Permit CITY TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 1/10/2007
PARCEL: 2S 111 AD -13600
SITE ADDRESS: 15107 SW 91ST AVE ZONING: R -4.5
SUBDIVISION: MALLARD LAKES LOT: 002 JURISDICTION: TIG
Project Description: Replace 50' water service.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: R3 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: 50 ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
HOUGHTON, RAYMOND C II AND
CAROLYN B Description Date Amount
2000 CONESTOGA LN [PLUMB] Permit Fee 1/10/2007 $72.50
WEST LINN, OR 97068 [TAX] 8% State Surcha 1/10/2007 $5.80
Phone : 503- 638 -2062 Total $78.30
Contractor:
•
MP (MILWAUKIE) 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 503.246.6699 or 1.800.332.2344.
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Issued By: 41,144144.tftui Permittee Signature: lJ /1
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: 01/10/2007 10:38 1t473 P.002 /003
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Plumbing Permit Applicati i ►� 1 ��. 2001
' . FOR OFFICE USL ONLY Y
City of Tigard ` . r 'i _ Receives dQ
13125 SW Hall Blvd., Tigard, OR 97223 C i Date/11 ' >Dg Permit No. � y �/�{ i t .
Plan Revie
Phone: 503.639.4171 Fax: 503. 598.196 11,11\ �P.,': r w�y r :'; Dale/By. Other Permit No.:
24- Hour Inspection Line: 503.639.4175 p� •' I Date Read B : feria/' t3
°_ ' - y Y See Page . for
Internet: www.ci.tigard.or.us Notified/Method: ` f Supplemental Information
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�� .Ifel�uill6,ltu�;r�111.6,�.tir 1,6,_II.�[1I �N..,.l...�._L_ 1���i�;�� l:;+n.,.,�.,sp.tl.Ji.li1S >, L!.l,�lL Llttu�.i G ��ut; ��tlli�U�., L,. 1. 11�1t�3,. f.. s, �l., c' �nc, olt� :v�e�ilra »l.,�i�amlla:�f,1��, Rily;,t , - ��.yAll
❑ New construction ❑ Demolition For special information use checklist
Description J Qty. I Ea. I Total
Fi Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
c r p I r jr( i; l jj1sirr 1 !1u 1t > rlu, :' a f a m p fnr{ tq. a� " S FR bath
u I 1 - f iri J, aTll%R4 - r tO. I tf! Ylrw i i I� IiIII #r . 1 5 t � l 1 f l
v I. 1 �... utl 1 z �0 fi l ( 249.20
t l •. ti'.�. t ` a 1:1 r �L� sr3tt .,, ,.f.6 ,n� I 'fit x �1.�i�1u _,. �sllu;.� �_ • s €��! . s.i,r � as:.
Ii 1- and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑Multi - family
SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
i ; a , t Fire sprinkler ( sq. ft) Page 2
? �� ' 11 � { F( flP i �r 4U + I X76 r�IfN i f ll L 2 �fP�€ 1 !:;�iiiv li N lld{ s �E {� } g
F p limpil i� omi f f ti� B h t 1 i ,t 1 3t I lr4th 1! lii: � 1
llLtt n klr,1 tP , as or. ,, il'iz 1 1mhlti!1+_ ,..ht l r3 W; , le2 t 4 _1, ILI S ut
Job site address: J j l S . , Catch basin or area drain E 16.60
City/State /ZIP: ,d i,- '72,? 5/ Drywell, leach line, or trench drain 16.60 ,
Suite/bldg. /apt, no.: Project name: Footing drain (no. linear ft.: ) - Page 2
A� ` 0!1 Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2 '
Storm sewer (no, linear ft.: f } ., ) t . Page 2
Subdivision: I Lot no.:
Water service (no. linear ft.: h t9) I Page 2
•
Tax map /parcel no.: Fixture or item
N 4 I n,lltit it t t 1 m, ma r, r I Fl„ t t Absorption valve 16.60
I
° rt i `` ,a�c°fP1at , li l i rtk 1 ii '� TI '
`' �� a. �,,,.. iii t.�,1t!- .�a...r�. ��..x- , sft. �.luial !l�t��r�a�3111i �at3 t3l��i,,:�t{ ., i�-� !,, +� r !£,f Backflow preveater Page 2
o ' 1. Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
' � ''"' - t t01 kf m• i+ed&7iw'�: z t n� i>�• t C ^ n P , 'r� aN i,.a3}tt„1 t �; ! 0 r 1 e gTr- Drinkm fountain 16.60
� 1 rt � >r l l t fi . �. k� i - f :.t 1, x,31 1arN ilm 41 ' �,.i i; :*;1.,1 g
F,jectors/sump 16.60
Name: M / s /1/_ / Expansion tank 16.60
Address: ir ., . / c Fixture/sewer cap 16.60
City/State /ZIP: h t &iir/ f P1 97,eg Floor drain/floor sink/hub , 16.60
Phone: ( Garbage disposal
( ) ,�� , / Fax ( ) . 16.60
y I i { 1 , 1, C i a ny I I , L 1=ivAtF t 'i ti�4ji I n Inn ir311� 1;11 � ; `w , 511"[1 I1tgl ff Hose bib 16.60
L e Li !h.. t� ; Y r ` , ,L. rt t t 1 ` x ` , Eitk . i ' )ll ; ....I ft ; IL I m i ur .!n ?� ; vr,ia ,i ! $ Ice maker 16.60
Business name: MP PLUMBING CO.
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
Phone: (503) 655 -9161 I Fax: : (503) 650 -7050
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
1 i �� r �� �ttl( ��,�, ,,��<g pg'��, i� n� t
7, ` ; s ' wuss . ��. r�{ 1 it i pi � 1 N '�yj�i a lg l u �t 1 � t j+ }�sE , (
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' ill 1 , [1 i II
l it iiUl l it fi '"il 'w� 1i , 1 1[I t I i Ii ll ts'jr� ,li :? i�.1 leitil il i{ill Water closet 16.60
Business name: MP PLUMBING CO. Water heater 16.60
Address: PO BOX 393 Other.
City/State/ZIP: CLACKAMAS OR 97015 Subtotal 5
Minimum permit fee: 572.50 r
Phone: (503) 655 -9161 Fax: (503) 650 -7050 Residential backflow minimum permit fee: S36.25 74 .
CCB Lic.: 5002 Plumbing Lic. no.: 3-17PB Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Authorized signature: 11� • `y// TOTAL •PERMIT FEE 9F,
Print name: TAMI GEORGE "` Daftly, /7 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\PLM- PermitApp.doe 06/05 440.4616T(10/02/COMPWEB)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: PLM2007 -00008
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1110/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ■
INSPECTION WORKSHEET FOR DATE: 'x/1212007 TIME: 7 :04AM PAGE: 213
SITE ADDRESS: 15107 SW 91ST AVE CLASS OF WORK:
SUBDIVISION: MALLARD LAKES LOT #: 002 TYPE OF USE:
PROJECT NAME: HOUGHTON
DESCRIPTION: Replace 50' water service.
OWNER: HOUGHTON, RAYMOND C II AND, PHONE #: 503-638-2062
CONTRACTOR: MP (MMIILWAUKIE) PLUMBING CO PHONE #: 503 - 655 -9161
Inspection Request Scheduled For: Date: 1/12/2007 Pour Time: •
Code # Inspection Description Confirm # Contact # - -
330 Water service 042071 -01 503 - 656.9161
Corrections/Comments/Instructions:
C( •
74 PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: /j Date: t- Phone #: (503) 718- ��`"/