Permit i
CITY TIGARD PLUMBING PERMIT
DEVELOPMENT SERVICES PERMIT #: PLM2003 -00290
6411 DATE ISSUED: 6/20/03
13125 SW Hall Blvd., T igard, OR 97223 (503) 639 -4171
SITE ADDRESS: 12285 SW THORNWOOD DR PARCEL: 2S1106C -TS023
SUBDIVISION: THORNWOOD ZONING: R -7
BLOCK: LOT: 023 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 [PLUMB] Permit Fee 6/20/03 $36.25
STE 100 GALEWOOD ST [TAX] 8% State Tax 6/20/03 $2.90
STE
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
Final Inspection
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
Issued By: A Permittee Signature: / /W /,/, A /i
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Jun 18 03 02: 00p dan edmonds 503 - 692 -0768 p.4
T
• - - 11` il Permit Application FOR OFFICE USE ONLY.
Received Plumbing
Da ►m �3 - 00.190
�Y -4 � � ®� P N No.:
City Of Tigard Planning Approval Sewer
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 r.. • Date/By :. PcrmitNo.:
Phone: 503 - 6394171 Fax: ;503 59,19. 0., , -. Post- Review Land Use .
/_ Y , i�� '• h` Date/By: J Case No.:
Internet www.ci.tigard.or us l' • �,- ,' :7i!. o ' ' ',� ell' Contact . • ' .a See Page 2 for
24 -hour Inspection Request 503- 639 -4175 Name/Method: I � Supplemental Information.
::.. -. :,.: ° >:. :T••YPE'OFWORK: ::..: :: ':.;:• ':::. FEE*• SCHEDIJ LE•( forspeiial�[ iiformatioii iise'checklist)`::'•
ew construction ❑Demolition
N ` Description Qty. I Fec(ca.) Total
❑❑ Addition/alteration/replacement ❑ Other. 4_:; :::;::::' New &2- farndy.:iiwellmgs ;
::- ....: ': `.: CATEGORY:OF ONSTRUCTION _ :. :. ;: • '_ • :.;: .
-.. ..: ;.:. :. 5 it1Wft. for utility :connecti' on): ::' : , : ; ' .
1 & 2- Family dwelling ❑ Comercial/Industrial SFR (1) bath 340.00
m
❑Accessory Building ID Multi-Family SFR (2) bath 350.00
SFR (3) bath • 399.00
❑ Master Builder ❑ Other: Each additional bath/kitchen 45.00
JOB: SITE LOCATION: ',!.,.'.. .:::::'''• Fire sprinkler - sq. ft: Page 2
Job site address: /.� SS 7?•1Crri co(., t_t_.)c .. ''.,'.;;- :. :; . .:: :Site Uti itie : :. ' -
Suite #: I Bldg. /Apt. #: Catch basin/area drain _ 16.60
Project Name: 71 i../..) aOGL • i.-6 T 0.3 Drywel Br ach line/trench drain 16.60
Cross street/Directions to job site: - Footing drain (no. linear ft.) Page 2
• Manufactured home utilities 110.00
S t-0 64,u " 1u 771? /2 Manholes 16.60
•
Rain drain connector 16.60
Sanitary sewer (no. linear R) Page 2
Subdivision: ien' n•Love d- I Lot #a-3 Storm sewer (no. linear fl.) Page 2
Tax map /parcel #: 6 5 5 B ( Water service (no. linear ft) Page 2 • .: ••.: ' , :,:: _ ._ Fixture ,
'1G(S c �. G,j Absorption valve 16.60
Backflow preventer
_ /3uP j CLe...U/ C t'_. Backwater valve Page 2 .,1 . SS
16.60
Clothes washer 16.60
Dishwasher 16.60
)51SROPERTYOWNER.r:::: '.: : :':
.. , °.; Drinking fountain 16.60
I ; Ejectors/sump 16.60
Name: Doll mz S c•t /IDY -i e-S Expansion tank 16.60
Address: 1 7 4 ,),30 Sw Ge. &_..,.aeon Shzey- Fixture/sewer cap 16.60
City /State/Zip: La-le e_ 6S- LCrClf O p i e_g 7 e3 y Floor drain/floor sink/hub 16:60
Phone: Garbage disposal 16.60
Fax:
Hose bib 16.60
PLICANT•:: : `::•: .CONTACT '::::"!...r.: Ice maker 16.60 •
Name: &7/e..") NtrPc� ,-ra-zt3 Interceptor /grease trap 16.60
Address: / ,?-a-OG s L.) IYI ti.Vanti RD Medical gas - value: $ Page 2
City /StatelZip7�Q.((jn p � e& Primer 16.60
(cy Roof drain (commercial) 16.60
Phone:
a - 59 y& I Fax: . ( - Q'7(a p . Sink/basin/lavatory 16.60
E - mail: Tub/shower/shower :' pan 16.60
r;:::: rCONTRACTOR :.: Urinal
.s • ;...:. 1.6.60
Business Name: /�fidS ate- p/-- d� � ilG Water closet 16.60
Address: /0300 4L.t) /'h ii ,S/Gt R_b Other heater 16.60
City /State /Zip L , 0 /Z- 970 ( ,L • Other: •
PhoneS03 (p C t 6 5' Fax: SCE ( a - 0 74. g - ... °Plrirotiing
D 4 '�; •�Permit�Fee"s* . - ?.... -,... ..
'� E c P lumb. Lic. #: • Subtotal $
CCB Lic. #:
Authorized Minimum Permit Fee $72.50 $
Signature; �{JDate: 4 // g/(1.3 Residential Backflow Minimum Fe . 3� . a5
G II a Plan Review (25% of Permit Fee) $
sparr-crt,� • State Surcharge Fee) $
arge (8% of Fee � , r/'Q
(Please print name) TOTAL PERMIT FEE S 39_ I S
Notice: This permit application expires if a permit is not obtained within AU new commercial buildings require 2 sets of plans with Isometric or
ISO days alter 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: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received late Requested ' ' 3 AM PM BUP
Location / 9 I /iall 4 _ Suite MEC
Contact Person Ph ( ) PLM
o 2 �6
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: AP."
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Sho , er Pan
it, or
, 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 El Please call for reinspection RE: fl Unable to inspect — no access
Fire Supply Line ��
ADA
Approach/Sidewalk Date 4, 2" 1(7 - Inspector Ext
Other:
Final DO NOT REMOVE this Inspection record from the Job site.
PASS PART FAIL