Permit C ITY OF TIGARD PLUMBING PERMIT
l j� DEVELOPMENT SERVICES PERMIT #: PLM2003 -00526
-JI 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/30/03
SITE ADDRESS: 13720 SW 124TH AVE PARCEL: 2S103CC 06800
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 015 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: Installation of residential backflow prevention device for irrigation.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD STE #100 [PLUMB] Permit Fee 9/30/03 $36.25
LAKE OSWEGO, OR 97035 [TAX] 8% State Tax 9/30/03 $2.90
Total $39.15
Phone : 503 387 - 3875
Contractor:
LANDSCAPE OREGON, INC.
12200 SW MYSLONY RD.
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone : 503 692 -5945 RP /Backflow Preventer
Final Inspection
Reg #: PLM 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 y: ` , � /�l ���;, P e rmittee Signature: v. /� , 7 r
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Sep 29 G13 03:08p dan edmonds 503 -692 -0768 p.4
FOR OFFCCE USE ONLY
Permit Application Received Plumbing - �5�0
Wg 7 0%, pj `/i Permit No.:
�` D Planning Approval Sewer
City o Td �' Date/By: Permit No.:
13125 S Hall Blvd. Plan Review Other
Ti az O on 97223 C CP ? r"' ? 1 c'' Date/By:. Permit No.:
$ g 1 P .c Post- Review Land Use
Phone: 5 3- 639 -4171 Fax: 503 -598 -1960 ,.,,,. , �J � (, a Contact
Date/By: Case No.:
Internet �ivwwi.tigard.or.us CITY O F TI G ra, ■ 1 A l ® See Page 2 for
24 - hour Inspection Request: 5d 639 4 I771V1 ` �� 1; Name/Method: , / • Supplemental Information.
' ':`,: TYPE OF WORK FEE* SCHEDULE (forspeclal Information use-checklist)
New construction
Demolition best nl tY . 1 tian i Q Fee() [ Total
Ncw 1 c 8 c Z ismtly dQ
Addi'ion/alteration/replacement ❑Other: fincludes100 for" each utility connection) -
CATEGORY- OF CONSTRUCTION .. ': SFR (1) bath 249.20
iii & - Family dwelling 0 Commercial/Industrial SFR (2) bath 350.00
Accessory Building Multi - Family SFR (3) bath 399.00
Masher Builder 0 Other: Each additional bath/kitchen 45.00
:1fOB SITE. INFORMATION and LOCATION ' ' Fire sprinkler sq. ft.: Page 2
: ,` Site Utiliti . .
Job site address: 13'7 ao & w ! L.(�?' , ,4 j 16.60
Suite #: I LBldg. /Apt. #: Catch basin/area drain
DryweWleach line/trench drain 16.60
Project *lame: W St1 e-ir'S l-.t CIJ fr t_mT t S Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
V ( � (s r Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
SubdiviStion: t - t)VN.tSt1 £r- S to - tc-- I Lot #i S Storm sewer (no. linear ft.) Page 2
6 Tax mtparcel #: li S - Water service (no. linear ft.) Page 2
. .:: DESCRIPTION OF WORK .. Absorption valve 16.60
L42Y1dSCQ. pL 0-C4C GLCJ ice Backflow preventer j Page 2 , Z']. SS"
Backwater valve 16.60
Clothes washer 16.60 ,
Dishwasher 16.60
Drinking fountain 16.60
;PROPERTY:OWNER .. • ` ,1. TENANT : " Ejectors/sump 16.60
Name: CAN 1 m (jy 1 & S L - r -itr I C -S Expansion tank 16.60
Addres : q-2 36 S1J0 & L( ° woo ct, Fixture/sewer cap 16.60
Floor drain/floor sink/hub 16.60
City /St te/Zip: t.ly�f Q7( Garbage disposal . _ 16.60
Phone: Fax: Hose bib 16.60
APPLICANT ` • ` "ICONTACT PERSON Ice maker . _ 16.60
Name: � 1. t:.0'1 S U t'1� -t� Interceptor /grease trap 16.60
Medical gas - value: $ � Page 2
Address: l ��O d S W rn jUYly 16.60
Ci /S te/Zi :1 �l�L 'rt O 1 2- 910 (
Printer
ty p' Roof drain (commercial) , 16.60
PhonWD03 tam - STILLS I Fax:503 69 a- 0710 Q Sink/basin/lavatory 16.60 ,
E-mail: . Tub/shower /shower pan 16.60
CONTRACTOR :: Urinal 16.60
Bus1n s Name: �i'1dSc t; D � dY� ► CG ' , water heater 16.60
Addr s: t? -OO hh t� &t ] leb. other
City /S te/Zip : - makoa r - b K.. cria0D-' Other
Pl Perinit`Fees* • 02: rf .55
Phone '0,3 t`aqa - � Si 1 s Fax�3 (oq� - orllo k
CCB Lic. #: 7gt)c Subtotal S Plumb. Lic. #: as
Minimum Permit Fee $72.50 $ ?� ,
Authorised b Residential Backflow Minimum Fee $36 25 •7
Signatur � �' � Date: Plan Review (25% of Permit Fee) S
Ell e r \ Cpa f Ma State Surcharge (8% of Permit Fee) $ .2 , f d
(Please print name) TOTAL PERMIT FEE $ ". /
Notice: is permit application expires if a permit is not obtained within All new commercial buildings require 2 sets of plans with isometric or
150 days Rer it has been accepted as complete. riser diagram for plan review.
- `Fee methodology set by Tri- County Building Industry Service Board.