Permit CITY T I GARD PLUMBING PERMIT
7 "71A I` DEVELOPMENT SERVICES PERMIT #: PLM2004-00144
c 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 4/5/2004
SITE ADDRESS: 12210 SW KELLY LN PARCEL: 2S103CC 08600
SUBDIVISION: WHISTLER'S WALK ZONING: R -4.5
BLOCK: LOT: 033 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: Backflow preventer.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES
4230 GALEWOOD ST [PLUMB] Permit Fee 4/5/2004 $36.25
STE 100 [TAX] 8% State Surcharl 4/5/2004 $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
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
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: Permittee Signature: ,07
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Apr 02 04 09:22a dan edmonds 503 - 692 -0768 p.
Plum :ling Permit - , i p ° i o R OFFICE Z �SE OiVLY
g �.�plica� • : . • FO
11 I &..... Date / By: , q Plumbing 1 A/ V-av/ 99
[1~StelBy =' / 5 Permit No.:
City of Tigard - `,, 2011 Planning Approval sewer
13125 SW Hall Blvd. A Date/By: Permit No.:
Tigard, Oregon 97223 Plan Review Other
CITY OF TIGP AD
Phone: 503- 639 -4171 Fax: 503- 5598r1960,,IG D1`..1 101\ { Post-Review �Pemtit moo.: •
Internet: www.ci.tigard_or.us t %7 i - Date/By: ions.: o.:
24 -hour Inspection Request: 503-639-4175 "` C°r Arts.: =f See Page 2 for
Name/Method: -�/6 Supplemental Information.
' r :: :. • - ;' , ' TYPE.OF . WORK'. :.' ,.. •;•,..'•i.: .': ��<:' .. FEE *.SCHEDUY E ( fors peaittiiifoiuiition .'useciieeklist) : '..- .
New construction 0 Demolition Description F
Addition/alteration/replacement 1 Qty. ete 1 Total
eP Other: : :::
;:• ::New :1= R& -Z= faitWy:dwellings
.:.: : .. CATEG ORY.OF. CONSTRUCTION = :ii:' : :: : ::: :. : -:" ::(ncludes100` ILlolleachutili
tY'connectiOnj:
I & 2- Family dwelling 0 Commercial/industrial SFR (1) bath 249.20
Accessory Building ❑ Multi- Family SFR ( bath 350.00
1,1 Master Builder pier SFR (3) bath 399.00
- JOB SITE:INFORMATION and LOCATION .: ;�:;: Fire additional
sprinkler i - sq. ft.: 4 2
Job site address: / •J 0 tt) k?.-1. (L (/ s R : Page 2
Suite #: I BldgJApt : Catch basin/area � drain .:.:,.4.:
6.60
Project Name:(;I h iS1 er'S LCC LCD )3rywelUleacit line/trench drain 1660
Cross street/Directions to job site: Footing drain (no. linear ie Page 2
Manufactured home utilities 110.00
,c t-k _-i 12 ST-7- i e. Manholes 16.60
Rain drain connector 16.60
Sanitary sewer (no. linear ti_) Page 2
Subdivision: te hi SF/ j l` ile-k- I Lot i t# : „ Storm sewer (no. linear ft.) Page 2
Tax map/parcel #: (p - ' S . 6 .. blazer service (no. linear ft
;... .: :;. Page 2
: F.'D CRIPTION OF WORK'. '.:":::".:1_ •::;: F�iztiire orxteni` • Page A
[gCq� � Absorption valve 16.60
r BackQow preventer I Page 2 �'7„ Ss
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
, I'ROPERTYOWNER':..,_ . # [. TENANT;;: ". `'; : ;, :: Drinking fountain 16.60
Name: c>61-, /y} CTY'rSSt(i2- i- - .,-IC
Ejectors/sump a n tan 16.60
Address: g-.3Q St t3 ( n . .,o o Expansion �seew�� 16.60
p 16.60
City / State /Zip: I43-4(..e_. 0S- tu+e56 q703.S Floor drain/floor sink/hub • 16.60
Phone: # Fax: Garbage disposal - 16.60
,APPLICANT..'::; .; .',::::: Hose bib 16.60
'QCONTACTiPERSON' :5 Ice maker
Name: el t c ", Sfyt.r1-o't.O Intence tor/ 16.60 '
Address: / D S...00-) y
Cl yt p Rtcase trap 1g 2
S�IMU 12.r.) Medical gas - value: $ Page 2
City/State/Zip: - in QL1-'� n . 0 se. 910(4a-. Primer 16.60
Phone9J3 (o9& - S ys` Fax:9�3 log a- O ?� Roof drain (commercial) 16.60
E-mail:
Sink/basin / lavatory 16.60
.:... . Tub/shower /shower pan
: .. , ... ...:: ? :, '!':: r; „•_
,• .; Urinal .60
Business Name: 16.60
LU 3'Y�SC L 1�pt� Q 9 - c., Water cl 16.60
Address: ID Ste) 1 l S � lam- Water heater 16.60
-�, - ,.;�,-.. - 6 Other: City /State/Zip:
�� � � �" other
•
Phone 69a - ViLiS I Fax333 (p�'�,j - ()We , .:- Pltiiabin :Permit : S
- 7e( J `7:
`� P lu mb. Lie. #: S u b total $
CCB Lie. #:
Authorized Minimum Permit Fee $72.50 S
Signature - t --,) .,Z Q Date � i L Residential Backflow Minimum F e e 536.75 96 3 S
l en kcpai" Plan Review (25 of Permit Fee) $
State Surcharge (8% of Permit Fee) S e2 1'6
(Please pint name) TOTAL PERMIT FEE $ I
Notice: This permit applies tie n expires ira permit is not obtained within �?. ! ,` c
180 days it has been accepted as complete. All new gra commercial n re vi require 2 sets of plans with Isometric or
riser diagram for plea t er++s.
*Fee methodology set by Tri- 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 /d: 3 Date Requested `�A 5' AM PM BUP
Location /22i0 Suite 41 . MEC
Contact Person e e PC Ph ( ;C ?2 -,395 l 4 -zZ ! 4L <
Contractor C'� 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 P n
O .-r.
Fin -
o 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 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: 0 Unable to inspect — no access
Fire Supply Line 9 .�
ADA • V l�
Approach/Sidewalk Date Inspector Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL