Permit (99) CITY OF TIGARD PLUMBING PERMIT
3111: COMMUNITY DEVELOPMENT Permit#: PLM2017-00197
13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/18/2017
T t l��''� 'O g Parcel: 2S 106DB 11600
Jurisdiction: Tigard
Site address: 17394 SW SHADOW TRAIL ST
Project: River Terrace Northwest,Lot 116 Subdivision: RIVER TERRACE NORTHWEST Lot: 116
Project Description: Adding additional water heater.
Contractor: MALMEDAL ENTERPRISES INC Owner: ADLV LAND HOLDINGS LLC
PO BOX 207 BY FORSUM, MICHAEL
BANKS, OR 97106 7600 E DOUBLETREE RANCH RD STE 1
SCOTTSDALE,AZ 85258
PHONE: 503-324-0759 PHONE:
FAX: 503-324-0580
FEES
Quantity Description Date Amount
1 ea Water Heater 05/18/2017 $37.52
Specifics: 1 12%State Surcharge- 05/18/2017 $8.70
Plumbing
Type of Use: SF 35 ea Minimum Fee Adjustment- 05/18/2017 $34.98
Plumbing
Class of Work: OTR
Type of Const:
Occupancy Grp:
Stories:
Total $81.20
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 not started within 180 days of
issuance, or if work is suspended for more the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon
Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001-0090. You may obtain a copy of the rules
or direct questions to OU' /(/
NC by calling 503.232.1987} or 1.800.332.2344.
n/
Issued By: / - Permittee Signature: S r
Call 503.639.4175 by 7:00 a.m.for the next available inspection 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 AnnlicalionRECEIVED
Building FixturesI a H; I i I I I l 1 1 `1 ,,,I \
• City of TigardSi
,QTY 17 2017 Dina < /�? Permit No.:�G .2 D l?-GY7 l'�'j
13125 SW Hall Blvd.,Tigard,OR 97%)/
Plmltev+ew OdlaPetmttNo,
Phone: 503.7182439 Fax: 503,598-LWDnteiBy: STS U!G'�C�5'�!�
Reeeiv
Inspection Line: 503.639.4175 OF TIGARD maceR r > � er 5eeP.ge2for
Internet w,Ww.tigard•or.gov BUILDING DIVISION 1JOtified/Medrod Supplement inferaeatioa `
.;;:•q '•.a, ,yra;,,;.,.: .. • ; .....;_•: ._ For dplGl7al ab)fOl' !1 use @hEYl�
igi New 0 Demolitiondal
1 Qty, I Ea, I Total
❑Addition/alteration/replacement 0 Other New 1-2-family dwelinga(includes 100 ft.for each utility connection)
. •C CATEGORY'OF cQNs itnoN• SFR(1)bath 312.70
• SFR(2)bath 437.78
®1-and 2-famrTy dwelling 0 Corawercial/mdusuial SFR(3)bath 500.32
Accessory building 0 Multi-family -
Each additional batb/kitchen 25.02
0 Master builder ❑Other: Fire sprinkler C.__sq.It.) Page 2
_ . ,jOB srr'E 1NFORMi4'I10N 11.ND LOCATION Site utilities:
Job site address J 7 3�!` S (S f rGu i/ st Catch basin or area drain 18,76
Drywall,leach line,or wench drain 18.76
City/State/ZIP:Tigard,OR 97224 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name:RAM,
ler r e tract Manufactured home utilities 50.03
Cross streel/dire tions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft:_•_) Page 2
Storm sewer(no.linear R:._) Page 2
Water service(no.linear ft.:___•-) Page 2
subdivision:'Q ivy' f ( ere... ( /oker-i-- I Lot aa,:if tp Fixture or item:
r" 'F Backfowpreventer 31.27
Tax map/parcel no.: Backwater valve 12.51"� tll"+.WOpR,Kr; ; Clothes washer 25.02
0 deb n a I'l '0I K U tiddiL•y a'CY. 1 �Dbhwasher 25.02
M51-2.010
)._�qg Drinidng fountain 25.02
L���"` Ejectom/sump 25.02
Expansion tank 12.51
®.1'1tOFER1 a`OWNER (. T7 iATiF Fixture/sewer cap 25.02
Name:ADVL Land Holdings,LLCFloor drain/floor sink/hub 25.02
Address:7600 E Doubletree Ranch Road Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694.4031 I Fax:( ) Ice maker 12.51
0 CON1'ACI PERSON. � ��p 25.02
®.APPCANF Medical gas(value:S ) Page 2
Business name:William Lyon Homes,Inc Primer 12.51
Contact nameN/t '•j/.0a Roof drain(commercial) 12.51
Address:109 East 13th Street Sink/basin/lavatory 25.02
City/StateZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Fax::(360)693-4442 Tub/shown/shower pan 12.51
Phone: Uri(360)b95-7700 /A al 25,02
1 E-mail: M rde•-�h 0 t y4wh S-fl�cWater loset 25.02
CONTRACTOR . Water heater i 37.52
Business name:Malmedal Enterprises Inc. Waterpiping/DWV 56.29
Address:PO Box 207 Other 25.02
Subtotal
City/State/ZIP:Banks,OR 97106 Minimum permit fee: 572.5
Phone:(503)324 0759 Pax:(503-)324.0580 Plan review (25%of permit fee)
' CCB Lies 102535 Plumbing Lic.no.:34-276PB State surcharge(12%of permit fee)
Authorized signature: C„. -.a TOTAL PERMIT FEE
I Date:04/25/2016 I This penultapplkaden expires if a permit is not obtained within ISO days
I Prlrt nam Carolina MalmeclaE after it has been Tri-County
B ed as eeaduets.
*Fee methodology set by Tei-County Building Industry Service Board.
L Ax roomA9 440.45161(10/02/COM/WEB)
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17394 SW SHADOW TRAIL ST, BEAVERTON,
OR, 97007
Record Type: Record ID:
Residential - Plumbing PLM2017-00197
Inspection Type: Inspector:
399 Plumbing final Don Sylvester
Result:
PASS - NoCofO
Comments:
1 . Plumbing final for extra water heater - approved
Violation Summary:
Inspector Contractor