Permit n CITY OF TIGARD PLUMBING PERMIT
7
° COMMUNITY DEVELOPMENT PERMIT #: PLM2007 - 00352
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 8/8/2007
PARCEL: 2S111BA -12500
SITE ADDRESS: 09551 SW MOUNTAIN VIEW LN ZONING: R-4.5
SUBDIVISION: TEMPLETON HEIGHTS LOT: 005 JURISDICTION: TIG
PROJECT: TEMPLETON HEIGHTS
Project Description: Backflow preventer for irrigation.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Owner: FEES
MASTERPIERCE CONSTRUCTION, INC
13849 SW MISTLETOE LN. Description Date Amount
TIGARD, OR 97224
[PLUMB] Permit Fee 8/8/2007 $36.25
[TAX] 8% State Surcha 8/8/2007 $2.90
Phone : 503- 750 -5549 Total $39.15
Contractor:
MALMEDAL ENTERPRISES INC
PO BOX 207
BANKS, OR 97106 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 324 -0759
Reg #: LIC 102535
PLM 34 -276PB
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.
a
Issued By: C Permittee Signature: a
vvv
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.
4mnbing Permit Application
FOR OFFICE USE ONLY
F.' . City of Tigard g '' . j e f R7 A Received t y Are J� i. - Permit N 7j-
Plan Review
f[/ i '- r
�7�
, q 13125 SW Hall Blvd., Ti ard, a • - 2 s
Plan Review
Phone: 503.639.4171 Fax: 5 8. 6 Other Permit No.:
2007 Date/By:
Inspection Line: 503.639.4175 D
y y;
T I G A 0 See Page 2 for
It Internet: www.li ard or. ov Date Read B
g g m ' -i6Amm Notified/Method: Supplemental Information
TYPE - ,1! WM DIVISiON FEE* SCHEDULE
F]'New construction ❑ Demolition For special information use checklist
Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
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:
Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities
Job site addres 9'65/ 5 ix.; �'��l u � ' L / � , � Catch basin or area drain 16.60
City /State /ZIP: `� l C{ 4 a IL /4 1. r \ t9 1 ' `1- 3 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: I Project name: Footing drain (no. linear ft.: ) Page 2
^fin � � Manufactured home utilities 110.0
,
Cross street/directions to job site: 9'^ � .- (\ (� •' (' e w
(( v 1 Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear ft.: ) Page 2
tVp1 CriltA, i9- rr I Lot no.: 3 Water service (no. linear ft.: ) Page 2
Tax map /parcel no.:
Fixture or item
Absorption valve 16.60
- DESCRIPTION OF WORK. Backflow preventer Page 2
j, C Ft ((t-0 (iv/ !VC Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
❑ PROPERTY OWNER ❑ TENANT Drinking fountain 16.60
n � Ejectors /sump 16.60
Name: ice` J I c-- f'i cc C j y ` s ? / h C • Expansion tank 16.60
Address: ('\ C `- a1 f - C J (' ` q "-? l c T ` r ' d Fixture/sewer cap 16.60
T City /State /ZIP t, J . it- ! V / `' r 4 I ' '2-1-3 Floor drain/floor sink/hub 16.60
Phone: I C! - S �� LL Fax: ( ) Garbage disposal 16.60
ag dis P
❑ APPLICANT . 0 CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name:
Interceptor /grease trap 16.60
Contact name: coli-i\i- Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) Fax:: ( )
Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRACTOR • Water closet 16.60
Business name: lvn ( A,t �� �, ( /of V b ( w c� Water heater 16.60
Address: ! /6 1ti a Other:
i 2
City /State /ZIP: �� ✓✓ 1 / • - k . . S . `1 r2-- Subtotal -
V Minimum permit fee: $72.50
Phone: ( ) Fax: ( ) II\\ r Residential backflow minimum permit fee: $36.25
CCB Lic.: ��umbing Lic. no.:/ V 2 ? 3 .� Pn dr (28% of permit fee
Authorized signature: State n surrec (8% of permit fee)
TOTAL PERMIT FEE 39 , P3
Print name: (i et,1' A w E-� -T'L Date: 1-4.--0 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 :\BuildingWermits\PLM- PermitApp.doc I2/27/06 440- 4616T(10 /02/COM/WEB)
CITY OF TIGARD ` -
BUILDING DIVISION PERMIT #: l ?i.M2007 -00352
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 818(2007
Phone: (503) 639 -4171 ono- '
Inspection Requests (24 Hrs.): (503) 639 -4175 "'I L
INSPECTION WORKSHEET FOR DATE: 2/8/2008 TIME: 7 :00AM PAGE: 25
SITE ADDRESS: 09 551 SW MOUNTAIN VIEW LN CLASS OF WORK:
SUBDIVISION: TEMPLETON HEIGHTS LOT #: 005 TYPE OF USE:
PROJECT NAME: TEMPLETON HEIGHTS
DESCRIPTION: E3at :kflow preventer for irrigation.
OWNER: MASTERPIERCE CONSTRUCTION, INC, PHONE #: 503 -750 -5549
CONTRACTOR: MALMEDAL ENTERPRISES INC PHONE #: 503. 324 -0759
Inspection Request Scheduled For: Date: 2/8/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 064735 -01 503 - 150-5549 N
Corrections /Comments/ Instructions:
C air Q, l c ( %.,a... Lea 9A,-/
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: (3 � ‘ v '' ''" Date: 2 IT I 0 crl Phone #: (503) 718-