Permit n CITY OF TIGARD PLUMBING PERMIT
� COMMUNITY DEVELOPMENT PERMIT #: PLM2008 -00253
DATE ISSUED: 6/5/2008
_mien.:" 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134DD -01500
SITE ADDRESS: 11777 SW TIEDEMAN AVE ZONING: R - 4.5
SUBDIVISION: LOT: JURISDICTION: TIG
PROJECT: VAN DOORNINCK
Project Description: Fire repair, other fixture is (1) expansion tank.
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: 1 CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: 1 URINALS: GREASE TRAPS:
LAVATORIES: 2 OTHER FIXTURES: 1
TUB /SHOWERS: 1 SEWER LINE: ft
WATER CLOSETS: 2 WATER LINE: ft
DISHWASHERS: 1 RAIN DRAIN: ft
Owner: FEES
WOLTER VAN DOORNINCK
6555 SW DALE AVE Description Date Amount
BEAVERTON, OR 97005 [PLUMB] Permit Fee 6/5/2008 $149.40
[TAX] 12% State Surcha 6/5/2008 $17.93
Phone : Total $167.33
Contractor:
MP PLUMBING CO
P.O. BOX 393
CLACKAMAS, OR 97015 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 655 -9161 .
FAX 503- 650 -7050
Reg #: LIC 5002
PLM 3 -17PB
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 46 6699 or 1.800.332.2344.
Issued
■ Permittee Si gnat e: ice i /a
/ '
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.
- ��From: 06/04/2008 10:04 11573 P.001/002
Plumbing Permit Anplicati � v . /
Building Fixtures ` , I At rtili c►rric1 ( ci�ii ,. ;.'
City of Tigard
J U I V � � 2 ( . Rece •. B � permit N .. .
• • DateB . iew
111 ' �offi , ,� o. : L1 y g ex S3
13125 SW Hall Blvd., Tigard, OR 97 }iii ' Plan Rev
. Phone: 503.639.4171 Fax: 503.59851860 1 �` 1� 4
ov '
lrp1e aWBy: Other Permit No.:
T l G n l: a
Inspection Line: 503.639.4175 4° '' 8 r; ^� l j j 1: Ia Read /B : .r
Int www.ti or. �� �' Y Y S See Pag 2 for
g Notified/Method: /(p Supplemental Information
TYPE OF WORK ,...: FEE *' g ',; ;a
' CBEDULE
❑ i ❑ Dem olition For special information u
New constructi ./• use checklist.
Description 1 Qty. f Ea. 1 Total
J5 Addition/alteration/replacement 0 Other: New 1- 2 -family dwellings (includes 100 ft. for each utility connection)
CATEdiiiik OP CONSTRUCTION _ SFR (1) bath 249.20
rii 1- and 2- family dwelling a Commercial/industrial SFR (2) bath _ 350.00
❑ Accessory building ID Multi-family SFR (3) bath 399.00
El Master builder Each additional bath/kitchen 45.00
❑ Other
Fire sprinkler sq. ft.) Page 2
'i JOB BTTE IIVFORA7AITON `AND LOCATION 1 Site utilities
Job site address: /J 777 . hi,/ (jj/� //77.d /, f jj , i +_ - Catch basin or area drain 16.60
City /State /ZIP: 4 1/j /t Irrf //0 I,J� g Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: Project name: l e rya � , J�, Footing drain (no. linear ft.: Page 2
Cross street/directions to job site: Manufactured.home utilities 110,00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: Page 2
Storm sewer (no. linear ft.: ,) Page 2
Subdivision: I Lot no Water service (no. linear ft.: _) Page 2 1
Tax map /parcel no.: Fixture or item
Absorption valve 16.60
` _� ' ; ; ; DF$6111li 70N'OF, WORK c o revers
...._ .. ,. . . , < - . �.. .. .. Ba kfl w p ter Page 2
?;1.EL Backwater valve 16.60
.i90//'
90// Clothes washer 16.60
- Dishwasher J 16.60 / k . &r%
't. , . PRQPFdtTY O i l i l e 1 :c Ejec is sump 3 Drinking fountain 16.60
Name: L( � � Y, v ?�1 : 'r ` �( r )�� I 16.60
Expansion tank i 16.60 14 u�
Address: 4 355 a LA.) - 7 - J, 4 9 t)/ E S IZ71� � Fixture/sewer cap 16.60
City/StateJZTP:" 3 02 e e 1009 Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
11 ' �1 x APPLLC iifF. ' `!i: ❑: ONTAC T ; PERSON ` Hose bib 16.60
Ice maker 16.60
Business name: MP PLUMBING CO., INC.
Interceptor/grease trap 16.60
Contact name: TAMI Medical gas (value: $ _) Page 2
Address: PO BOX 393 Primer 16.60
City/State/ZIP: CLACKAMAS OR 97015 Roof drain (commercial) 16.60
16.60 i
Phone: (503) 655 I Fax: : (503) 650-7050 Sink/basin / lavatory 7 ,/.
it
Tab /shower /shower pan ) 16.60 .g ,de,
E - mail: TAM1G@MPPLUMBING.COM
Urinal
16.60
r ,`: . !:1.. ai, � f i4.1,CONT1tACTt)R ; ii :...< ,._ i,i,` E0 ..;a ''_ Water closet 1 16.60 3 �...-
Business name: MP PLUMBING CO., INC. Water heater / 16.60 ft 619
Address: PO BOX 393 Other:
City/ State/ZIP: CLACKAMAS OR 97015 Subtotal AA . 5,-.
Minimum pemtit fee: 572.50
Phone: (503) 655 -9161 Fax: (503) 650 -7050 Residential backflow minimum permit fee: $36.25
CCB Lic.: 5002 Plumbing Lic. no.: 3 -17PB Plan review (25% of permit fee)
Authorized signature: diii /� State surcharge (12% of permit fee) /i J%
`� // TOTAL PERMIT FEE / L ��
Print name: TAMI RILEY Date: �,1:A Tbis permit application expires if a permit Is not obtained within
i�' 180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
1: 1Bui1ding \Pcrtnits\PLMF- PamitApp.doc 12127/06 440.4616T(10/O2/COM/WEB)
CITY OF TIGARD 1
BUILDING DIVISION PERMIT #: PLM2O08 002%3
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: €iia►2008
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 619/2008 TIME: 7:01AM PAGE: 29
SITE ADDRESS: 11777 SW TIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: VAN•000RNINCK
DESCRIPTION: Fire repair, other fixture is (1) expansion tank.
OWNER: VAN DOORNINCK, WOLTER PHONE #:
CONTRACTOR: MP PLUMBING CO PHONE #: 503 -655 -9161
•
Inspection Request Scheduled For: Date: 6/9/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
320 Plumbing rough -in 071081 -01 503.655 -9161 Y
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ANrAL'A1`--2_ Date: ro 0 11(.)Qi Phone #: (503) 718-