Permit C ITY OF TIGARD PLUMBING PERMIT
I �, DEVELOPMENT SERVICES PERMIT #: PLM2003 -00577
411
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 - 4171 DATE ISSUED: 11/5/03
SITE ADDRESS: 13690 SW 124TH AVE PARCEL: 2S103CC 06900
SUBDIVISION: WHISTLER'S WALK ZONING: R - 4.5
BLOCK: LOT: 016 JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: SF WASHING MACH: BACKFLOW PREVNTRS: 1
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: ft
DISHWASHERS: RAIN DRAIN: ft
Remarks: Backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD STE #100 [PLUMB] Permit Fee 11/5/03 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Surchan 11/5/03 $2.90
Total $39.15
Phone : 503- 387 -7538
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone RP /Backflow Preventer
hone : 503 692 5945
Final Inspection
Reg #: LIC LCB: 7804
PLM ALL PHASES - PLL
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: f b l�G j� Permittee Signature: ,,_,VCC
�l/
Call (503) 639- 175 by 7:00 P.M. for an inspection needed the next business day
Nov 05 03 11:42a dan edmonds 503 - 692 -0768 p.1
FOR OFFICE USE ONLY
Plumbing Permit Application Received , Plumbing
RECEIVED Date/By: ,, /i 0 Permit No.: C. N ' -065
Planning Approva Sewer
City of Tigard DatrJBy: PCrmit No.:
13125 SW Hall Blvd. Plan Review Other
NOV 5 20 Date/By: Permit No.:
Tigard, Oregon 97223 P - R Land Use
Phone: 503- 639 -4171 Fax: 503 - 598 -1960 ,,„, i , fly D Case No.:
Internet: www.ci.tigard.or.us CITY OF TIG ' , 4.'1: i l Contact -- is See Page 2 for
24 -hour Inspection Request: 50303361.41.151S DI , " '.
Name/Method: / ' r '• Supplemental Information.
• : SCHEDULE information;usechecklist)`;
' - : . _: TYPE OF WORK _ ` ; ,. .
HEDULE�(for "
- :: - t Fee(ca.) 1
D New construction ❑ Demolition
Description Qty. 1 Total
Addition/alteration/replacement ❑
Other: . , '. - -, .-- - New 1- & 2-family , '' '
- - • - (incl des 100 { 0:_ for dtilwteonnect on)
CATEGORY .OF CONSTRUCTION - - SFR (I) bath 249.20
ISI 1 & 2- Family dwelling D Commercial/Industrial SFR (2) bath 350.00
[]Accessory Building 0 Multi - Family SFR (3) back _ 399.00
D Master Builder D Other: _ Each additional bath/kitchen 5
4 00
JOB SITE INFORMATION and LOCATION Fire sprinkler sq. ft.: Page 2
" .: .,.. Site ;iJtiltttes `
Job site address: 13( �R1 / a-LJ n1 1 Catch basin/area - . drain - . L,
Suite #: Bldg. /Apt. #: 16.60
L130-0-k, _ DrywelUleach line/tren,ch drain
Project Name:(., lii site * C.C. % 1/e- Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: _Manufactured home utilities 110.00
A-1,1 ,, Manholes 16.60
`� r 5-1 Rain drain connector 16.60
Sanita sewer no. linear ft. Pa: e 2
Storm sewer (no. linear ft.) Page 2
Subdivision: { 1', St7vS Walk__ I Lot #: if(, 'Water servic (no. linear R) Page 2
Tax map/parcel #: (0 -5 .$ b.S Fiztare or Item _
'DESCRIPTION OF WORK .`. ,...., Absorption valve - _ 16.60
eund
L C LCtch0ee) 61.03 I C & Backflow preventer _ / Page 2 xi. SS"
Backwater valve 16.60 _
- Clothes washer 16.60 _
Dishwasher 16.60
Drinking fountain - _ 16.60
IS- PROPERTY: OWNER ; -` 1 t] TENANT ' ' Ejectors/sump 16.60
Name: pt, 111 (5 f S, 0 ? - e- i--k-YYIt3..S Expansion tank 16.60
Fixture/sewer cap 16.60
Address:42, 3o St v &4-,...24..s-300 Floor drain /floor sink /hub 16.60
City/State/Zip: !-lam' f 04-'b �f - 1 U Garbage disposal _ 16.60
Phone: Fax: Hose bib 16.60
;APPLICANT ' `CONTACT: PERSON Ice maker . 16.60
Name: el Lori l S O..rl1 LO Interceptor /grease trap 16.60
Address: l �� 0 S-1-0 rn ic)n9 R.1D p eddiecr l gas - value: $ Page 2
16.60
City /State/Zip: u .& ' ft- 10 Roof drain (commerc 16.60
Phone 9)3 (04+x- - 914.51 Fax:b3 lag a.- 071/, g Sink/basin/lavatory 16.60
E -mail . i 6.60
Tub/shower /shower pan 16.60
::CONTRACTOR Urinal
Water closet 16.60
Business Name: [ii y1G(SCI.t f3Yx X1'1 e, Water heater 16.60
Address: la 0 S - 1m t •c OD- Other.
City /State/Zip:mA..& v-- Ah R.- - c )O o - Other. _
S L i S Fax (p9 - 071 f { Plumbing Penult Fees* <7 S5
PhoneSo3 ![�� - Subtotal $
CCB Lic. #: - 1 kL�`f Plumb. Lic.#: Minimum Permit Fee $72.50 $ 3 Lo � S
Authorized , / //c)( Residential Backflow Minimum Fee $36.25
Signature,:,../e-- L% � Date:- -' Plan Review (25% of Permit Fee) $
Elie") er . Spar State Surcharge (8% of Permit Fee), ' $ e2 , ' )
V (Please print name) TOTAL PERMIT FEE _ $ 3?_ ! 5
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.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested / / AM PM BUP
Location / 3G O /1' Ave • Suite MEC
Contact Person
h Ph( ) (09 -S9 LAS 011 3 -o
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
Ftg Drain Access: ELR
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors R
Ext Sheath/Shear ✓ ° vCC12- yew/re,.
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
FAIL
• :eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
air .
_ oi,r v'
S 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 ❑ Please call for reinspection RE: _ ❑ Unable to inspect — no access
Fire Supply Line
Approach/Sidewalk Date v I Inspector Est
Other:
Final DO OT REMOVE this inspection record from the job site.
PASS PART FAIL