Permit (48) mama
CITY OF TIGARD PLUMBING PERMIT
' COMMUNITY DEVELOPMENT Permit#: PLM2017-00319
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/15/2017
Parcel: 2S110DC01000
Jurisdiction: Tigard
Site address: 11065 SW MEADOWBROOK DR 6
Project: Summerfield Appartments Subdivision: WILLOW-BROOK-FARM Lot: 17
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
Class of Work: ALT Plumbing
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: "G%�` Permittee Signature:
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
Building Fixtures
1;r OOFFICI�: IS0.11.tifif1
City Of Tigard RU1EW, eived 7 ` ll /-�
INC111 13125 SW Hall Blvd.,Tigard,OR 97223 mate/By: ,t� I/` Permit E No.: p !/'�U 3I
Phone: 503.718.2439 Fax: 503.598.1960 Plan Review
Inspection Line: 503.639.4175 �' +% Date/By: Other Permit No �7'ZYJS
rlcnizu M ( a ZI it .'
Internet: www.tigard-or.gov ��-� Date Ready/By: loris: See Page 2 nor
fied/Method
� �* f� '�� bra, _t;,-,:- ;��{ � �.,„.� s ' Supplemental Information
n^ tc-7y :.e .s'f r rt Q d.. ` :N>•"` [,�- z1;;,-41-:.:',;!:=M:
- $ 6 44,..;-„,
in k. y,�t11,:��, �,.kJ�+f r .z@ 7 6, a- I 6 ''_�„ '�s"`
t :. {ms's'.s4.`% 3... ...,.:2
❑New construction 1 .
❑De+ ,� G , 1 For special information use checklist
Description
❑Addrtion/alteration/replacement Other: I , / („ � Qty. � Ea. � Total
,�: r ti.; Q0�(a r; W aye r New 1-2-family dwellings(includes 100 ft.for each utility connection)
�z4' '` r g tir'�et i,s`t Cr('k'( �` -Z ' y ,_ SFR(1)bath 312.70
0 1-and 2-family dwelling Commercial/industrial SFR(2)bath 437.78
❑Accessory building 0 Multi-family SFR(3)bath 500132
❑Master builder ❑OEach additional bath/kitchen 25.02
Other:
Fire sprinkler( sq.ft.) Page 2
':`, .:mss _ ;iI .lt ; 4! G , '� 4 'a K, �" " g
,,, ,4� -cam ,. a Site utilities:
Job site address: !/ b, ,5i` .� ; L.)r Catch basin or area drain 18.76
Drywell,+rt y ��l UOttl Z 2 4 leach line,or trench drain 18.76
1.Suite/bldg./apt.no.: / I Project name: 1 Footing drain(no.linear ft.:_) Page 2
S J"Nei i G Manufactured home utilities
Cross street/directions to job site: 18.76
Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.:__) Page 2
Subdivision: Water service(no.linear ft.: ) Page 2
Lot no.: Fixture or item:
Tax map/parcel no Backflow preventer
31.27
r:NVY'i'i-_ a (4- e c t ,. ,„- Backwater valvea„ -0 . „- , w 5 12.51
` 1 / � �'`�`� Clothes washer Mil to Ct )CLS& 1
�� Dishwasher I
Drinking fountain 25.02
i
<� �� � � Ejectors/sump I
u. :: - -7n-140,114-i- ! =s Expansion tank 12.51
Name: Fixture/sewer cap 25.02
Address: Floor drain floor sink/hub 25.02
City/State/ZIP: Garbage disposal 25.02
Phone:( ) Fax ( )
Hose bib I
rIce maker12.51
• . ""`?* ' � *���'� ', Interceptor/grease trap I
�° e Hciwl C�.. �-r -t _ -
Business name: C Medical gas(value:$ )
t y
Contact name: N tL� Lj Lc Primer 12.51
Address: I Q J Cc.j ,� J L4 Roof drain(commercial) 12.51
Sink/basin/lavatory i
City/State/ZIP: c, g �,
t / 4t, 0 k 77 e 2 1/
Solar units(potable water) 62.54
Phone:( S•-p S ¢i ( ,- 5)g 7 I Fax::( ) Tub/shower/shower pan 12.51
E-mail: I t tt..k-eis `e o ` Urinal I
CONTRACFOR" Water closet 25.02
Business name: �/J �pWater heater 37.52
/-YD/U4 ! 74, Q 4.11Water piping/DWV 56.29
Address: 3A t e 41 e .r--�7A_ .s 7 Other:
C '� O �� �/� 25.02
City/State/ZIP: Vakiefe, 14/4-vey-- ,i,a 3 Subtotal
Phone:(777) 3 7(e" .2)/3 I ( )
Fax: Minimum permit fee: $72.50
/7 7 Plan review (25%of permit fee)
Authorized signature: 911 7�j/26
CCB Lic.: 7 Z//709 Plumbing Lic.no.: / State surcharge(12%of permit fee)
kA
TOTAL PERMIT FEE
I Print name: Al t .t - W'tf I Date:%--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 10/01/09 440-4616TO0/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
11065 SW MEADOWBROOK DR 6, TIGARD, OR,
97224
Record Type: Record ID:
Commercial - Plumbing PLM2017-00319
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor