Permit •
4 C 11f OF TIGARD
PLUMBING PERMIT
COMMUNITY DEVELOPMENT PERMIT #: PLM2007 -00528
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 DATE ISSUED: 12/3/2007
PARCEL: 1S134CB-13400
SITE ADDRESS: 12394 SW MILLVIEW CT ZONING: R-4.5
SUBDIVISION: MILLVIEW LOT: 034 JURISDICTION: TIG
PROJECT: POLLOCK
Project Description: Replace 60ft 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
POLLOCK, JAN MARIE
12394 SW MILLVIEW CT Description Date Amount
TIGARD, OR 97223 [PLUMB] Permit Fee 12/3/2007 $72.50
[TAX] 8% State Surcha 12/3/2007 $5.80
Phone : NA Total $78.30
Contractor:
•
DETEMPLE CO INC
1951 NW OVERTON ST
PORTLAND, OR 97209 REQUIRED ITEMS AND REPORTS
Contact # : PRI 503- 227 -2641
FAX 503- 274 -7686
Reg #: LIC 2510
• PLM 26 -25PB
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.
Issued By: Lt , Permittee Signature: 61 cLifaiaL.
•
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.
,...
'-DEC/03/2007/MON 08:41 AM DETEMPLE PLUMBING CO FAX No.503 274 7686 P. 001
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Plumbingyermit .3 „Jig , Nt FOR OFFIC 1)Sr. ONLY
MN"
- • Received
• City of Tiga .'. Permit No.: f." 22,9
Datelay; 1. • - o • p _ r •
7g3
II q 131 SW Nall Blvd., Tigard, sia .„_ . Plan Review
Phone: 503.639.4171 Fax: 8. teilEty Other Permit Na.:
Inspection Line; 503.639,4175 i N 'NY Date Ready/By: , a See Page 2 for
TIGARD r 1 •
Internet: woNi.tigard . .:46 • ik , Notified/Method: Supplemental Information
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. . ''''''' :':-.'“••:'•'•''''' .. ' ' ... . • Demolition -- ' ' - ' • - .. '••••••• ' '-'•• -------. - - For special Information use checklist.
New construction ti Description I Qty. I Ea. i Total
O Addition/alteration/replacement 0 Other: New 1- 2-family dwellings (includes 100 ft. for each utility conniption)
',. • • ::' .;:.!.... ;:: . .1.: < .... Of"CmaiiitgitIrtiartiligitt SFR (1) bath 24920 • .•
• :: . - ••••:'. • ." lir: ' 4-- - ..6. ,-,... .....' . , . -..., :....*: . .1337:03! .4: 3 ..!.3 _ .
l- and 2-family dwelling 0 Commercial/industrial SFR (2) bath 350.00 ;.
-j- ..
0 Accessory building 0 Multi-family SFR (3) bath 399.00
Each additional bath/kitchen 45.00 7 ..
O Master builder 0 Other::
Fire sprinkler L sq. ft.) Page 2
.vaidluiliimitriio..■ .
:..,:: :7 gite Si t„ til i ti ES ..i'..;
Job site address: I '2-S L i SW .., ri ', \ \ NA -C 1/4.,..) C-A -- Catch basin or area drain 16.60
• ,..::.
City/State/ZIP -„ ex _ Ac k. t . Drywall, leach line, or bench drain 16,60 - •
• •
• Footing drain (no. linear ft,: ___,) Page 2 .. :
Suite/bldg./apt. no.: Project name: P ‘‘ 0 cr ig_Res n u
110.00
• Cross street/directions to job site: Manufactured home utilities . .. .
• Manholes 16.60 "
Rain drain connector '
16.60 •%
=.1r
• Sallthlry sewer (no. linear ft.: ) _ Page 2 .
Storm sewer (no. linear ft.: _.,,) Page 2 .• :
1 -
Subdivision: . - I Lot no.: Water service (no. linear ft.: te 0) I 1-- Page 2 j t5p
Fixture or Item
• • ... -
Tax map/parcel no.: .. ,
Absorption valve 16.60 ,
4 .....---,„
.:i
!" ' : • ••••••:. ir: 7'.6.-r:.' . B preventer Page 2
, ..
' 1 • ,, - .,....'•".:::- ".k.,ni:!!...:1,re. ... , •
• _0.1142DCLC \ ANNtLA Q).0 LI/ Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60 •1!;
..
•• • . sr- r--b-r*r***-1, -,),..--,.. Drinking fountain 16,60 0!-'
..'t.T.4*.0,4*.KOWN REPZIANAMbraireMg: ljectors/surnp 16.60 0,- •
.•-, '
...,
Name: A
wev-A. Ac%o ic= . Expansion tank 16.60 :.
..,:v•
Address: Fixture/Sewer cap 16.60 .• %.
• City/State/ZIP: Floor drain/floor sink/hub 16.60 :.,...,
Garbage disposal 16.60
Phone: ( ) Fax: ( ) - ..,.•:,
IttlEig[P112 ia7r6).7F,,,ii Hose bib
''' :; : ' . -: '.1: 111 ;14K.10. 1.' ' ', - • ' ''' • .'t.1 '' .-*-71-
16.60 • :
.-, •
Business name: Interceptor/grease trap 16.60 k. :": •
Contact narne: • Medical gas (value: $ _ ) Page 2 .....
Address: Primer 16.60
----4-7'.
City/State/ZP?:
Roof drain (commercial) 16.60
_
Sink/basin/lavatory 16.60
Phone: ( )
I Pax: : ( ) -
Tub/shower/shower pan 16.60
-
E-mail: - Urinal 16.60 -
• : " .: '' :: T,' : " .Z.n"..;. ' 0, Water closet 16.60'
• ; ".•_.,...:...,•,:-„ y : cya+.0....*”....: ml Im4rml......1............ ,.,.... ..IPM
Business nisme:2, - TA, n-‘ -e • Water heater 16.60
-
Address: i. s i i-,_ 0 -.i. Other:
-
Subtotal 55 ,..-
Cit eV Da, C r/ 2-09 Minimum permit fee: $72.50 -- 7 . 2.. St)
Phone: (5A)) . ar) -24 U i Fax: (b3 1 7) LI - INA:.? Residential backflow minnnumpermit fee: $36.25 /
CCB Lie.: 6-,1g I D Plumbing Lic. no.: Plan review (25% ofpermit fee) --"
• a (6.--aseal,
Cp
' . State surcharge (8% of permit fee) 5 eC)
r V2 4 1'0
TOTAL PERMIT FEE
Print name: X t I 1 Date: 7g,g 0
This permit application expires if a permit is not obtained within
"V-..,1 AuthOriZed signature: . . p,041 _g 31
180 days after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
lAlluildintgermitAPLM-PereicApp.doe 01426/06 . 440-4616T(10/02/COWWE5) ,
. ..-
. .
CITY OF TIGARD .►,. • A
BUILDING DIVISION PERMIT #. Pl M2007 -00528 •
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED 12/3/21107
Phone: (503) 639 -4171 A"lWil
Inspection Requests (24 Hrs.): (503) 639 -4175 _ ..
INSPECTION WORKSHEET FOR DATE: 8/4/2000 TIME: 7:03AM PAGE: 27
SITE ADDRESS: 12394 SW MILI..VIEW CT CLASS OF WORK:
SUBDIVISION: MILLVIEW LOT #: 034 TYPE OF USE:
PROJECT NAME: POLLOCK
DESCRIPTION: Replace 60ft water service.
OWNER: POLLOCK, JAN MARIE, PHONE #: NA
CONTRACTOR: DETEMPLE CO INC PHONE #: 503-227 -2641
Inspection Request Scheduled For: Date: 814/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
399 Plumbing final 073649 -01 503 969 -6863 N
Corrections /Comments /Instructions:
C at-c.. c L, .-L ,t so k.J
1'l PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0- ( 14 - 1 2.- Date: r) (4 ` (')?, Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION • PERMIT #: PLM2007- 00528
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: '12J312007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/4/2007 TIME: 7 :01AM PAGE: Q8
SITE ADDRESS: 12394 SW MILL.VIEW CT CLASS OF WORK:
SUBDIVISION: MILLVIEW LOT #: 034 TYPE OF USE:
PROJECT NAME: POLLOCK
DESCRIPTION: Replace 60ft water service.
OWNER: POLLOCK, JAN MARIE, PHONE #: NA
CONTRACTOR: DEI CO INC PHONE #: 503 227 - 2641
Inspection Request Scheduled For: Date: 1214/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 060695.01 €9 N
Corrections /Comments /Instructions: , 11
6 c 't 486,3
Pe ✓ Se c;4■ 9 DLl , $ D Sc Nov me,-fro. r, (,J a �-�✓ Sz■
(p `a,c e �v.c J Mt,�e311t<, 4 J4.4 cv .L ✓�r�kQ.. ■ �e�. ∎ee e v7e
r'n u� vD1 i h S l� k-T 2 nn, d 1b -b (i ' e Lc ' : 1 a A✓ { 16
I�b wvA ,S r!-t'�w�, W ke,✓ t� �! -o� �i I•/�'o [-C,' -dL ,/'.- r p ✓�U`.l.
Re, Ca, k ( (-3 V 6v -�-c✓ Se•��� rds i k- � ✓bVe.k _ _
w �, . Se, . pv - rb we,' e4 , tJ - c,>^.. t PaAA
❑ PASS Nt PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 0311). .it 1 \; _ Sb3 71? 243 1 Date: I II t.( 1t: Phone #: (503) 718-