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Permit CITY TIGARD PLUMBING PERMIT A DEVELOPMENT SERVICES PERMIT #: PLM2004 -00114 I 13125 S Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 3/18/04 SITE ADDRESS: 13670 SW 124TH AVE PARCEL: 2S103CC 07000 SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5 BLOCK: LOT: 017 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 3/18/04 $36.25 LAKE OSWEGO, OR 97035 [TAX] 8% State Surcharl 3/18/04 $2.90 Total $39.15 Phone : 503 387 - 7538 Contractor: LANDSCAPE OREGON, INC. 12200 SW MYSLONY RD. TUALATIN, OR 97062 REQUIRED INSPECTIONS Phone : 503 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 Issued By:7L_..aiyyf Permittee Signature: _ 4P /,� _ _ _� !kg4- Call 5 3 639-4175 3�5 b 7:00 P.M. for an inspection needed the next bu in ss da ( ) by p day Mar 18 04 10:48a elan edmonds 503 - 692 -0768 p. 2 Plumbing PermW'O.Erplication FOR OFFICEUSE ONLY Rcceiv � y ��" Plumbing Da tr/Byd 1J " ` Pcnnit Noffinc290, `i / _Ct i i Li City of Tigard MAR 18 2004 Planning Approval Sewer 1 3125 SW Hall Blvd. Plan Review Permit No.: Plan Review Other Tigard, Oregon 97223 CITY OF TIGARD Date/By.• PcmritNo.: Phone: 503 - 639 -4171 Fa '31AQ 1 l IsI0 +, - r. Post Revie . ,. land Use 3 > Internet: www.ci.4gard.or.us 1;;∎• c' ts 'I l's Contact • Case No.: 24 -hour Inspection Request: 503 - 639 -4175 -w I Juris.: t: See Page 2 for NameJMethod: ( Supplemental Information. TYPE OF WORK :- : r . ., ,, , ''.-:° . ' FEE* SCHEDULE (for specialinfoririatlon use checklist) I. New construction M Demolition Description 1 Qty. I Fee(ea) t Total Addition/alteration/replacement ❑ Other • New 1 -& 2-family, dwellin CATEGORY OF. CONSTRUCTION : , ,. ' (r dudes.100 `it. for each utility connection) al & 2- Family dwelling ❑ Commercial/Industrial SFR (I) "bath zg9.2o ' ccessory Building 0 Multi- Family SFR (z) bath 350.00 El Master Builder SFR (3) bath 399.00 ❑ Other: Each additional bath/kitchen 45.00 JO8 SITE INFORMATION and LOCATION : Fire sprinkler sq. R ; Job site address: / �� 7CC .12-i.-C /.) c1'1T7 4 Page 2 �� •'` - ` . " -; ..;'" Sit :;,:: .. - Suite #: Bl dgJApt_ #: Patch basin/area drain 16.60 Project Name: WA r s t%t-� walk. < / '7 Do/well/leach line/trench drain 16.60 Cross street/Directions to job site: Foaling drain (no. linear ies pace 2 S_LU 4; j�-z.X Manufactured home utilities - 1 1 0.00 Manholes 16.60 Rain drain connector 16.60 Sanitary sewer (no. linear EL) Page 2 Subdivision:.i Lt.) h i s f / c, ((v ' k- 1 Lot #: / 7 Storm sewer (no. linear ft.) Pa e 2 Tax map /parcel #: (p SS e Sy Water service (no. linear ft R ' : - , PTztureorltem Page 2 Lart S C[ p cicho�j �� Absorption valve 16.60 !- Backflow preventer / Page 2 4 2 1 7. ''S' Backwater valve 16.60 Clothes washer 16.60 Dishwasher ' ROPERTY OWNER 1 0 TENANT r.. ' <.:., : ; Dunking fountain 16.60 ill 16.60 Name: boll TV) fIY/SS3ZfiFe. Neill � Ejectors/sump 16.60 t'S Expansion tank 16.60 Address: . 30 Su) &zi- Ee..v.,Q p CSC, Fixture/sewer cap City /State/Zip: Lis -46e_ pS we _ 16.60 Jv q 1 --3 . le Floor drain/floor sink/hub 16.60 Phone: Fax: Garbage disposal 16.60 APPLICANT;' .:: • : NTACTPERSU Hose bib COlY', = ' liar _ Name: 16.60 c ' ��J04-t�Iz 16.60 Address: / �� 0 Sl cl ► Y► �1 Iflt rori e: 16.60 Medical - valu $ Page 2 City/State/ZiF: Tikes -tc A-- © IZ 970 f a Primer 16,60 PhoneSe3 co w - 59' 1- 1.5 Fax 5�3 (09 a,- o7 � Roof drain (commercial) 16.60 E -mail: Sink/basin/lavatory 16.60 Tub/shower /shower pan 16.60 • t.' :: :. - Urinal 16.60 16.60 Business Name: Lp y,c(S water closet Address: i d es O o h 1 V / ' 1 G water heater 16.60 City /State /Zi P :11� ..a.to_tl - "i6, /L - a7Qi0 D.. Other: • PhoneS:S 5 O3 (tea - Lt. - Faxes CCB #: ��� 3 .1 - 0`7tok • Plumbing: Permit Fees* X2 /7-, `� Plumb. Lic. #: Subtotal S Authorized . Sigtrature / ' „, Minimum P 50 5 ermit Fee 572, 1 � Date: ��� S /OC( Residential Backfiow Minimum Fee 536.25 .36 S 1 en Plan Review (25% of Permit Fee) S State Surcharge (8% of Permit Fee) $ , () (Please print name) o2 TOTAL PE Notice: This permit application expires ic es permit not obtained within RMIT FEE S 9. /5- 180 days after it has been accepted as complete. AL new gra for plan commercial review_ require 2 sets of plans with isometric or riser diagram for plan u revview_ `Fee methodology set by Tri Cooaty Building Industry Service Board. CITY OF TIGARD 24 -Hour BUILDING Inspection Line: (503) 639 -4175 INSPECTION DIVISION Business Line: (503) 639 -4171 MST / BUP Received g Requested 3 / 3e) AM PM BUP Location /5_6_70 / 2 -7 "i Suite , MEC Contact Person �L Ph ( 2 ) /z9 ? ' d M■ // Contractor Ph ( ) SWR BUILDING Tenant/Owner ELC Footing Foundation Access: ELC 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: Othe Final PASS PART FAIL PLUMBING Post & Beam Under Slab Rough -In Water Service Sanitary Sewer Rain Drains Catch Basin / Manhole Storm Drain Shower P n O • .r: S PART FAIL CHANICAL 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: Ei 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