Permit CITY TIGARD PLUMBING PERMIT
' I DEVELOPMENT SERVICES PERMIT #: PLM2003 - 00374
..�"( 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 07/30/2003
SITE ADDRESS: 12130 SW KELLY LN PARCEL: 2S103CC 08800
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 035 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: back flow preventor
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 07/30/2002 $36.25
STE 100 [TAX] 8% State Tax 07/30/2002 $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 #: 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 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: I � Q� Permittee Signature: I)-1 / _
Call (503 639 -4175 by 7:00 P.M. for an inspection needed the next busine s day
Jul 29 03 02:02p dan edmonds 503 -692 -0768 p.2
Application FOR OFFICE USE ONLY
4tl icing Permit App Received Plumbing � '(l
Date/By: Permit N o�AL2AD3 '�3 T
• IR � r " Planning Approva Sewer
City of Tigar ` Date/By: Permit No.:
13125 SW Hall Blvd. n 20 0' Plan Review Other
9 Date/By: • Permit No.:
Tigard, Oregon 97223 JUI- 2 Post - Review Land Use
Phone: 503 639 - 4171 Fax: 503 -598 -1960 , 4 r. i Post - Review Case No.:
Internet: www.citigard.or.us ctl� Contact Inds.: igl Sec Page 2 for
24 -hour Inspection Request: 503 - 639 -4175 - , Name/Metho Supplemental Information. _ -
TYPE OF WORK FEE* SCHEDULE (for special information use ihecklist)
(New construction
Demolition Description I Qty. I Fee(ea.) I_ Total
New, l- & 2 famrly dwellings:.
0 Addition/alteration/replacement ❑ Other: _ (includes 100 ft. for each utility connection) .
,:CATEGORY OF CONSTRUCTION SFR (1) bath 249.20
N I & 2- Family dwelling [1 Commercial/Industrial SFR (2) bath 350.00 ,
_ (]Accessory Building ❑ Multi - Family SFR (3) bath 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 5 •
JOB SITE INFORMATION and LOCATION • ' " Fire sprinkler - sq ft..: Page 2 -
Job site address: /c /30 S C[.) Kz/ I L Lccn e� ': Site 'Utilities
Catch basin/area drain 16.60
Suite #: B1dgJApt. Drywell leach line/trench drain 16.60
Project Name: Go hiSi - lc' • tlia-Le COT Footing drain (no. linear ft•) _ Page 2
Cross street/Directions to job site Manufactured home utilities 110.00
St-L) /0)--/ a? All, Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ft.) _ Page 2
Storm sewer (no. linear ft.) Page 2
Subdivision: (,1'17 / flS G..1- I Lot #: ,3S` Water service (no. linear ft.) Page 2
Tax map /parcel #: Ce SS i8 S Fiztur a ar.Item
.. - : DESCRIPTION OF WORK ' Absorption valve 16.60
?_tit -r? C/ S C c z 2Kr/ 1 G2-7 Backflow preventer j Page 2 Z7 . SS
36 7l6r143 C-1-2-1-}(C Backwater valve _ 16.60
Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
OPERTY'OWNER •- I- Q TENANT - Ejectors/sump 16.60
Name: 7)L vi f YJCY% S S Lt �G /1z'YYi _s - Expansion tank 16.60
Address: Lf30 SLts G^cc_CeLLyec 6 Ye-'f# Fixture/sewer cap 16.60
Floor drain /floor sink/hub 16.60
City /State /Zip: 1.eLke,_ 6S ¢a O,2_6I7L3
Garbage disposal 16.60
Phone: Fax: Hose bib 16.60
, APPLICANT • ....-CONTACT'PERSON Ice maker 16.60
Name: J /et) i i tc) Interceptor /grease trap 16.60 -
Address: j �-a06) s CO in G-' cf - n L 120 Medical gas - value: $ Page 2
Primer 16.60
City /State/Zip7(at/l''7rt, 0 g--. r7v* Roof drain (commercial) 16.60
Phone: S 3 toga - 5 (1.6 I Fax:S (o9a - 074: V Sink/basin/lavatory 16.60
E-mail: Tub/shower/shower pan _ 16.60
;;CONTRACTOR Urinal 16.60
Water closet 16.60
Business Name: lends C apa_ C.r i6n W=/1G Water heater 16.60
Address: / JG •t7 " ySIC 1 Yi -tJ. Rb Other: -
City /State/Zip: 7U try. -" OA-- 9X70 ( Other:
Phone603 °Elumbing PermitFies*
in4� - 6 FaX Su3 (09 - L g Subtotal S
CCB Lic. #: '� G Plumb. Lic.#: Minimum Permit Fee $72.50 S
Authorized Residential Backflow Minimum Fec+lb a. <(.; • ... Signature -iLL/L- Date: Plan Review (25% of Permit Fee) S .
T I lei Spy - State Surcharge (8% of Permit Fee) $ , TO
(Please print name)
4 - t TOTAL PERMIT FEE 5 a qt _ I S
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 Tri- County Building Industry Service Board.
CITY OF TIGARD • 24 -Hour
BUILDING Inspection Line; X003) 639 -4175
INSPECTION DIVISION . Business Line: (503) 639 - 4171 MST
BUP
Received Date Reque ted 47' 21 AM PM BUP
Location la / 36 1 Suite • MEC
/
Contact Person Ph ( ) P LM 3 -6 63
Contractor Ph ( ) SW,R
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
r '-
Firewall
Fire Sprinkler
Fire Alarm f
Susp'd Ceiling , / J
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:
AP'
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: Unable to inspect — no access
Fire Supply Line 1
ADA Date 9, ,U3 inspector ''y) JJ I I Ext
Approach /Sidewalk � P
Other:.
Final DO NOT REMOVE this inspection record from the job site.
PASS PART FAIL