Permit (47) CITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00318
T[GA D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2017
Parcel: 2S110DD00109
Jurisdiction: Tigard
Site address: 11033 SW SUMMERFIELD DR 2
Project: Summerfield Appartments Subdivision: WILLOW-BROOK-FARM Lot: 15
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.
Issued By: ', Permittee Signature:
'
Call 503.639.4175 by 7:00 a.m.for the next available inspectio late.
This permit card shall be kept in a conspicuous place on the job site until co pletion of the project.
Approved plans are required on the job site at the time of each inspection.
Plumbing Permit Application
Building Fixtures REC .
City of Tigard Received ftt
.111,1 U 13125 SW Hall Blvd.,Tigard,OR 9722,,3,,�,( i.--i.
Date/By: � Permit No.�/A/ r)�Z/�
: ■ Phone: 503.718.2439 Fax: 503.598.k u7 7�� 1 Plan Review Other Permit No ' t/ J
1 1 G ARD Inspection Line: 503.639.4175 Date/By: Ce 2 for
Internet: www.tigazd or gov yp Date Ready/By .runs: Supplemental Sleee Page 2 for
n�; I ._ y Information
Notified/Method:
..,e y �.r, .x� ,�,a. � �3. �-11--,Ir� I.- "ea IA- �:t �` ��t -�=� ice, ;,� -�rs� 3V
: . r t. 1 . . ,4 ,' s , , . ,s .tom ...„,':--wit,,,,-).-.;:::,
For special information use checklist
❑New construction ■ Demolition
Description
❑Addition/alteration/replacement (f Other Lad,d r j �� QtY• I Ea. Total
W ,S - New 1-2-family dwellings(includes 100 ft.for each utility connection) _
,1 _ r-141 441NA A 1 ,.. SFR(1)bath 312.70
❑ 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500132
0 Master builder Each additional bath/kitchen 25.02
❑Other.
Fire sprinkler(_sq.ft.) Page 2
~ 6� f
� • ulti ..� r, rj•. � � � iiiies:
Job site address: I 0 S 3 S , . ,(_ . _ pr Catch basin or area drain 18.76
City/State/ZIP: t t k��l U� q 7 Z 2 4 Drywell,leach line,or trench drain 18.76
L l Footing drain(no.linear ft.:_) Page 2
Suite/bldg./apt.no.: I Project name: s J•.Nel f.,c..1.1
Manufactured home utilities 50.03
Cross street/directions to job sitsManholes 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
. ,, s d ° f Axa 4 ,* Backwater valve 12.51
(/' rr �*� 4 Clothes washer
l o Ce. t k • 0 as {� n 25.02
9_UtDishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
' ,,, :: t :), .,.-' t :g A, �� �, , "`:� Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain/floor sink/hub 25.02
Garbage disposal 25.02
City/State/ZIP:
Hose bib 25.02
Phone:( ) Fax ( )
��, � �' Ice maker 12.51
.` � a a � t +p $() J Interceptor/grease trap 25.02
Business name: Set v r Cwt 4u�-� Medical gas(value:$ ) Page 2
Contact name: N �tLLi LC kik Primer 12.51
Roof drain(commercial) 12.51
Address: 91/0 5,4 c) 0/ 1"....
Sink/basin/lavatory 25.02
City/State/ZIP: 4 t m/ G z2- Solar units
/ �� � (potable water) 62.54
Phone:( s'p'S ¢i cr 5)g 7 Fax::( ) Tub/shower/shower pan 12.51
E-mail: tt f.is�. .C..,,,..N_ Urinal 25.02
Water closet
CON '�3R � 25.02
. ., ,... s . Water heater
.-.� :: 37.52
Business name: Pia iiii c Pb..../4/4/i4;...
Address: Water piping/DW V 56.29
`;';�y Sin 5--/-
Other: 25.02
City/State/ZIP: I/G KPOH vr`. 1/i/4( i6
Subtotal
•
Phone:(r?7) 37ri.2 713 Fax:( ) ,/j/� Minimum permit fee: $72.50
CCB Lic.: i4 All�O Plumbing Lic.no.: ��`7 � Plan review (25%of permit fee)
Authorized signature:
9�i a- - State surcharge(12%of pemvt fee)
�f tYi TOTAL PERMIT FEE
Print name: /I t`K. W fC lye Date: D..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:\Building\Permits\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:
11033 SW SUMMERFIELD DR 2, TIGARD, OR,
97224
Record Type: Record ID:
Commercial - Plumbing PLM2017-00318
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor