Permit Y }
CIT OF TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2004 -00017
.. " 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/15/04
SITE ADDRESS: 13720 SW 122ND AVE PARCEL: 2S103CC 09100
SUBDIVISION: WHISTLER'S WALK ZONING: R - 4.5
BLOCK: LOT: 038 JURISDICTION: TIG
CLASS OF WORK: ALT GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
OCCUPANCY GRP: 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
Remarks: Backflow preventer
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD STE #100 [PLUMB] Permit Fee 1/15/04 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State 1/15/04 $2.90
Total $39.15
Phone : 503- 387 -7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062
REQUIRED INSPECTIONS
Phone : 503 692 5945 RP /Backflow Preventer
Reg #: LIC 7804
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.
Issued By: / Permittee Signature: /p4 / i / . .. .i
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next bus' n . ss day
Jan 14 04 01:46p dan edmonds 503 p . 2
Plumbing Permit Application FOR OFFICE USE ONLY
Received
_ Date/13y: 1,l Plumbing -
Permit No./ ae)e) 7
r '
e-D- - el
City of Tigard
Planning Approval Sewer
RECEIVED Date/By: Permit No.:
13 125 SW Hall Blvd.
Plan Review Other
Tigard, Oregon 97223 Date/By:. Permit No.: fil..cre2t/a3
Phone: 503-639-4171 Fax: AN.51841604 ,.,,,, IA. 1 Post Land Use
rn
Inteet: www.ci.tigard.or.us _dr - 14 il Date/By:
Contact , Case No.:
Juris.: I El See Page 2 for
24 Inspection Request: dimigfeARD Name/Method: I Supplemental Information.
BUILDING DIVISION
' FEE* SCHEDULE (for sPecIal infoitnation tise "Checklist)
' J New construction 0 Demolition Description I Qty. I Fee(ea.) I Total
D ddition/alterationfreplacement D Other: . .. New 1-.11c 2-family dwellings . •
CATEGORY OF CONSTRUCTION , . • ,.' : (in eludes 100 ft
(includes each u connection)
.. , . , . ' ' '
SFR (1) bath
\18' y SFR (3) bath 399.00 249.20
1 & 2-Family dwelling 0 Commercial/Industrial
SFR (2) bath 350.00
Accessory Building 0 Multi-Famil
,.
[1] Master Builder Ei Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION ' Fire sprinkler - sq. ft.: Page 2
Job site address: / 3g:.20 S LC l Tic( ,4-c e., . . - ', .. Site Utilities . •
Suite #: 1 Bldg./Apt.#: Catch basin/area drain 16.60
, Drywell/leach line/trench drain 16.60
Project Name: Whi.Si LO Ca kr.- LOT ag
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site:
Manufactured home utilities 110.00
U /0 /' 7 Manholes 16.60
Rain drain connector l6.60
Sanitary sewer (no. linear ft.) Page 2
Subdivision: i..44 I sri er is Lotul-A [ Lot #: 3g Storm sewer (no. linear ft.) Page 2
Water service (no. linear ft) Page 2
Tax map/parcel #: et* .E; s es
• .. , Fixture ot'Item , •
'DESCRIPTION OF WORK l' '' ' '.
Absorption valve • I 16.60
Larldg Cap C. ritiCiChOLL) C.t 03 i c ej
Backflowpreventer 1 Page 2 „,19.. s '
Backwater valve 16.60
Clothes washer 16.60
_
Dishwasher 16.60
Drinking fountain 16.60
ELPROPERTY OWNER ' 1 D.TENANT 1 •
Ejectors/sump 16.60
Name: Dayi TV) 0 i-knyic,S Expansion tank 16.60
Address:4g 30 ...c._1.0 ('&o0 ci, Fixture/sewer cap 16.60
City/State/Zip: L4-iie_. 0S-A-lue.56 q Floor drain/floor sink/hub 16.60
Garbage disposal . 16.60
'
Phone: FaX
Hose bib 16.60
'
ARAPPLICANT • la CONTACT PERSON ' . - Ice maker 16.60
Name: el la" Sp arat° Interceptor/grease trap 16.60 _
Address: / .)=.10 0 S..to rity..c1CY1.9 a-D Medical gas - value: S ._ Page 2
Primer 16.60 .
City/State/Zip: iita_12.0:411\__ a g. 97(31 a._,
Roof drain (commercial) 16.60
Phonea>3 to 9.2... - S 4.5 I Fax:S03 log 3.- 076g Sink/basin/lavatory 16.60
E-mail:
, Tub/shower/shower pan 16.60 - • .. ' . ' ' ' • ' ---' . ' 'CONTRACTOR , ..-'-• Urinal 16.60
Water closet 16.60
Business Name: LM
a...SCri-piz_ 0 ft- -- r,,
Water heater 16.60
Address: 1>D-00 LW MIASaityty en Other:
City/State/Zip:;\ - t ,t. - coot° a-- Other:
Phone:543 telicQ - S9 L/ I FaxS)3 (o9c1 - &Wok • .. '. : - 'Plumbing Permit Fees* . ' .21:7;s5
Subtotal 1 S
CCB Lie. #: - 7i-D-1 Plumb_ Lic.#:
Minimum Permit Fee $72.50 $
Date: ) - I L-0(1) , .,
Authorized Z. , i
Residential Backflow Minimum Fee S36.25 '--, Le
Signaturs..--- /4 9 ,NSpe)---L-4--ext, i
Plan Review (25% of Permit Fee) S
L /i en c--/OarrrE/3 State Surcharge (8% of Permit Fee) S ..2 , 96
(Please print name)
TOTAL PERMIT FEE f $ .9 '
Notice: This permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
180 days after it has been accepted as complete. riser diagram for plan review.
*Fee methodology set by Tri-County Building Industry Service Board.
iMsts\Permit Forrns\PImPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received fZ z 7 - / Requested _ 2 /2 3 /U/ AM PM BUP
Location ! 7 C 0 / 2 Z `" a 4 J Suite 2 f 3 7 MEC
Contact Person �� Ph ( 3 3) r'' 92- 594/S4210 _ � 4 / - 0001 7
Contractor t d4-C. (p (') Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing ELC
Foundation Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING _
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower n
PA PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: ❑ Unable to inspect — no access
Fire Supply Line
ADA '
Approach/Sidewalk Date • Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 vl d l
INSPECTION DIVISION Business Line: (503) 639 -4171
BUP
Received 0- De l f Requested l Z Z '1) M PM BUP
Location /3720 / 2 2- i- Suite MEC
Contact Person o. Ph ( ) b 9 - 4 3 7 M 2 oOV- (v o/7
Contractor (//1 Ph
r►�t ( )
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Access:
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: r I "2.604- 006 -1 SIT
Post & Beam 1
Shear Anchors 'Gt t./K - L 0\/.1 C; V -
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Othpr,;„
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final -
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE El Please call for reinspection RE: Unable to inspect - no access
Fire Supply Line
ADA ,+ 2 2.- 4- 1
Approach/Sidewalk Date / Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL