Permit A CITY OF TIGARD PLUMBING PERMIT
Ail A ° DEVELOPMENT SERVICES PERMIT #: PLM2004 -00068
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 2/13/04
SITE ADDRESS: 13620 SW 124TH AVE PARCEL: 2S103CC -07300
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 020 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 INC
4230 SW GALE WOOD ST 100 [PLUMB] Permit Fee 2/13/04 $36.25
LAKE OSWEGO, OR 97034 [TAX] 8% State Surcharl 2/13/04 $2.90
Total $39.15
Phone :
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 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
' _ Alf � � Permittee Si nature:
Issue By: �- ;:..�. �4 ..-z.., g i � i
Call (5 1 ` 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Feb 12 04 08: 32a clan edmonds 503 -892 -0788 p.2
Plumbing Per i li UR OFFICE USE ONLY
eation Received �•� Plumbing / /
§•.! Date/E1 : . /�/ I. / Permit No.: J, 4 , - 4 #� (� ib
City of Tigard Planning A... Sewer
0 04 Date/By: Permit No__
13125 SW Hall Blvd. FE3 1' Plan Review Other
Tigard, Oregon 97223 Daffy- Permit No_:
Phone: 503- 639 -4171 (36314 Post - Review Land use
• • +1 Contact Case No.:
w
Internet ww.ci.tig tk. G DIV p v 1 - 1 C 111 +i� act Iys r � ur
N � See Page 2 for
24 -hour Inspection R ues`t � 03- 639 -4175 j`" L Name/Method: ia Supplemental Information.
- TYPE: OF WORK c : _ -, . FEE* SCHEDULE` (for special information` use checklist)
New construction , [] Demolition Description t Qty j Fee(ea.) J Total
I _ Addi tion/aiteration/replacernent , ❑ Other. New 1= Sc?,- famlty'dwellings
i CATEGORY OF .CONSTRUCTION'. -. Cneludes a00 ft. for each utiiity'connection) :: ,.. ,
1 & 2- Family dwelling [=I Commercial/Industrial
SFR (2) bath 249.20
350.00
Accessory Building 0 Multi- Family SFR (1) batty
_ SFR (3) bath 399.00
fl Master Builder ❑ Other: Each additional bath/lotdien 45.00
JOB SITE INFORMATION and LOCATION T % < Fire sprinkler - sq. ft: Page 2
Job site address: /3(,,,...0 ,.5 LU (.4_(---/ Y) /+1-(_ - ^ Sitc
Suite #: Bidg. /Apt. #: Catch hasin/area drain _ 16.60
Project NameLA) i7 !drys 1)) CLL/C LO T () DrywelVleach line/trench drain 16.60
Footing drain (no. linear ft.) Page 2
Cross street/Directions to job site: Manufactured home utilities 110.00
-cL o C /� / T Al , Manholes (6.60
` l I tlt i Rain drain connector 16.61)
Sanitary sewer (no. linear IL) Page 2
Subdivision: W h/S -/ Cj . 4 , I Lot #: 21) Storm sewer no_ linear ft.) Page e 2
Tax map /parcel #: Co S c 5 Water service (no. linear ft) Page 2
'DESCRIPTION 'OF WORK ^- ; ure or
- .: .... ' 'Fixture ;.Item ' -.
Absorption valve 16.60
1- Ar1dS Cap - -t✓1-C 1oce.) C-1.0-31 Back low preventer f Page 2 ,.,2!7_ SS
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
' PROPERTY OWNER T
Drinking fountain 16.6
0 ENANT - 16.6
TENANT 0
Name: Do.y /)7 tSY1S4-Q41 l - y1C-S Expansion tank 16.60
Address:4-A313 Stt) &(-1- 0.{s'oo Fixture/scwercap 16.60 _
City/ State / Zip: 1.-0-1,._ CAS -t-ut Q7c).3.5 Floor drain/floor sink/hub 16.60
Garbage disposal _ 16.60
Phone: Fax: Hose bib 16.60
-. APPLICANT . . 'ELCONTACTTPERSON `
Ice maker 16.60
Name: al 1 t-o'1 Spo.rry u.1) Interceptor /grease trap 16.60
Address: / - o o .Emu- yYt jy kip Medical gas - value: $ Page 2
City /State/Zip: M . 1
-L 60 f>`. C) 1� 9 to a._, Primer 16.60
Roof drain (commercial) 16.60
PhoneS03 (off. - Sri 4s1 Fax O3 (o(3 (94.- 07/o 2 Sink/basin/lavatory 16.60
E -mail: Tub/shower/shower pan 16.60
.:'.::CONTRACTOR L - - Urinal 16.60
Business Name: + fci p 0 i�q -- r-�. -1 Water closet 16.6
Address: ( �D a � l Water heater 16.60
Svo h`) I giCna ie-L3 Other
City /State1Zip: n a .. - 6/2.._. c00(o 2 . Other: '
Phone :03 f(gcl - Sgt./5 Fax)3 (D9a - Oglo k Plurntiingperatit Fees* '7-„55"
CC13 Lic. #: 7ffbt -1 Plumb. Lic. #: Subtotal $
Authorized Minimum Permit Fee $72-50 $
Q _ f a7101-1 . 3 (- o . -
Signature-�- u --� 1 aA J,C!- 'U -!�'L� Dat / Residential Backflow Minimum Fee $3625 -
11 Plan Review (25% of Permit Fee) $
ET/ erg U rola State Surcharge (8% of Permit Fee) $ a ,
(Please print name) TOTAL PERMIT FEE $ , /
Notice; This permit application expires if a permit is not obtained within All new commem-eial buildings require 2 sets of plans with Isometric or
ISO days after it has been accepted as complete.. riser diagram for plan review.
*Fee methodology set by TA-County Building Industry Service Board.
-Fee methodology set by Tri- County Building Industry Service Board.
-.
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175 MST
INSPECTION DIVISION Business Line: (503) 639 -4171
/ BUP
Received
` P= 3 / Date Requested 3! / 0 Se AM PM BUP
Location /3 6 Za / Z 4C` /4J Suite MEC
Contact Person n �� Ph ( ) (Q 72 3S S�P 7`'� 7 62
Contractor t Lc r p at- t • Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation ELC
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 A•an _ fi
/Other: JS t
Fin -
PART FAIL
M ANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL
Service
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Final El 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 04 Fire Supply Line P
ADA Inspector Cri1/4Z- Date N Ext
Approach/Sidewalk (? V `'
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL