Permit CITY TIGARD PLUMBING PERMIT
IA DEVELOPMENT SERVICES PERMIT #: PLM2003 -00543
. 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 10/16/03
SITE ADDRESS: 13790 SW 124TH AVE PARCEL: 2S103CC -06500
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 012 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: Install irrigation backflow preventer.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 10/16/03 $36.25
STE 100 [TAX] 8% State Tax 10/16/03 $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 RP /Backflow Preventer
hone : 503 - 692 5945
Final Inspection
Reg #: LIC LCB: 7804
PLM ALL PHASES - PIA.
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
i
Issued By. t� / 71-12___ Permittee Signature: &Az / 97 0 / 7 4,/ e/5
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Oct 14 03 04:42p don RECE 503- 692 -0768 p.2
a
Plumbing Permit Application FOR OFFICE USE ONLY
U � 4 Received Plumbing ,,, -etas-9_3
2003. Date/By: /f/O.' Permit No. /�o03
City Of Tigard Plnning Ap oJal Se
13125 SW Hall Blvd. CITY OF T! Datc/By: Permit No•:
Tigard, Oregon 97223 BUILDING >t . D te/By Review Other
Permit No.:
Phone: 503 - 639 -4171 Fax: 503 -598 -1960 Post-Review Land Use
Internet: www.ci.tigard.or.us I ■"`� h - e; Pi �'� Date/By: Case No.:
24 -hour Inspection Request: 503 -639 -4175 �" "� 4 W Contact E1 See Page for
N° eu od= ,I E1 Supplemental S Page Information.
TYPE;OF WORK: � .
FEE* SCHEDULE (for special uiformation;use checklist
iSkNe construction
Demolition Description I Qty (Fce(ea) Total
❑ Add tion/alteration/replacement I 0 0 Other: New x - & 2=family.dvietltngs
CATEGORY',OF.CONSTRUCTION:: . _ . (includes100 ft. for: each utility connection)
I & ' - Family dwelling ❑ Commercial/Industrial SFR (i) Batt' 350.20
• ACC so Buildin _ • Multi - Famil SFR (2) bath 350.00
SFR (3) bath 399,00
• Mas ler Builder ❑ Other: Each additional bath/kitchen 45.00
OS SITE INFORMATION and LOCATION ` -: - Fire sprinkler sq. ft
Job site address: /3 Sc;v i� Y•t 3 1 ,q z.. +,� Page 2
Suite #: J B1dgJApt. #: Catch basin/area drain 16.60 f .,;.
Project ainez)i1/ S77C.. S Lt iG (.(.j'7- / )L Drywctl / leach line/trench drain 16.60
Cross s i • t/Directions to job site: Footing drain (no. finest ft.) Page 2
j l,=) I .c/7- ` Manufactured home utilities 110.00
Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) Page 2
Subdivis on: LL)YI i S 1•1 tz s L(,) a-t c. I Lot #: / Storm sewer (no. linear ft.) Page 2
Tax map parcel #: (.,,n S 3 S Water service (no. linear ft.) Page 2
:`; DESCRIPTION OF WORK Fixtuie or.Itetii`
1../-1,144g A a p Ve c/Chcu) elefi /C'. Backflown valve 16.60
preventer / Page
2 „.27• SS'
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
IQ;PRUPERTY :OWNER ' : - Drinking fountain .
1 0: TE NANT - _
16.60
, Ejectors/sump 16.60
Name:
Dtp-1 m (3Y i Ss.1 e_ 7- mein CS Expansion tank 16.60
Address: 4� 3O SLO &a-Lit-v- Cd' Fixture/sewer cap 16.60
City /Stabe/Zip:l./s �, C We c s q Floor drain/floor sink/hub 16.60
Phone: Fax: Garbage disposal 16.60
'APPLICANT . ' Hose bib 16.60
laCONTACT PERSON .• ."-, ' • Ice maker 16.60
Name: El E cn . pa-► ) Interceptor /grease trap
Address: /.)a-o o Cu Y LLJh� rzo M gas - value: $ age 2
2
J Page
City /State /Zip: "1I t. 0 1e 970 le a... Roof 16.60
Phone to ct1 - S�f ys r Fax 5)3 (Q 3...- (Y1(0 Q Roof drain (commercial) 16.60
Sink/basin/lavatory 16.60
E -mail Tub/shower /shower pan 16.60
: : CONTRACTOR . - Urinal _ 16.60
Business Name: La.indSCCL Q q� n e, Water closet 16.6 k.
Address: (a- c .&t.13 ry) I .c( tJ �b Water heater 16.60
/State/Zi Other:
Ci n
ty P= �i1hGt -QO X1+1- 1� Q� OC � � . Other
Phone:513.3 (tea - S S'" ! Fax3)3 (ortd -- (Y(p ,': Pluinbin : Peripit Fees* .. _ S-5 " '
CCB Lie_ #: - 7enq l Plumb. Licit: Subtotal $ _
Authorized Minimum Permit Fee $72.50 S
Signatur4-L Date:tO ` /'-// I Residential Backtlow Minimum Ftx 536.25 3 ( , - S Eli C /j � � Plan Review (25% of Permit Fee) $ reza _ _ State Surchar (8% of P erm it Fee) S 0 2,
yd
(Please print name) TOTAL PERMIT FEE $ .39- / S
Notice: This permit application expires if a permit is not obtained within All new commercial buildings
180 days after it has been accepted as complete• gs require 2 sets of plans with isometric or
riser diagram for plan review.
-
'Fee methodology set byTri- 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 Ave )2 / ( AM PM BUP
Location /3 12'f l` A • Suite MEC
Contact Person IY f r+ Ph ( ) 6 2 - ce'S 415 3 - a0 S/' 3
Contractor Ph ( ) SWR
BUILDING Tenant/Owner ELC
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes: gz 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
RT FAIL
UMBIN
eam
Under Slab
Rough -In
Water Service /
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
eth- . 8e-4K-ft° w
, f t- r ? p , aas,/ CP—
PART FAIL
HANICAL
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 111 Please call for rein pection RE: 111 Unable to inspect - no access
Fire Supply Line
ADA /�
Approach/Sidewalk Date I v � Inspector 197 2/ Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL
CITY OF TIGARD 24 -Hour
BUILDING Inspection Lifie: (503) 639 -4175
ICIP 2 _J cJ/ -----
INSPECTION DIVISION Business Line: (503) 639 -4171
• BUP
Received Received / 3 53 Date Requested 1Z-/ < 2/0 .SAM PM BUP
Location 1 3 7 2 0 /2 4 `- Suite MEC
Contact Person Ph ( ) - 99 er 3 7 3 ` 0
Contractor a /27 4/ 21—. Ph ( ) SWR
UILD 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:
i_kik
PART FAIL
UMBIN
Po • : eam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
ina
RT FAIL
HAII1 L
PosT& eam
Rough -In
Gas Line
She Dampers
in
SS PART FAIL
CA
S ee
Rough -In
UG/Slab
Low Voltage
�•� Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PART FAIL
• fl Please call for reinspection RE: fl Unable to inspect — no access
Fire Supply Line
ADA l2 / � 3
Approach/Sidewalk Date � V 0 Inspector or Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL