11180 SW SUMMERFIELD DRIVE STE 1 �k
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11180 SW Summerfield Drive #1
CITY OF TIGARU-) 24-1•1.)ur
BUILDING
Inspection Lira- (503) 639-4175 MST - - -
INSPECTION DIVISIO14 Business Line: (503) 639-4171 BUP -
�Q AM BUP _----Date Re uested_____ --- --- F
Received _. l _ q �—
d-S�;�_--- -- MEG -- --
Location �
Suite-- ---
_____ Ph( ) - �- PLM �- 004
Contact Person -- —�-" SWR
- _- -
Contractor __ - — ------ Phi—) -
e3UILDING Tenant/Owner _—___
ELC
ELC -- -
Footing
Foundation Access: ELR -
Fig Drain __ _
Crawl Drain SIT
Slab Inspection Notes:
Post&Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing —
Insulation -
Drywall Nailing
Firewall — -
Fire Sprinkler —
Fire Alarm —
Susp'd Ceiling -
Roof
Other: -
Final -PASS PART FAIL ^.—
PLUMBING --
Post&Beam - —Under Slab ---- — -----_-^ _
Rough-In --. ----- —_
er ery --- --
ary Sewer
Rain Drains -�
Catch Basin/Manhole
Storm Drain
Shower Pan
Other. _ --- - ------- —� —
Fi
PART FAIL —----- ___ ---
MECHANIC_A_L ------ --
Post R Beam
Rough-In -- -- — --- --- _ _
Gas Line -- -
Smoke Dampers -
Final —s---- ------
PASS PART _FAIL -- _
ELECTRICAL — --- --
Service — —
Rough-In -
UG/SIaL --
Low Voltage — - '--'
Fire Alarm
Final Reinspecti,,n fee of$__---- required before next inspection. Pay at Cary Hall, 13125 SO?Hall Blvd.
PASS PART 'FAIL Unable to inspect-no access
SITE F] Please call for reinspection RE: --
Fire Supply Line Ext
�?
ADA
Approach/Sidewalk Date_ -
Other: p0�NOT REMOVE this Inspection record from the Job site.
Final
PASS PART FAIL
A C RI Y OF T I GA R D PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT#: PLM2003-00473
DATE ISSUED: 918/03
13125 SW Ii all Blvd., Tigard, OR 97223 (503) (jo9-4171
PARCEL: 1 S 134CB-00207
SITE ADDRESS: 12535 SW SUMMER CREST DR
SUBDIVISION: ;'ONING: R-4.5
BLOCK: LOT: JURISDICTION: TIG —
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
1 YPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS.
OCCUPANCY GRP: R: FLOOR DRAINS: TRAPS-
STORIES:
RAPSSTORIES: WATER HEATERS: CATCH BASINS:
_ FIXTURES _ LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB/SHOWERS: SEWER LINE: ft
WATL R CLOSETS: WATER LINE: ft
DISPWASHERS: RAIN DRAIN: ft
Remarks: Replacing 60ft. of\A ater line. —
FEES
Owner: _ _ Description Date Amount
MASON, LLOYD C +MYRNA R TRS 114 11MBI Pcrmit Fee 9/8/03 $72.50
12535 SW St'MMERCREST DR ITAX1 x stale Tax 9/8/03 $5.80
TIGARD, OR 97223 —
Total $78.30
Phone :
Contractor:
CROWN PLUMBING
5429 SE FRANCIS
PORTLAND,OR 97206 REQUIRED INSPECTI''VS
Water Line Insp
Phone : 503-771.9449 Final Inspection
Reg#: I.IC 42671
111.�i 3.4-701)li
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: Oregoo law requires you to follow rules adopted by the Oregon
Issued By: Permittee Signature:
Call (503) 639-4175 by 7:00 P.M. for an inspection needed`"{e._i xt b iness day
1
utlll ipg r IXtures
Plumbing permit Application
Received "lumbing
Uate/B : Pd VOt'ertnit No.: U3"QG .l
City of Tigard Da / pproval Sewer
atcte/BBy: Permit No.:
13125 SW Fall Blvd. Plan Review Other
Tigard,Oregon 97223 Dat B : Permit No.:Post-
Use
Phone: 503-639-4171 Fax: 503-598-1960 �,, Date/
Date/By: Land Case No.:
Internet: www.ci.tigard.or.us Contact Jun'f,• See Page 2 for
?4-how Inspection Request: 503-639-4175 Name/Method: ( supplemental Information.__
_ TYPE OF WORK V_ FEE"SCHEDULE(for special information use checklist
[� New construction [] ciTiolitio_n_
Description_ ,-�ty. Fcr(ca.) Total
r] Addition/alteration/re lacement Other: New 1-&2-family dwellings
(includes 100 ft.for each utllity cot nertion
CATEGORY OF CONSTRUCTION SFR 1 beth 249.20
I."1 k-2-Family dwelling-welling Commercial/Industrial_ SFR 2 bat. 350.00 _
Accessory Buildin _Multi-Family___ _ SFR 3 bath _ 399.00
Master Builder Other: Each addition♦. )ath/kitchen 45.00
JOB SiTE INFORMATION and LOCATION Firesprinkler- fl.: Pae 2
o
Job site address: .' , ��.. � „ ; �; �'� �c'i. y � Site Utilities _
Suite t $ld ./A t.#: Catch basin/area drain 16.60 _
Dr ell/leach line/trench drain 16.60 _
Project Name: -, Footing drain Lnu.linear ft. Pae 2
Cross street/Directions to job site: Manufactured home utilities 110.00
y Manholes 16.60
Rain drain connector 16.60
Sanitary sewer(no. linear fl.) Pae 2
LOt#: Storm sewer 'no.linear ft. Pae 2 -_
Subdivision: �- - Water service no.linear fl.) I'aU2
Tax map/parcel #: _ Fixture or Item
DESCRIPTION OF WORK _ Absu tion valve 16.60 _-
Backflow preventer Pee 2
--�� - - - - Backwater valve _ 16.60
Clothes washer 16.60
- -- - Dishwasher _ 16.60
_ Drinkingfountain 16.60
ROPERTY OWNER TENANT _ Ejectors/sump _ 16.60
Name:/ � 16.60� if� k
Address: 5 % s` Ir< _;� i��i//� 1) Fixture/scwer cap 16.60
.- Floor draintfloor sink/hub 16.60
City/State/Zi i(. �� C ' J i�arbage disposal 16.60
�Plione' 4 .:�'+✓' FSX: How bib 16.60
PPI,ICANT_ COT 1'PERSON- Ice maker 16.60
Name: !nterccptor/grcase trap 16.69
-,r-' - Page
• Medical gas-value: S _
Address: -;;S.�� �;i 6c J� .✓�11"'L'61 t' Prinicr Ih.6U
City/State/Zip:,//6 /J.G' r�'' -1 Roof drain commcrcia�J___ 16.60
Phone*.�,�;rC iy_ ', Fax: Sink/basin/lavatory 16.60
E-mail: _^J Tub/shower/shower an 16.60
CONTRACTOR Urinal 16.60
_
`--`�--- `---- Water closet 16.60
Business Name: c � �
t ----_--- - --- Water heater ----- I6.60
Address: Other:
City/State/zip:1 4(i i ) `/ Other.
Phone: •c;, ri Fax: Plumbin Permlt Fees*
`L ��` Subtotal S _
CCB l.ic. #; -"'Z 7 1 Plumb. LlcA Minimum Permit Fee$72.50 S
Authorized -7 � - Residential Backflow Minimum Fee$36.25 "?J
Signature:, t�C-/._Lr Date:
Plan Review(25%of_ _
_ �-.-�- Permit Fee S
State Surcharge 89'a of Permit Fee $
(hlcase print _ TOTAL PERMIT FEE $
;
Warne)
Notice: This permit application expires If a permit Is not obtained within All new commercial buildings require 2 sets of plans with Isometric or
190 days after it lus been accepted as complete- riser dlagram for plan review.
*Fee.aethodology set by Tri-County Buildinp Industry Service Board.
1\DstAPermit romts\PlmPcrmitApp w)c 01/03
Plumbinp.Permit Application - City of Tigard
Page Z -- Supplemental Information
C,1'ee Schedule: Residential Fire Suppression Systems:
Site Utilities _ Qty. free Ica) Totai Square Footage: Permit Fee:
Footing drain- 1"10' 5500 0 to 7000 _ _ — $115.00
Footing drain-each additional 100' 46.46 2,001 to 3'600 — $160.0
3,601 to 7,200 $220.00
Sewer- Ist 100' 55.0 7,201 ane greater $309.00
Sewer-each additional 10' 46,40
Water Servire- Ist I(NY 55.00 Medical Gas Svstems'
Water Service-cacti additional 100' 46.40 _ Valuation: Permit Fee:
Stour,&Rain Drain-Ist 10' 55.00 $1.00 to$5,000.00 Minimum fee$72.50
Storm&Rain Drain-each additional 100' 46A0 $5,001.00 to$10,000.00 $72.50 for the first$5,000.00 and$1,52 for each
additional$100.00 or fraction thereof,to and
Fixture or Item Qty. "'ee(ea) 7 olal including$10,000.00
Commercial Back Flow Prevention Device 4o 40 $10,001,00 to$25,000.00 $148.50 for the first$10,000.00 and$1.54 for
Residential Backflow preventinn Device each additional$100.00 or fraction thereof,to
minimum permit fcc$36.25) 27 55 and including$25,000.00
Rain Drain, ot,gie family dwelling 05.25 $25,01.0 to$50,0(10.0 $379.50 for the first$25,000.0 and$1.45 for
Inspection of cxistiug plumbing or each additional$100.0 or fraction thereof,to
specialty requested inspections-per hour 72.50 and including$50,000.00.
Subtotal $50,01.0 and up $742.00 for the first$50,00.0 and$1.20 for
each additional$10,0 or fraction thereof.
Fixture Work.
Are yot:capping,moving or replacing existing fixtures? If'
"ye,,",plea a indicate work performed by fixture. Failure to
ii-curateiy report fixtures could result in increaser) sewer fees*.
Quantity b Fixture Work Performed_ Comments regarding fixture%work:
Fixture Type: Replace
_ New Moved F,114tin Cap ed - — ---
Ba
!lath "ib/Shower
-Jacuzzi/Whirl pool --
Car Wash -Bach Stall
-Uri vc'i'hru
Cuspidor/Water Aspirator -�
Dishwasher -Commercial -
-Do,nestic
Drinking Fountain -�-Eye Wash
Floor Dmin/sink .2"
.Y -
-4" _ __ _
Car Wash Drain — *Note: If the fixture work undo, This permit results in an
Garbage -Domestic _
Disposal -Commercial _ - increase of sewer EDL1s,a sewer permit will be issued and
-industrialfees assessed for the sewer increase must be paid before the
Ice Ma,ii./R0169.Drains _ —�� plumbing permit can he Issued.
Oil Sspnratoi Gas Station
Rc..Vehicle Dun Station
Sho,vcr -Gang
-Stall
Sink -Bar/Lavatory
-Bradley
-Commercial
-Service
Swimming,Pool Filter
Washer-Clothes
Water Extractor _
Water Closet-Toilet _
Urinal
Other Fixtures:_
is\Dsts\Permit Fnnns\PlmpermitAppPg2.doc• 01103