Permit (159) CITY OF TIGARD PLUMBING PERMIT
11 , ' COMMUNITY DEVELOPMENT Permit#: PLM2019-00151
and OR 97223 503.718.2439
13125 SW Hall Blvd.,Ti Date Issued: 04/16/2019
T(f,r4t.Ta 9
Parcel: 2S 109BA05000
Jurisdiction: Tigard
Site address: 13773 SW MISTLETOE DR
Project: Montgomery Subdivision: HILLSHIRE SUMMIT NO.2 Lot: 32
Project Description: Replacing(2)tub/shower pans,(2)lays,and(1)water closet.
Contractor: AMERICAN UNIFIED CONSTRUCTION Owner: MONTGOMERY, MARK J
2105 NEALS LN VANCOUVER 13773 SW MISTLETOE DR
VANCOUVER, WA 98661 TIGARD,OR 97224
PHONE: 360-213-6600 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 ea Lavatories 04/16/2019 $50.04
Specifics: 2 ea Tub/Shower/Shower Pan 04/16/2019 $25.02
1 ea Water Closet 04/16/2019 $25.02
Type of Use: SF 1 12%State Surcharge- 04/16/2019 $12.01
Class of Work: ALT Plumbing
Type of Const:
Occupancy Grp:
Stories:
Total $112.09
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 • started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow t ales adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. Yo • obtain a copy of the rules
or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
•
Issued By: 341\..A.... ...._
Permittee Signature: ' / —
/fi/ NIII
Call 503.639.4175 by 7:00 a.m.for the next available inspe •n 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 Applicatior
Building Fixtures RECEIVED
ECEIVE®
City of Tigard APR 1 Received
g' 6 2019 st 11. t t �y- Permit No uM i4-� t��
Date By: -
ig 1 3125 SW Hall Blvd..1 hard.OR 97223
Plan Restos
1 Phone 5(13.718 2439 fax. 503 598.101ATY OF TIGARDDate.BF Ocher Permit No
1 I c. );t4 Inspection Line 503.639.4175 BUILDING DIVISION Date Reath H's tnri, ®I See Page 2 for
Internet: vsww,tigard-orgov Notified Method Supplemental Information
TYPE OF WORK FEE* SCHEDULE
0. ❑Demolition For special information use checklist.
New construction
Description I Qty. [ Fa- I 1 otal
Additionraltcration'replacement ❑Other: New I-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY Y OF CONSTRUCTION SFR(I I bath 312.70
and 2-family dwelling 0 Commercialiindustrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building 0 Multi-family
Each additional hath/kitchen 25.02
❑'Master builder 0 Other: Fire sprinkler( sq.ft) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Joh site address: /3 9.73 si.J +,gut to e...... D17 Catch basin or area drain 18.76
F-• Dry well,leach line.or trench drain 18.76
( its State./IP: 04,,) OI- 9 7- l2_
Footing drain(no linear ft.:_) Page 2
Suitc!bldg apt.no.: Project name: 5
�(��^,"�{,\(xlR� Manufactured home utilities 50.03
Cross streetidirections to job site: �} Manholes IS 76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:_) Page 2
Storm sesser(no.linear ft.:-) Page 2
Water sen ice i no.linear Ii._1 Page 2
Subdivision: lot no.: Fixture or item:
lax map.parcel no.: Backflow presenter 31.27
DESCRIPTION OF WORK Backwater valve 12_51
Clothes washer 25 02
.I2e pIA(4.... Vic 5A1.1s'"`)e`r wM5 AVtt,.:) 54 ' Dishssasher 25.02
(A hit. -I-04-",14 At& ) rvift•'tA✓1 . Veil IlL. . Drinking fountain 25.02
a-,1641 Z. iti-tru. ibi 1 hlit.4- 1..., C°''yf i�Iii, LGe,aii/+u.$ Ejectors/sump 25.02
0 PROPERTY OWNER 0 TENANT Expansion tank 12 51
Name: Fixture/sewer cap 25.02
Floor drain/floor sinklhub 25,02
\ddress:
Garbage disposal 25.02
Cits'State'/IP: Hose bib 25.02
Phone:( ) Fax:I I Ice maker 12.51
0 APPLICANT ❑ CONTACT PERSON Interceptor grease trap 25.02
Medical gas(s aloe=$ ) Page 2
Business name:
Primer 12 51
i'ontact name:
Roof drain(commercial) 12.51
lddress: Sink;basin/lasatory "j_. 25 1)2
C its'State'ZIP: Solar units(potable water) 62.54
Phone:( I Fax::( ) 'Iuhlshower/shower pan '2.,, 12.51
F.-mail: I.rinal 25.02 1
CONTRACTOR Water closet I 25.02
Water heater 37.52
13usmess name:. rut„ ant, L,HS4-r 410et LLC.- Water piping/DWV 5629
!� lddress: V 05-- A1c I5 I�i,,t._ Other: 25.02
Cits:'State,/IP: kioN co tAtott.r. Ufj6t 98'Ggl Subtotal
Phone:(3tO 1101 -ri 5a__, Fax:( ..--t Minimum permit fee $72.50
Plan restew (25"0 of permit tee)
CCB Lie.: I eil et 5- Plumbing Lic.no.: p 4 55 1
State surcharge(I 2°10 of permit lee)
1uthori/ed
signature: 4,,, IOIAL PERMIT FFF
Print name: t C(i.AV1 ' ) %f, Date: 4 i 5' 11 This permit application espires if a permit is not obtained within Ifni days
after it has been accepted as complete.
*fee methodology set by Tri-County Building Industts Sw's we Baa+d
i Bmtling'Penins,P15)1 Femme App do, i c`f,} 440-4615110 D2.C 011112E g1
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
13773 SW MISTLETOE DR, TIGARD, OR, 97224 May 23, 2019 at 9:59:23 AM
Record Type: Record ID:
Residential - Plumbing PLM2019-00151
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS - NoCofO
Comments:
Violation Summary:
Inspector Contractor