subdiviniorr Lot ne.: ftlatare or item Tax map,parce too.: _ _ /d,sovgon valve 16.60 T `: Batkilow ptevaRter Pogo 2 1upptyftnala11 13WV di water plymhing Cox clothes dryer Renhwater valve [6.60 • Clothes washer 1 16.110 16.60 ..- Ptah washer 16.60 -- a Dde]ttngftunatn 16,60 I !',: , _, ' , :, a . I Pirelt?te/FUmp 111 16.60 Name; WSC Real 1Q4ra+e, Inc - Expansion tank 16.60 • Adorr,SS: 1500 SW First Avenue. Sake 1020 EMMEMMENIMM11111 16.60 Ci y,.Si ta/ZIP; Portland, OR 97201 Roar drain /flow aink/bub 16,60 • Phnnc: 1, 509)54(.47'12 Fax: (503)5465301 Garbage disposal 1640 p S i .T. ,--r Hanablh 16.60 ° P ;. ,. ,,..-,i . rii I . . S , t l n. , -t c x. f n lc r 'FAO 1 1 SuF1 aces Hama: Skyward Construction, Inc inl:^c4ptor /grease tray . 16.60 Contact norm Chad Wa1'ker Medical gas (value: S ) ill Paso 2 Address: 1 N!; 10 Avenue Primer 16,60 CirfeStatolZIP: Ridgefield, WA 98661 Roofthola (cammotClai) • 16.60 Sink/basin:lavatory 16.60 Phone: (31411) 546 - 1625 I Fax:: (360)546 30 nih /nhowcrtnhnvrcr awl 16.60 E-mail: chad ®ekywardcorauttetaon.totn Urinal 1111.1 16.60 f .kF'.t ?t .: . r , . .. , }. .i ; i , .ii., :,• 7,. J ./. .. Water dent MNIMI Business name: Ka',+'s PInm1>sng water hmcer _ 16.90 Addteis: 152001c1F Caplen, Suitt C Other: ' Subtotal City /State /Z1P: Brush Prairie, WA 98606 Mllilmum omit fee: 572.50 Fhuee: (3W1) 5924700 Fax: (360) 892 -9644 Rondrntio1 beoklen minimum 9errtit. fee: 53625 CCB tic.: 31207 Plumbing Lie, no.: 31 -Jyc pa Plan review (2558 of permit fee) State narchorge (a44 or permit fee) .a•.ithonzod signature: I / TQPAL PERMIT F613 pri7rn tnc Ditto: Q./ This permit tisnotobtainedwithltt yang. 180 days Mier it Ions been accepted as complete. 'fee mathoeology set by Tr}.Connty Rending fidustry Service Board. p.'.nn;t .,,eis Tn :.nur- rcrro.co.be aR,asOa 4441.1rrctirnofiarr{Mle+atoi ;/"" Building Division TIGARD Request for Permit Action TO: CITY OF TIGARD Permit System Administrator 13125 SW Hall Blvd., Tigard, OR 97223 Phone: 503.718.2430 Fax: 503.598.1960 www.tigard-or.gov FROM: ❑ Owner ❑ Applicant . Contractor ❑ City Staff (check one) REFUND OR Name: INVOICE TO: (Business or Individual) 5 K y war Gn S(' VOID Mailing Address: /-c900 City/State/Zip: / �9 b t' 4)E/0 C t u e / 2 3 oz 6 � 7 � /State /Zi p * r �.�1/9 / / Phone No.: 3 Co /C 5 PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): b CANCEL PERMIT APPLICATION. REFUND PERMIT FEES (attach receipt, if available). ❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below). QQ nw-.� El REMOVE REMOVE CONTRACTOR FROM PERMIT (do not cancel ermit). cevvve "' 9" to • Permit #: 1--) 4 , (1 O o o'1 ci /Ke (,IA Site Address or Parcel #: / 0 3 r,✓ 1"t eu d o e„! CV 0 le �2.... Project Name: S r•tR �r f d ATT Subdivision Name: E,Jj1 /6 VO � .,� Lot #: EXPLANATION: TeA)O„ i Can/ c-e le d GJ G, tvr, /r f a gin• s �u 1 4 2_ dtVuL 11 4 0-411J4t1/42, pit/ 7 6 it • Lit/V1/41,0ALCAAA-)1 Signature: ,v c— Date: 3 -/c'-Or) Print Name: kfR ,`3 v 0. uI%) Refund Policy 1. The Director or Building Official may authorise the refund of: a) any fee which was erroneously paid or collected. b) not more than 80 °-0 of the land use application fee when an application is withdrawn or canceled before any review effort has been expended. c) not more than 80% of the land use application fee for issued permits. c) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended. d) not more than 80% of the building permit fee for issued permits prior to any inspection requests. 2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds. FOR OFFICE USE ONLY Rte to S Admin: Date As'Q -m Rte to Bld• Admin: Date �® B y�f Refund Processed: Date 3 a 6p 7 By i '47 Invoice Processed: Date By ✓ Permit Canceled: Date / �� n 7 By-4W- Parcel Tag Added: Date By /� Receipt # e 7 — ,5 Date p 7 Method ' Amount $ /� I: \Building \Forms \RegPermitAction.doc Re i05/24/06 = r _ � `�— o _� • _ -„m„—