Permit N. '� CITY OF TIGARD PLUMBING PERMIT
�� I� DEVELOPMENT SERVICES PERMIT #: PLM2004 -00373
+L � 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 8/18/2004
SITE ADDRESS: 12459 SW ASPEN RIDGE DR PARCEL: 2S110BC -04600
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 017 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: New backflow device.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 8/18/2004 $36.25
STE 100 [TAX] 8% State Surcharl 8/18/2004 $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
P RP /Backflow Preventer
Phone : 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
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: p Permittee Signature: c>
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
BuildAng Fixtures
Plumbing Permit Applic EI ``® Y E t. FOR OFFICE USE ONLY
City of Tigard Received /� U Permit No.: q
13125 SW Hall Blvd., Tigard, OR 97223 AUG 18 201 Dat ' " 7 1 �� Jij Va3 �3
Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 4' I, ;,� Other Permit No.:
24- Hour Inspection Line: 503.639.4175 v fT E I '':'� 11
www.ci.tigard.or.us wtivci.tigard.ot.us CI 1 T 1 N TI ' """ Date Y �a 53
Supplemental See Page 2 f n r o n
No
:.....:. :. ...... .. SCHEDi3L'
N New construction ❑ Demolition For special information use checklist.
- Description I Qty. I Ea. I Total
❑ Addition/alteration/replacement ❑ Other: New 1- 2- family dwellings (includes 100 ft. for each utility connection)
,CA TEGORY: OF ,CO. STRUC1i01 , ,` ..: - SFR (1) bath 249.20
\
+
I - and 2- family dwelling ❑ Commercial/industrial SFR (2) bath 350.00
❑ Accessory building ❑ Multi- family SFR (3) bath 399.00
❑ Master builder Each additional bath/kitchen 45.00
❑ Other:
Fire sprinkler ( sq. ft.) Page 2
. " . 1 0 * S . i E ` T N F O 4 4 ; i T i ; X N ' U L ' O C A T ' I O N ' . -- Site utilities
Job site address: / L/ S l ielspeyt l ei d G < br e- Catch basin or area drain 16.60
City/State/ZIP: -T/4 GL1� Ok 9 7 a �- e../ Drywetl, leach line, or trench drain 16.60
Suite/bldg. /apt. no.: 1 Project name: f Footing drain (no. linear R.: ) Page 2
-
Manufactured home utilities 110.00
Cross street/directions to job site: Manholes 16.60
�i r ^ L L Li f si v `' '� -t " .-D . - Rain drain connector i 6.60
Sanitary sewer (no. linear ft.: __) Page 2
Storm sewer (no. linear ft.: ) Page 2
Subdivision: - (1h,�y � 0 (XL. I Lot no.: 1 Water service (no. linear ft.: ) Page 2
Tax map /parcel no.: Co S 12:;4_,0 Fixture or item
Absorption valve 16.60
".:: 'D OF; WORfC "' ' . . . •. .. Backllow preventer / Page 2 _,7 7 55'
Lan G>'s . i fJ ; rr/ / c ..Jy) back:: f-- 10,,(.) 61 i / e , Backwater valve 16.60
Clothes washer 16.60 I
Dishwasher 16.60
PR�YE TY u Drinking fountain 16.60
P. R2 - OWNER= ®:'•` '''`- , `
;; A Nx. Ejectors/sump 16.60
Name: b en/1 inn/ - r(S S e_-/- f Holy) e. J Expansion tank 16.60
Address: Z.74Q. 3 0 .. ( fit 6 1, --4" co 0 C:orL. Fixture/sewer cap 16.60
City /State/ZIP:Let_ /e; L 0.c c LU . / 6 ok- 4. 1 .7 b -,s 5 Floor drain /floor sink/hub 16.60
Phone: ( ) Fax: ( • ) bae disposal 16.60
Gar
, • ".`
y . r . Hose bib 16.60
APPLICANT; :` ... .- '�"�' {{ 1 Ti C ,rERso , ., -
: ' ` : y;' , '? "1CO ...,. Ice maker 16.60 •
Business name: Lail a S E'C, ).t Uf- !'L Tom;
t Interceptor /grease trap 16.60
Contact name: ,F -4,e- „Sr LL I . r, Medical gas (value: $ ) Page 2
Address: I - � - vc - . W f yitisi All (4 t � ) Primer . 16.60
City/State/ZIP:Taa (,1 i A G , - -70(. ,L . Roof drain (commercial) 16.60
�" Sink/basin/lavatory 16.60
Phone: (5u3) LG' ei'• `- .J l L ! S I Fax: : (�'3) & Y:A. - 76',_c
Tub /shower /shower pan 16.60
E -mail:
Urinal 16.60
CONTRAC�'OIt::.', '
• , ... .. Water closet 16.60
Business name: Water he ater
�._- L•C. l)l� - S�t� �)-C. (�r� � LJ � ��) C: W 16.60
Address: / ?..t_oo $ (i) rn i - f b '1: K RID Other:
City/State/ZIP: ' [ �,�-�� U� "1 f7U & Subtotal
Minimum permit fee: $72.50
Phone: (64.3) (6,Q,..„1 59j _ Fax: (503) 69c;? - p'70 g• Residential backflow minimum permit fee: $36.25 3 (" . as
CCB Lie.: 7 eU Plumbing Lic. no.: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ,, • q 0
Authorized sign .,Left 7
s
TOTAL PERMIT FEE 3 `I • I S
Print name 7/ e _� -v- 1 Dat• / ! 21 Q1f This permit application expires if a permit is not obtained ■"ithin
+ 180 days after it has been accepted as complete.
*Fee methodology set by Tri County Building Industry Service Board
a = -. ._. .
-- BEO =60 . 170 131: 2nd
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested g — AM PM BUP
Location S r _ :� �•� � �� J_ _�! uite MEC
' 7
Contact Person Ph ( ) P LM 7 ' o03 • 3
Contractor 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 Pan
Other: ` !�
07.7s 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 Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
PASS PART FAIL
SITE Please call for reinspection RE: El Unable to inspect — no access
Fire Supply Line
ADA
Approach /Sidewalk Date F120) p y Inspector c r b I ) - - ) \\ s . Ext
Ext
Other:
Final DO NOT REMOVE this inspection record from the job site
PASS PART FAIL