Permit CI TY OF TIGARD PLUMBING PERMIT
. l, DEVELOPMENT SERVICES PERMIT #: PLM2004 -00016
'' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 1/15/04
SITE ADDRESS: 13750 SW 124TH AVE PARCEL: 2S103CC 06700
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 014 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 ST [PLUMB] Permit Fee 1/15/04 $36.25
STE 100 [TAX] 8% State 1/15/04 $2.90
LAKE OSWEGO, OR 97035 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: 1 Permittee Signature: _
Call ( 03) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Jan 14 04 01:49p dan edmonds 503 - 692 -0768 p.1
FOR OFFICE USE ONLY
T P hh r& Ling P.ermq Efiig I I s4 1,' 1 Received Plumbing �L m ' ` � �� / ( e
Date/By: c ' ) Permit No.' In `7 1
4
q Planning Appr4fval Sewer
City of Tigard 'JAN 1 4 200k Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Q ARp Date/By:. Permit No.: m 5 raD3 -- DO Yg
Past- Review land Use
Phone: 503 - 639 -4171 Fax: 4101/IS1 iaaa " % �s' to Date/By: Case No.:
Internet. www.ci.tigard•or.us 1i J . e { Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503 -639 -4175 "` ''''' Name /Method: _ Supplemental Information.
TYPE OF'WORK tE* SCHEDULE (for special inforsnation;use checklist)
New construction
❑ Demolition Description I Qty. I Fee(ca) f Total
:Nt:w I- : 8c 2 faint {y.dtvelhngs -
[� Addition/alteration/replacement ❑Other: (includes 100 11. for•each utility 'connection) ,
CATEGORY: SFR (1) bath 249.20
1SLI & 2- Family dwelling ❑ Commercial/Industrial SFR (2) bath 350.00 ,
❑Accessory Building . ❑ Multi - Family SFR (3) bath 399.00
❑ Master Builder El Other: Each additional bath/kitchen 45.00
JOB SITE INFORMATION and LOCATION Fire sprinkler sq. ft Page 2
Job site address: ./,; '7S6 Si,) A.214 1)-1 AZ t✓ Site:.Utilities, : .
Catch basin/area drain 16.60
Suite #: Bldg. /Apt. #: Drywellneach line /trench drain 16,60
Project Name:LU 11 i S t ie . U) et-t -fr- 1.-Z ii I Li Footing drain (no, linear ft1 Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
Manholes 16.60
S (._A /i4 / j u-c... Rain drain connector 16.60 _
Sanitary sewer (no. linear ft) Page 2
Storm sewer (no. linear ft.) Page 2
Subdivision: l) h i S tiers I,t,) Lot #: Water service (no. linear 11) Page 2
Tax map /parcel #: S s tnre . m
. __ t: , ,- T+tX .o X _ . to . .
DESCRIPTION. OF WORK Absorption valve 16.60
1- Cap J L GJG' -- /ou) L LOJ I( € Backflow preventer i Page 2 .1.'7. SS'
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
PROPERTY.. OWNER I []:: TENANT , . Ejectors/sump 16.60
Name: Dart (l (SYIS4_02 k- kielrri cS Expansion tank 16.60
Address:4 2.30 S1,0 & t�-y j Fixture/sewercap 16.60
FIoor drain /floor sink/hub • 16.60
City/State/Zip: 1 -'t C�S�- j6 Cl �U Garbage disposal 16,60
Phone: Fax: Hose bib 16.60
APPLLCANT .``s `.CONTACT PERSON Ice maker 16.60
Name: El ) CK'1 S /)OJ7 J Interceptor /grease trap 16.60
Address: / D ° 0 SA3 rilis 1 01 (l d Medical l gas - value: $ Page 2
(6.60
City /State /Zip: TlA_CLI .51 iv 0 A. 910 (0 3.- Roof drain (commercial) 16.60
PhoneS03 (o$a_ - -S L!S 1 Fax:Sa3 loci o1lo g Sink/basin/lavatory 16.60
E -mail: Tub /shower /shower pan 16.60
' CONTRACTOR , Urinal 16.60
Water closet 16,60
Business Name: i i'1ct.SCc:Ipe_ O rvcdy. •`znC, Water heater 16.60
Address: la Oo SW 1 rt t��(m -j AID_ _ Other: .
City /State /Zip:`T1A L1O-t n-- C, A.. Q� Uo a- Other:
PhoneSa3 (dj - ON S Fax3 ( - O ?lo Plumbing Periitit Fees* a 2'I SS :.
Subtotal $
CCB Lic. #: �` { Plumb. Lic.#: Minimum Permit Fec $72.50 $
Authorized (��, )] Residential Backflow Minimum Fee $36.25 ` 3L ''
Signatur e {J(G�I/t"a -0 Datd - ) 44' y 0 Plan Review (25% of Permit Fee) f $
El to \Spa-4- State Surcharge (B% of Permit Fee) $ eQ . /6
(Please print name) TOTAL PERMIT FEE $ ,' . / F
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 TN-County Building Industry Service Board.
is \Dsts \Permit Forms \PlmPermitApp.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (50 -4175
INSPECTION DIVISION Business Line: 0 ,r • 71 MST
BUP
Received h l i os Date Requested 4 AM PM BUP
Location /3 7 50 Suite p-"r! MEC
Contact Person et of t_ Ph (_4) (2 Z — ,S 9' 4/ 5—
Contractor d -Cp (9R 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 I
Other:
Final
PASS ART FAIL
AUMBIbib
Post & Beam
Under Slab
Rough -In *
Water Service
Sanitary Sewer C}
Rain Drains
Catch Basin / Manhole
Storm Drain
� Sh • e;Pn
• PART FAIL
ANICAL
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
ADA :z3
Approach/Sidewalk Date 2 / /d T Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
L