Permit C ITY OF TIGARD PLUMBING PERMIT
sr DEVELOPMENT SERVICES PERMIT #: PLM2004 -00421
' �� II 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 DATE ISSUED: 9/13/2004
SITE ADDRESS: 12260 SW THORNWOOD DR PARCEL: 2S1106C -05600
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 027 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 backflow device.
FEES
Owner:
Description Date Amount
DON MORISSETTE HOMES [PLUMB] Permit Fee 9/13/2004 $36.25
4230 GALEWOOD ST., #100
LAKE OSWEGO, OR 97035 [TAX] 8% State Surchar! 9/13/2004 $2.90
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
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( 2 Permittee Signature: _a A
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next busin'e §s day
*a
to -
Plumbing Permit App 'RECEIVED
FOR OFFICE USE ONLY
City of Tigard
13125 SW Hall Blvd., Tigard, OR 97223
SEP 13 2004 D'ea,,,ted q -/S ci if)L.
Phone: 503.639.4171 Fax: 503.598.1960
Other Permit No.:
24 Hour Inspection Line: 503.639.4175 CITY OF TIG!.4.i' Date/By:
Plan Review
Internee www.ci.tigard.or.us BUILDING DI .--- = --- Date Ready/By:
Notified/Method: )61 Fa See Page 2 for
7 1 Supplemental In forma don
:....:,:.:;:.:: ..'„',:. ::. ...-:,....:,.,:.z .-:.:leAft1.:.0,#PRK :. .: . :::' .. ; • :;; ;; ...1':' .-: :: • T ''. '''' ...::: 6'1 ':'' ',.;: . -y '.. 1., .',. .....".. ' . ; .: ... FEE,:SCHEDULE • •.:.::'.-:. s . ''. - . .
New construction
0 Demolition For special in
0 ddition/alterationireplaeement
A
0 Other: - Description formation use checklist
FT4t7.1 E.7. TE
New 1- 2-fandly dwellings (includes 100 ft. for each utility connection)
...... f ,':-...;;.:•••• ,r.:::-..:2; :'....:.-...f..-L4q*:1:%94Y.:9#..i:00,144'r4:Piicm::.:::..• :• ........ .i .,...::. SFR (1) bath
249.20
. )!N- and 2-family dwelling 0 Commercial/industrial SFR (2) bath
350.00
0 Accessory building 0 Multi-family SFR (3) bath
399.00
0 Master builder 0 Other:
Each additional bath/kitchen 45.00
Fire sprinkler ( , sq. ft) Page 2
APii)§4g: ..'-;':: ....i site utilities
Job site address: / .-,P- c 0 S w Thorn Le) 004, Drit)-e_ Catch basin or area drain 16.60
City/State/ZIP: 7 ; 01 an et o it_ ei 3 Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: ' • (Project name: T L,,t:1 r a ri Footing drain (no. linear ft.: ) Page 2
Manufactured home utilities 11000
Cross street/directions to job site:
Manholes 1660
SU) 8u_1r rvvre.1 R_D,
Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2_1
Storm sewer (no. linear ft.: ) Page 2
Subdivisiort oley 0 Lot no.: Water service (no. linear ft.: ) Page 2
. 1 al
Fixture or item
Tax nsap/parcel no.: i j o 5"Se Es 4,
Absorption valve 16.60
j Page 2
Backwater valve 16.60
Clothes washer 16.60
Dishwasher 16.60
16.60
:.-• 'L,• : :.1 SZFROP . c.410R: ....,';:•::: - •. '. . : . : ;17..: ......-....-; . ?..... Dri"king fuuntain CesIS 16.60
Name: bo /c)-, s s (:: 1- # /1 e.f., Expansion tank 16.60
Address: z--, A c a 3 c_s s w 6y:4_1 C.L.c..1 0 L. Fixture/sewer cap 16.60
City/State/ZW:La_ f c 4) ..c CU -e 76 0 k. ` .- 2C-33 5 Floor drain/floor sink/hub 16.60
Phone: ( ) I Fax: ( ) Garbage disposal 16.60
16.60
!•:..._'. , .J:: .':* ',..: ":••• :-': :,::-..;1• ..: *, E.J?•SON.. .. :. ' : - . • Ice maker
16.60
13usiness name: Le a f cz).6 Or r C
Interceptor/grease trap 16.60
/
Contact name: .- -. --- 71 .4e) Zrar
Medical gas (value: $ ) Page 2
Address: / 0 -,C• ti) nivS /twit/ PD Primer 16.60
City/State/ZIP:-Mia ok__ ,. --' q 70;4. L).-- Roof drain (commercial) 16.60
Phone: (5e3) (G ci -S- 9z/5 - 1 Fax: : 2'3) 6 ea _ c ; , Sink/basin/lavatory 16.60
Tub/shower/shower pan 16.60
E-mail:
Urinal 16.60
...., • • : " - ." : . .. :..... . .. ...- ••••• CONTRACT OR . . • t:: '....- ..... .: .. ..::. - .. .':-.. Water closet 16.60
....-:-.......-... -• .....• ._
Business naine l-CLAti-S(!-' p?..- 0 7r-90 - 71 . Water heater
16.60
Address: L _sit) fri q.S.104 ti kin Other:
Subtotal
City/State/ZIP: 7U,-?rt s'ae s • 7062 :: A.
Minimum permit fee: $72.50 3 Phone 6 -S-94/.&'-' i Fax: 6.03) (,9Q - 070g Residential backflow minimum permit fee: $3625 %.3 6 • P .
CCB Lic.: 7 4 &z.) Plumbing Lic. no.: Plan review (25% of permit fee)
signs e_eit .....
...
State surcharge (8% of permit fee) .2-.9/3
Authorized sig,
TOTAL PERMIT FEE - 1.3q,
Print nalne et) ..c77a/ I Datqfi 3 /0 Li This perm (apphcatmne expires if a permit is not obtained "t hi n
180 days after it has been accepted as complete.
*Fee methodology set by Tri-Cotmty Building Industry Service Board.
1:11lluildimpPermirAPLMILPmnilAPPdoc 12103 440-46161( t0/02/CONI/WEB)
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CITY OF TIGARD 24 -Hour
BUILDING Inspection Une: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 -4171 MST
BUP
Received Date Requested -Z3 M PM BUP
Location oL L rL _ A II Imr�r� I \/J ite MEC
Contact Person - Ph ( ) PLM ;De - ° 0 2 0 - 1
Contractor Ph ( ) SWR
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
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 / j
Other: T
PART FAIL
MECHANICAL
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 f /
ADA Approach/Sidewalk Date 1 2 3 ! I nspector �O �� / / // r Ext
Other:
Final DO NOT REMOVE this inspection record from the Job site.
PASS PART FAIL