Permit illCITY OF TIGARD PLUMBING PERMIT
COMMUNITY DEVELOPMENT Permit#: PLM2017-00193
T t G, R 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 05/18/2017
Parcel: 2S 106D B 10600
Jurisdiction: Tigard
Site address: 17437 SW AMELIA ST
Project: River Terrace Northwest, Lot 106 Subdivision: RIVER TERRACE NORTHWEST Lot: 106
Project Description: add 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
Class of Work: OTR Plumbing
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 OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
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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 APPli"tiRECEIVED
Building Fixtures I 0Ic 011 it i. 1 ,I <��1 ,
City of Tigard MAY 17 2017 c1/17/7 p t �L10DI?-061�3
13125 SW 3iaU Blvd„Tigard,OR 9
Phone: 503.718.2439 Fax: 5o339g 9d0'' O F 1;79.10Degaly: o Pens*No 5- 0/G t°) . -
IaspexxiasLux: 503.639,4175 BUILDING DIVISION Date Ready/ay: twin to See raise 2 for
Iritemct www.tigard ar.gov Nodlfied/Metbod , Sppplcmaatai Informs ton
ri."1'+•7"i+•yti"1f./^•°., 17. .. , ..,.. ..b.G's .•�...: r J-2er�:i•'a,X...‘1....A.4. ::�f
®Islew construction 0 Demolition .
For a asec/9eca'i�at
Total
0 Addition/at�nt 0 Other: Description-2-family dwellings(includes 100 ft.for each utility�connection)
. ,, -'CATEGORY'OF CONTSF.RUCTION• : .. • . . _SFR(1)bath 312,70
®1-and 2-family dwelling 0 Commercial/industrial SFR(2)bath 437.78
D Accessory buildfmg 0 Multi-family SFR(3)bath SOR 32
Each additional bath/kitchen 25.02
D Master builder D Other: Fire sprinkler(_._sq.fl.) Page 2-
. : •= TOB SITE 1NFORMA 1011.AND'LOCATION Site utilities:
Job site address:11451 VNO Arei i a rt- Catch basin or area drain 18.76
City/State/ZIP:Tigard,OR 97224 Drywall,leach line,or trench drain 18.76
Footing drain(no.linear ft.: 1 Page 2
Suite/bldg./apt.no.: Project name:&A/er. I?react a q'�e .j- Manufactured home utilities 50.03
Cross street/directions to job site: r Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear It: ) Page 2
Storm sewer(no.liner ft: . ) Page 2
`1 1r",ve.�'7 y Water service(no.linear ft: ) Page 2
Subdivision:giver /Gtr act.. /1/ Lot no.:I Future or item: J
Tax map/parcel no.: Backflow preventer 31.27
DESCR1T1T09i) OF•WORK Backwater valve 12 51
Clothes washer 25.02
%� n ,,W,.( r y)a,1 M >r p,,, •
�4!'(��a■1 r�tl�lk�.�/I�1 - V� l• •�[.tN+�� i D'uhwmher , 25.02
�` S .CO5fs7 Drintdag fountain Iain 25.02
Ejectors/sump 25.02
-,-11Rop R'1'Y oy1VER • . 1. D 'fFf+1AIVT Expansion tank 12.51
Name:ADVL Land Holdings,LLC name/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:7600 E Doubletree Ranch Road Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 liose bib 25,02
Phone:(602)694-4031 Fax:( ) Ice maker 12.51
:.•-.•O.•APPLICAN F . ❑ COM')
PERSON Interceptor/grease�p 25.02
Business name:William Lyon Homes,Inc Medical gas(value:S ) Page 2
ATL Primer 12.51
Contact nameN/thli/r 1701 Roof drain(commercial) ' 12.51
Address:109 East 13th Street Sink/basirdlavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)695-7700 ,� ! Fax::(360)693.4442 Tltblshower/shower pan 12.51
Urinal 25.02
E-mail: M€Me••/h (�i/�polifgainotnrr cpm Water closet 25.02
t;OA"1RA Water heater , 37.52
Business name:Maimedat Enterprises Inc. Wateri ' WV 56.29
p'p
Address:PO Box 207 Other: 25.02
City/StaWZIP:Batiks,OR 97106 Subtotal
Phone:(393)324-0759 Fax:(503-)324.0580 Minimum permit fee: $72.50
Plan review (25%of permit fee)
' CCB Lic.:102535 Plumbing Inc.no.:34-276PB surcharge(12%of permit fee)
Authorized signature: C,.-- TOTAL PERMIT FEE r
This permit application expires Na permit is net obtained within ISO days
Print name:Carolina llMalmedal Date:04/25/2016atter it has ben accepted as complete.
"Pee methodology set by Tri-Count Building ladoshy Service Board.
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