Permit CITY F TOG "k PLUMBING PERMIT
'- COMMUNITY DEVELOPMENT
PERMIT #: PLM2008 -00277
Tr t; 0 „ 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 6/25/2008
PARCEL: 25111 DC -14700
SITE ADDRESS: 15993 SW KREICK PL ZONING: R -7
SUBDIVISION: KREICK MEADOWS LOT: 001 JURISDICTION: TIG
PROJECT: PAUL
Project Description: Installing backflow preventer.
CLASS OF WORK: ALT 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
PAUL CICINORUE
7501 SW 195TH PL Description Date Amount
ALOHA, OR 97007 [PLUMB] Permit Fee 6/25/2008 $36.25
[TAX] 12% State Surch 6/25/2008 $4.35
Phone : Total $40.60
Contractor:
MECHANICAL SERVICES INT. LLC
21185 NW EVERGREEN PKWY
STE. 106 REQUIRED ITEMS AND REPORTS
HILLSBORO, OR 97124
Contact # : PRI 503- 439 -9999
FAX 503 -439 -1 999
Reg #: LIC 126015
PLM 37-421PB
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. Permittee Si nature:, - — __ •
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.
:.Plumbing Permit Application
i
Building Fixtures ; 6 4W R
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City of Tigard Received l Qc-
p Permit No.: j �
l v 13125 SW Hall Blvd Ti OR 972,- i 0 P lan Review `
0 ; Phone: 503.639.4171 Fax: 503. A ti t c • - -' ` k % , Date/By. 01her Permit No.:
a its Inspection Line: 503.639.4175 - -' w\ ��
YT f G A R'D` Ready /By: Ions: ® See Page 2 for
e z.vt srs ardor. ov \v i Internet: www.ti 1
g g \� ��� � � ohfi Z( Supplemental Information
TYPE OF WORK J _ Q� FEE* SCHEDULE
❑ New construction El D For special information use checklist
SI ��V Description Qty. Ea. 1 Total
Addition /alteration/replacement ❑ Olhet�� New 1- 2- family dwellings (includes 100 ft. for each utility connection)
CATEGORY OF CONSTRUCTION • SFR (1) bath 249.20
® 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00
❑ Accessory building El Multi-family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other. Fire sprinkler ( sq. ft.) Page 2
JOB SITE INFORMAT ION AND LOCATION • Site utilities
Job site address: /5 L `I 3 S Lk) /-i r e i c k Fl Catch basin or area drain 16.60
City/State /ZIP: �' , . P• 6 l 2 G� 2 41 Drywell, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 I Project name: Pp, �t c ,' No as Footing drain (no. linear ft.: ) Page 2
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.: ) Page 2
Subdivision: Lot no.:
Water service (no. linear ft.: ) Page 2
Fixture or item
Tax map/parcel no.: Absorption valve 16.60
DESCRIPTION OF WORK
a Backflow preventer ( Page 2
.. I1✓ 5 r?+(( r, c- 3 L t
� W 6A..19- U-61 r... C 14 e e1 Backwater valve 16.60
l Clothes washer 16.60
=1s ✓ ; le r' • � �T . 6 ,-J Std- s i .e... ->^
Dishwasher 16.60
PROPERTY OWNER I ❑ TENANT Drinking fountain 16.60
Ejectors /sump 16.60
Name: ? -L 4 C. C t f1 By�..� Expansion tank 16.60
Address: 54, ....e..., Fixture /sewer cap 16.60
City /State /ZIP: Floor drain/floor sink/hub 16.60
Phone: ( ) Fax: ( ) Garbage disposal 16.60
• ❑ APPLICANT ❑ CONTACT PERSON Hose bib 16.60
Ice maker 16.60
Business name: Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) F es:: ( ) Sink/basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: Urinal 16.60
CONTRACTOR Water closet 16.60
• Business name: /'6 w : G'D._k S S 1.wT L Le. Water heater 16.60
Address: 2It S /L c o E ✓ e✓ 0 C e N ?K fe h e6 Other:
`, Subtotal
City /State/ZIP: 1'L t ((S to wf d . 7 7! 2 et _
Minimum permit fee: $72.50
Phone: ( C1 3 ci - ' i 9 G Fax: (S 8 3) ' j 3/_/11 7 Residential backflow minimum permit fee: $36.25 3L 2-s-
CCB Lic.: ' L b b i s 7 Plumbing Lic. no.: 3'7 - q `Xj pe Plan review (25% of permit fee)
State surcharge (12% of permit fee) /35
Authorized signature: ��tAIV
_ A Ili+ . ` TOTAL PERMIT FEE /0
I Print name: & j i ,� 1 I Dater QsA G� This permit application expires if a permit is not obtainwithin
1 t 180 days after it has been accepted as complete.
CITY OF TIGARD =
BUILDING DIVISION PERMIT #: PLM2008- 00277
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: €125/2i10ti
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 7/15/2008 TIME: 7 :OOAM PAGE: 45
SITE ADDRESS: 15993 SW KRElCK PL CLASS OF WORK:
SUBDIVISION: KRE_JCK MEADOWS . LOT #: 001 TYPE OF USE:
PROJECT NAME: PAUL
DESCRIPTION: Installing backflow preventer.
OWNER: CICINORIJE, PAUL PHONE #:
CONTRACTOR: MECHANICAL SERVICES INT. LLC PHONE #: 603 439 - 9999
Inspection Request Scheduled For: Date: 7/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
395 Misc. inspection 072609. 01 603.439.9999 Y
Corrections /Comments/ Instructions:
CL c c V( r-T Re t - CO
e 1 / 4 .A se...c6 6V".
CeA.it
•
PASS ❑ PARTIAL APPROVAL CANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: LvM -���1 � t off_ Date: 71 CYO?. Phone #: (503) 718-